bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome-wide Variant-based Study of Genetic Effects with the Largest Neuroanatomic Coverage
Authors: Li Jin , Liu Wenjie , Li Huang , Chen Feng , Luo Haoran , Bao Peihua , Li Yanzhao , Jiang Hailong , Gao Yue , Liang Hong , Fang Shiaofen
Published: October 2020

Background: Brain image genetics provides enormous opportunities for examining the effects of geneticvariations on the brain. Many studies have shown that the structure, function, and abnormality (e.g., thoserelated to Alzheimer's disease) of the brain are heritable. However, which genetic variations contribute to thesephenotypic changes is not completely clear. Advances in neuroimaging and genetics have led us to obtaindetailed brain anatomy and genome-wide information. These data offer us new opportunities to identify geneticvariations such as single nucleotide polymorphisms (SNPs) that affect brain structure. In this paper, we performa genome-wide variant-based study, and aim to identify top SNPs or SNP sets which have genetic effects withthe largest neuroanotomic coverage at both voxel and region-of-interest (ROI) levels. Based on the voxelwisegenome-wide association study (GWAS) results, we used the exhaustive search to nd the top SNPs or SNPsets that have the largest voxel-based or ROI-based neuroanatomic coverage. For SNP sets with >2 SNPs, weproposed an efficient genetic algorithm to identify top SNP sets that can cover all ROIs or a specific ROI.Results: We identified an ensemble of top SNPs, SNP-pairs and SNP-sets, whose effects have the largestneuroanatomic coverage. Experimental results on real imaging genetics data show that the proposed geneticalgorithm is superior to the exhaustive search in terms of computational time for identifying top SNP-sets.Conclusions: We proposed and applied an informatics strategy to identify top SNPs, SNP-pairs and SNP-setsthat have genetic effects with the largest neuroanatomic coverage. The proposed genetic algorithm others anefficient solution to accomplish the task, especially for identifying top SNP-sets.
Evaluating the TubridgeTM flow diverter for large cavernous carotid artery aneurysms
Authors: Jia Luqiong , Wang Jiejun , Zhang Longhui , Zhang Yunfeng , You Wei , Yang xinjian , Lv Ming
Published: October 2020

Background: The TubridgeTM flow diverter (TFD) was recently developed in China; however, its safety and efficacy in treating large cavernous carotid artery aneurysms (LCCAs) are unclear.Our objective was to evaluate the safety and efficacy of the TFD in patients receiving TFDs to treat LCCAs (10–25 mm). Methods: Between June 2013 and May 2014, seven patients with LCCAs were enrolled in our study, and all seven patients underwent TFD implantation combined with coils.Results: Angiographic follow-up images were available for all seven patients at a median of 57.5 ± 16.7 (range, 6–69) months. Seven patients obtained favorable angiographic results defined as O’Kelly–Marotta Scale C and D. Clinical follow-up data were available for all seven patients at a median of 73.32 ± 3.6 (range, 66–78) months. No patients developed new neurological deficits. Six patients achieved a modified Rankin scale score of 0, and diplopia improved in the remaining patient.Conclusions: Results were excellent for the aneurysms treated with TFDs in our patients with LCCAs. TFDs are feasible for the treatment of LCCAs, but a multicenter, controlled clinical trial is needed to evaluate the long term safety and efficacy of the TFD to treat LCCAs.
Advancing Pediatric Palliative Care In a Low-Middle Income Country: An Implementation Study, A challenging but not impossible task
Authors: Garcia-Quintero Ximena , Parra-Lara Luis Gabriel , Claros-Hulbert Angelica , Cuervo-Suarez Maria Isabel , Gomez-Garcia Wendy , Desbrandes Francois , Arias-Casais Natalia
Published: October 2020

Background: The disparities in access to pediatric palliative care and pain management in Latin America remains an unaddressed global health issue. Efforts to improve the development of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Care (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program, “Taking Care of You ” (TCY) , in a tertiary care, university hospital in Cali, Colombia. Methods: A program’s database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis was carried out to evaluate the impact of the program and service delivery. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. Results: Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of ambulatory patients increased by 80% every trimester between 2017-2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. Conclusions: The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a PPC program and how the referral times, coordination of care, communication with other hospital services were improved while providing compassionate/holistic care to children with life-limiting and threatening diseases and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.
Whole-brain irradiation differentially modifies neurotransmitters levels and receptors in the hypothalamus and the prefrontal cortex.
Authors: PEREZ JAVIER FRANCO , MONTES SERGIO , SANCHEZ-HERNANDEZ JOSUE , BALLESTEROS-ZEBADUA PAOLA
Published: October 2020

Background: Whole-brain radiotherapy is a primary treatment for brain tumors and brain metastasis, but it also induces long-term undesired effects. Since cognitive impairment can occur, research on the etiology of secondary effects has focused on the hippocampus. Often overlooked, the hypothalamus controls critical homeostatic functions, some of which are also susceptible after whole-brain radiotherapy. Therefore, using whole-brain irradiation (WBI) in a rat model, we measured neurotransmitters and receptors in the hypothalamus. The prefrontal cortex and brainstem were also analyzed since they are highly connected to the hypothalamus and its regulatory processes.Methods: Male Wistar rats were exposed to WBI with 11 Gy (Biologically Equivalent Dose= 72Gy). After one month, we evaluated changes in gamma-aminobutyric acid (GABA), glycine, taurine, aspartate, glutamate, and glutamine in the hypothalamus, prefrontal cortex, and brainstem according to an HPLC method. Ratios of Glutamate/GABA and Glutamine/Glutamate were calculated. Through Western Blott analysis, we measured the expression of GABAa and GABAb receptors, and NR1 and NR2A subunits of NMDA receptors. Changes were analyzed comparing results with sham controls using the non-parametric Mann-Whitney U test (p<0.05).Results: WBI with 11Gy induced significantly lower levels of GABA, glycine, taurine, aspartate, and GABAa receptor in the hypothalamus. Also, in the hypothalamus, a higher Glutamate/GABA ratio was found after irradiation. In the prefrontal cortex, WBI induced significant increases of glutamine and glutamate, Glutamine/Glutamate ratio, and increased expression of both GABAa receptor and NMDA receptor NR1 subunit. The brainstem showed no statistically significant changes after irradiation.Conclusion: Our findings confirm that WBI can affect rat brain regions differently and opens new avenues for study. After one month, WBI decreases inhibitory neurotransmission in the hypothalamus and, conversely, increases excitatory neurotransmission in the prefrontal cortex. Increments in Glutamate/GABA in the hypothalamus and Glutamine/Glutamate in the frontal cortex indicate a neurochemical imbalance. Found changes could be related to several reported radiotherapy secondary effects, suggesting new prospects for therapeutic targets.
Longwall Top Coal Caving Design for Thick Coal Seam in Very Poor Strength Surrounding Strata
Authors: Jangara Hossein , Ozturk C. Atilla
Published: October 2020

Alpu lignite field is an important coal deposit with nearly 2 billion tons of coal resources located in the middle of Turkey. The mine deposit consists of three main seams. The thickness of two of them vary from 4 m to 30 m. The surrounding rock mass is very poor in terms of strength. The high clay content and weak rock mass make mechanized mining difficult. In this research, applicability of the longwall top coal caving method was investigated. The very weak strength behavior of the coal and the surrounding strata increases the importance of research in the mine site in terms of ground control. The aim is to design the mechanized longwall mine based on ground control principles. First of all, classification of the roof, coal, inter-burden, and floor strata were classified based on geotechnical aspects. Then, cavability index, shield, and floor bearing capacity were investigated. Different methods were applied to understand the limitations of a mechanized system that is very critical due to the very low strength strata. According to the main results, roof strata was classified as immediately caving while mining height was calculated as 5 m to 6 m. Finally, the relations among geotechnical characterizations of roof and floor strata, cutting and caving heights, and required shield capacity were presented based on analytical and numerical applications. The proposed approach can be used as a ground control method for the applicability as well as the limitations of mechanized longwall mining design in weak strata conditions.
Microbiome dynamics during the HI-SEAS IV mission, and implications for future crewed missions beyond Earth
Authors: Mahnert Alexander , Verseux Cyprien , Schwendner Petra , Koskinen Kaisa , Kumpitsch Christina , Blohs Marcus , Wink Lisa , Brunner Daniela , Goessler Theodora , Billi Daniela , Moissl-Eichinger Christine
Published: October 2020

Background Human health is closely interconnected with its microbiome. Resilient microbiomes in, on and around the human body will be key for safe and successful long-term space travel. However, longitudinal dynamics of microbiomes inside confined built environments are still poorly understood. Herein we used the Hawaii Space Exploration Analog and Simulation IV (HI-SEAS IV) mission, a one year-long isolation study, to investigate microbial transfer between crew and habitat, in order to understand adverse developments which may occur in a future outpost on the Moon or Mars. Results Longitudinal 16S rRNA gene profiles, as well as quantitative observations, revealed significant differences in microbial diversity, abundance and composition between samples of the built environment and its crew. The microbiome composition and diversity associated with abiotic surfaces was found to be rather stable, whereas the microbial skin profiles of individual crewmembers were highly dynamic, resulting in an increased microbiome diversity at the end of the isolation period. The skin microbiome dynamics were especially pronounced by a regular transfer of the indicator species Methanobrevibacter between crewmembers within the first 200 days. Quantitative information was used to track the propagation of antimicrobial resistance in the habitat. Together with functional and phenotypic predictions, quantitative and qualitative data supported the observation of a delayed longitudinal microbial homogenization between crew and habitat surfaces which was mainly caused by a malfunctioning sanitary facility. Conclusions This study highlights main routes of microbial transfer, interaction of the crew and origins of microbial dynamics in an isolated environment. We identify key targets of microbial monitoring, and emphasize the need for defined baselines of microbiome diversity and abundance on surfaces and crew skin. Targeted manipulation to counteract adverse developments of the microbiome could be a highly important strategy to ensure safety during future space endeavors.
The Progression of Intracerebral Hemorrhage (ICH) Is Related to the Expression of Integrin Β1 (ITGB1)
Authors: Ma Hai-Yang , Xu Yan , Qiao Chun-You , Peng Yi , Ding Qi , Wang Li-Zhong , Yan Jun-Fei , Hou Yuan , Di Fei
Published: October 2020

Background: Intracerebral hemorrhage (ICH) is fatal and detrimental to quality of life. Clinically, options for monitoring are often limited, potentially missing subtle neurological changes. Integrin β 1 (ITGB1) and β 3 (ITGB3) are the main components of integrin family receptors, which regulate the formation and stability of blood vessels. This study explored the relationship between expression of ITGB1, ITGB3 in intracerebral hemorrhage (ICH) to analyze their functional and clinical relevance.Methods: The expression of ITGB1 and ITGB3 in ICH was accomplished by immunohistochemical (IHC) staining and western blotting (WB) analysis, respectively. Results: Furthermore, the results demonstrated that ITGB1 was expressed in ICH tissues, but ITGB3 was not expressed in ICH tissues. Conclusions: In summary, the clinical progression of ICH was related to the expression of ITGB1. ITGB1 may be a potential biomarker and contribute to the treatment of ICH.
T cell phenotypes associated with insulin resistance: Results from the Berlin Aging Study II
Authors: Sbierski-Kind Julia , Goldeck David , Buchmann Nikolaus , Spranger Joachim , Volk Hans-Dieter , Steinhagen-Thiessen Elisabeth , Pawelec Graham , Demuth Ilja , Spira Dominik
Published: October 2020

Background Obesity is associated with chronic low-grade inflammation leading to metabolic and cardiovascular diseases, but a subset of obese individuals is considered insulin sensitive (IS) and metabolically healthy. The underlying pathophysiologic mechanisms remain elusive and clinical studies on the relationship between inflammatory markers and metabolically healthy obesity (MHO) are scarce. Methods In this cross-sectional analysis, we included a sample of 437 older participants (60-84 years) from the Berlin Aging Study II (BASE-II). Peripheral blood mononuclear cells were isolated, immune cell subsets were analyzed with multiparameter flow cytometry and systemic cytokine levels were measured. Immune cell parameters were correlated with metabolic measures and multiple linear regression analysis was conducted and adjusted for various demographic and clinical factors. Results We found that frequencies of naïve and memory CD4+ and CD8+ T cells inversely correlated with measures for insulin sensitivity in the older population. Moreover, the percentages of naïve CD4+ and CD8+ T cells were significantly higher, whereas activated T cells and IL-6 levels were lower in IS compared to insulin resistant (IR) obese individuals. The percentages of naïve CD4+ and CD8+ T cells were predictive for impaired insulin sensitivity (ß=0.16, p=0.01 and ß=0.11, p=0.04), and the association of naïve CD4+ T cells with insulin sensitivity persisted after multivariate adjustment (ß=0.14, p=0.02). Conclusions These findings support the hypothesis that parameters of systemic inflammation can differentiate IS from IR obese individuals that are at higher risk for cardiometabolic diseases and may have clinical implications with regard to obesity treatment stratification. Trial registration: DRKS00009277. Registered 31 August 2015 - Retrospectively registered, https://www.base2.mpg.de/de
Trophic states regulate assembly processes and network structures of small chromophytic phytoplankton communities in subtropical coastal ecosystem
Authors: Chen Xing , Zhao Huaxian , Jiang Gonglingxia , Tang Jinli , Xu Qiangsheng , Chen Si , Zou Shuqi , Dong Ke , Hou Weiguo , Pan Lianghao , Wang Pengbin , Li Nan
Published: October 2020

Small chromophytic phytoplankton (SCP) are anticipated to be more important for a significant proportion of primary production in estuarine-coastal ecosystems. However, responses of SCP community to coastal eutrophication are still unclear. In this study, we investigated diversity, co-occurrence and assembly features of SCP communities, as well as their relationship with environmental factors in the subtropical Beibu Gulf. The results exhibited that the alpha diversity (ANOVA, p < 0.001) and beta diversity (ANOSIM, p < 0.001) of SCP communities were significantly different among eutrophic states. Co-occurrence network analysis revealed a complex interaction between SCP community and environmental factors. Most OTUs in modules of the network were specific to trophic states. Further, phylogenetic based β-nearest taxon distance analyses revealed that stochastic processes mainly provided 69.26% contribution to SCP community assembly, whereas deterministic processes dominated community assembly in a heavy eutrophic state. Importantly, increased environmental disturbances, such as nitrogen and phosphorus nutrients, could alter SCP community structure and disrupt ecological processes. Overall, our findings elucidate the mechanism of diversity and assembly in marine SCP community and promote the understanding of SCP ecology related to subtropical coastal eutrophication.
Effects of Preservatives on Corneal Collagen Parameters Measured by Small Angle X-Ray Scattering Analysis
Authors: Kelly Susyn , duPlessis Lizette , Soley John , Noble Frazer , Wells Hannah Carolyn , Kelly Patrick John
Published: October 2020

Objective: Small angle X-ray scattering (SAXS) analysis is a sensitive method for determining the ultrastructure of collagen in various tissues. Little is known about how parameters measured by SAXS are affected by preservatives, commonly used to prevent autolysis and strengthen sample tissues. We determined the effects of formalin, glutaraldehyde, Triton X and saline on measurements of fibril diameter, fibril diameter distribution, and D-spacing of corneal collagen using SAXS analysis. Results: Compared to control sheep and cats’ corneas, frozen at -80 °C, those preserved in 5% glutaraldehyde and 10% formalin had significantly larger mean collagen fibril diameters, increased fibril diameter distribution and decreased D-spacing. Corneas preserved in Triton X had significantly increased collagen fibril diameters and decreased fibril diameter distribution. Corneas preserved in 0.9% saline had significantly increased mean collagen fibril diameters and decreased diameter distributions. Subjectively, the corneas preserved in 5% glutaraldehyde and 10% formalin maintained their transparency but those in Triton X and 0.9% saline became opaque. Subjective morphological assessment of transmission electron microscope images of corneas supported the SAXS data. Workers using SAXS analysis to characterize collagen should be alerted to changes that can be introduced by common preservatives in which their samples may have been stored.
Thermal and Mechanical Activation of Dynamically Stable Ionic Interaction toward Self-Healing Strengthening Elastomers
Authors: Peng Yan , Hou Yujia , Wu Qi , Ran Qichao , Huang Guangsu , Wu Jinrong
Published: October 2020

Biological tissues can grow stronger after mechanical damage and self-healing. However, artificial self-healing materials usually show decreased mechanical properties after repairing mechanical damage. Here, a self-healing strengthening elastomer (SSE) is developed by engineering kinetic stability in elastomeric ionomers through introduction of large steric hindrance. Elastomeric ionomers are usually thermodynamically instable due to the none-directionality and none-saturation of electrostatic interaction and the high mobility of molecular chains; thus, their mechanical properties change with time in an uncontrollable manner. However, the large steric hindrance on the cationic groups prevents the formation of new ionic bonds and rearrangement of ionic aggregates under room temperature, thus SSE is kinetically stable. Once heat or external force is applied, the kinetic stability is disrupted and the material becomes stronger driven by the thermodynamic instability. Consequently, the self-healing efficiency of fractured SSE is as high as 143%. This work provides controllable and universal strategy to fabricate biomimetic self-healing strengthening materials.
EGFL6 Promotes Colorectal Cancer Cell Growth and Mobility and the Anti-cancer Property of Anti-EGFL6 Antibody
Authors: Sung Ting-Yi , Huang Han-Li , Cheng Chun-Chun , Chang Fu-Ling , Wei Po-Li , Cheng Ya-Wen , Huang Cheng-Chiao , Lee Yu-Ching , HuangFu Wei-Chun , Pan Shiow-Lin
Published: October 2020

BackgroundA reliable cancer biomarker will be critical for advanced colorectal cancer (CRC) therapeutic approaches since current treatments are limited to certain patient characteristics, such as age, sex, comorbidities and patients received self-expandable metal stents implantations. The association of epidermal growth factor-like domain 6 (EGFL6) with cancer development has been reported. Here, we focused on the role of EGFL6 in CRC progression and its clinical relevance. MethodsAn anti-EGFL6 antibody was generated by phage display technology to investigate the potential therapeutic efficacy in CRC. Methylene blue staining was applied to investigate the EGFL6 expression in CRC patients and animal tissue. Protein and DNA level of EGFL6 expression as well as related pathway investigation were determined by western blot and quantitative real time PCR. Silence EGFL6 by siRNA transfection, transwell migration and invasion assay were performed to verify EGFL6 function. Student t test, Kruskal-Wallis test and multiple comparisons were used to statistical analysis results. ResultsSignificant EGFL6 expression was found in colon tissues from patients and spontaneous tumorigenesis mouse but not in normal tissue. Furthermore, we found EGFL6 could enhance cancer cell migration, invasion and proliferation in CRC via up-regulating ERK/ AKT pathway, as well as reducing ADAMTS1 and Snail expression. We also found EGFL6 regulates cell abilities through EGFR/αvβ3 integrin receptors. By conducting animal experiments, our anti-EGFL6 antibody, EGFL6-E5-IgG, showed tumor inhibition and anti-metastasis ability. Furthermore, no impact on angiogenesis and wound healing by using EGFL6-E5-IgG were observed. ConclusionsWe demonstrated that EGFL6 plays a role in CRC tumorigenesis and tumor progression, indicating that EGFL6 is a potential cancer biomarker and therapeutic target worth further investigation.
Molecular Characterization of Carbapenemase-Producing Escherichia coli and Salmonella in children with diarrhea in rural Burkina Faso
Authors: DEMBELE Rene , Soulama Issiaka , Kaboré Wendpoulomdé A. D. , Konaté Ali , Kagambèga Assèta , Coulibaly David N'Golo , Traoré Oumar , Seck Abdoulaye , Traoré Alfred S. , Guessennd Nathalie K. , Gassama-Sow Amy , Barro Nicolas
Published: October 2020

Background: In recent years, carbapenemase-producing Enterobacterales (CPE) resistance to antibiotics has dramatically increased leading to limitations of their treatment options. In the present study, we investigated the occurrence of carbapenemase-producing Escherichia coli and Salmonella in rural Burkina Faso. Methods: Salmonella isolates were serotyped according to the Kauffman White scheme. Diarrheagenic Escherichia coli (DEC) strains was identified using 16-plex Polymerase Chain Reaction (PCR), whereas antibiotic susceptibility was realized using the disk diffusion method. Furthermore, multiplex PCR assays were carried out using oligonucleotides to detect the presence of genes of the blaKPC, blaVIM, blaIMP, blaTEM, blaSHV, blaOXA and blaCTX-M types in all E. coli and Salmonella strains.Results: The study highlighted high resistance rates of the identified bacteria to common antibiotics. Likewise, two strains of E. coli were imipenem resistant with carbapenemase-encoding genes. The genes detected were Klebsiella pneumoniae carbapenemase (KPC), Verona integrin-encoded metallo-β-lactamase (VIM) and Imipenemase (IMP-2) reaching a rate of 40% each in E. coli strains. However, no Salmonella carbapenemases blaKPC, blaVIM or blaIMP were detected.Conclusions: This study showed that for a real-time infection control and prompt application of antimicrobial chemotherapy, characterization of carbapenemase-producing Enterobacterales in patients is crucial.
Using text and acoustic features to diagnose Mild Cognitive Impairment and Alzheimer’s disease
Authors: Ning Liu , Luo Kexue
Published: October 2020

The authors have requested that this preprint be removed from Research Square.
The effect of WeChat-based training on improving the village doctors’ knowledge of tuberculosis management: a pre-and-post intervention study from China
Authors: Gao Lei , Xin Henan , Zhang Haoran , Cao Xuefang , Feng Boxuan , Quan Zhusheng , Du Ying , He Yijun , Wang Dakuan , Zhang Bin , Jin Qi , Liu Zisen , Pan Shouguo , Guan Ling , Shen Fei , Liu Jianmin
Published: October 2020

Background: In China, around 70% tuberculosis (TB) cases occurred in rural areas. Village doctors played a crucial role in TB cases referral and management. The current study aimed to evaluate the effect of WeChat-based training program on improving the village doctors’ knowledge on TB management.Methods: A One-year WeChat-based training was conducted by means of releasing original contents (in forms of text, poster, video or cartoon), through WeChat subscription account (WeChat SA) once a week, with the topics of TB detection, treatment, prevention and patient’s management. Based on a self-control design, pre-and post-training offline tests were hold using the same self-administered questionnaire to evaluate the training effect.Results: A total of 467 village doctor registered in Zhongmu County (Henan province, China), who worked in the local village clinic or community health center, were included in the study. During the training, sixty original articles were posted through WeChat SA during the one-year training. There are 19, 26 and 15 were displayed in the form of text, poster and other types (such as video or cartoon), and the corresponding average reading times were 245, 38, 199, respectively. With respect to the two tests, the median score increased from 50 (40.0-60.0) to 60 (53.0-70.0) (p<0.001) after training. The median scores were always higher after training no matter what kind of article contents and forms. In addition, the effectiveness of such training was found to be influenced by gender and education level.Conclusions: Our results indicated that WeChat-based training could improve the knowledge of village doctors on TB management. It is worthy to explore more effective new media-based training methods that might promote TB control work in rural China.
An Integrated Knowledge Translation Study to Address Avoidable Rehospitalisations and Unplanned Admissions for Older People: Study Protocol
Authors: Harvey Gillian , Pham Clarabelle T. , Inacio Maria C. , Laver Kate , Lynch Elizabeth A. , Jorissen Robert N. , Karnon Jonathan , Bourke Alice , Forward John , Maddison John , Whitehead Craig , Rupa Jesmin A. , McNamara Carmel , Crotty Maria
Published: October 2020

BackgroundRepeated admission to hospital can be a stressful and negative experience for older people and their families and puts additional pressure on the health care system. While there is evidence about strategies to better integrate care and improve older patients' experiences at transitions of care, thus helping to reduce hospital readmissions, implementing these strategies at scale is challenging. The objective of this project is to improve the pathways of care for older people after discharge from hospital by leveraging existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. MethodsThe project will be undertaken in the state of South Australia and focuses on people aged 65 and over. A mixed methods approach will be adopted, with three inter-linked work packages that aim to: analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; evaluate the effectiveness and cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; implement and evaluate a statewide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The study is underpinned by an integrated approach to knowledge translation, with active engagement of a broad range of stakeholders throughout, to optimize the relevance and sustainability of the changes that are introduced. DiscussionThis project highlights the uniqueness and potential value of a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) to improving health services. The project aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.Trial registrationNot applicable.
Characterization of Amorphous Silica and Crystalline Silica From Rice Husk Ash on Water Filtration Application
Authors: Zainal Nur Saadah , Mohamad Zaleha , Mustapa Mohammad Sukri , Badarulzaman Nur Azam
Published: October 2020

The presence of water pollution which consists of heavy metals, fecal and others has produced a major problem. These can lead the water to the toxicity and the impurity of water will be disrupted. Therefore, it would not be safe to drinks and could be threatening to live health. In addition, the current market now is dealing with high-cost production to develop ceramic membranes and has been using expensive material to make the filtration system works. In order to challenge the issue, the preparation of ceramic water filtration at low-cost production and using an effectively silica from natural waste rice husk was evaluated. Rice husk was fired at 700ºC and 1000ºC respectively and produced rice husk ash which mutated to amorphous and crystalline silica. Five samples were fabricated after been mixed with the compositions of rice husk ash, kaolin clay, and wheat flour, used at 40:40:20 ratios by weight respectively. The fabrications of the ceramic membrane were conducted by using dry pressing. The samples then were dried in the oven at 60ᵒC for 1 hour followed by sintering at 1000ᵒC respectively. These samples (OO, C1, C2, N1, and N2) were tagged based on unwashed and washed material with the chemical. The properties of silica which the microstructure and pore size, from rice husk ash were obtained by using X-Ray Fluorescence (XRF) and x-ray diffractometer (XRD). Effect of silica content in ceramic filtration membrane was investigated and characterized in term of porosity, density, water absorption, pore size, the turbidity of water (before and after filtration) and pH value. From the result, sample C2 was the best option to support the objective by 98.60% silica content, 64.82% of porosity, 1.1433 mg/cm3 of density, 40.59% of water absorption, and pH of 7.62 of water after filtration. In general, the quality of the ceramic filter membrane is reliant on the raw material, while the water clarity is dependent on the pore size of the filter membrane.
Posttraumatic Stress Disorder among Adolescents in Brazil: A Cross-sectional Study
Authors: Avanci Joviana , Serpeloni Fernanda , de Oliveira Thiago Pires , de Assis Simone Gonçalves
Published: October 2020

Background: The frequency of trauma and violence exposure in urban areas and their effects on mental health in adolescents in developing countries are poorly investigated. Most information about traumatized young people comes from war scenarios or disasters. This study aimed to determine the prevalence of PTSD in trauma-exposed students in a low-resource city of the state of Rio de Janeiro, Brazil. The effects of sociodemographic, individual, family factors in the development of PTSD were also investigated.Methods: Through multi-stage cluster sampling, 862 adolescents (Mage = 15 years old, 65% female) from public and private schools in the city of São Gonçalo were selected for the study. Self-rating structured questionnaires were applied to assess sociodemographic profile, exposure to physical and psychological violence (family, school, community), sexual abuse, social support, social functional impairment, resilience, and posttraumatic stress disorder. The data were grouped in blocks regarding sociodemographic, individual, family, and community variables. For statistical analysis, chi-square, Fisher's exact test, and logistic regression were performed. Results: The PTSD prevalence was 7.8% among adolescents. Boys were significantly exposed to more events of community violence while girls to family violence. The adjusted odds ratio (OR) for PTSD were statistically significant for age (OR, 1.45, [95% CI, 1.043–2.007]), social functional impairment (OR, 4.82, [95% CI, 1.77–13.10]), severe physical violence of the mother (OR, 2.79, [95% CI, 0.79–9.93]), psychological violence by significant people (OR, 3.96, [95% CI, 1.89–8.31]) and a high number of episodes of community violence (OR, 3.52, [95% CI, 1.47–8.40).Conclusions: There was a high prevalence of PTSD within this population associated with violence exposure. Not only physical but also psychological violence contributed to PTSD. The results also raise awareness for the differences in life trajectories between boys and girls regarding violence. These differences need to be better understood in order to develop effective preventative interventions. Treating and preventing mental health disorders presents a challenge for countries, especially those with a lower degree of social and economic development and who have high community violence.
Compressible Flow Simulation with Moving Geometries using the Brinkman Penalization in High-Order Discontinuous Galerkin
Authors: Pour Neda Ebrahimi , Anand Nikhil , Klimach Harald , Roller Sabine
Published: October 2020

In this work we investigate the Brinkman volume penalization technique in the context of a high-order Discontinous Galerkin method to model moving wall boundaries for compressible fluid flow simulations. High-order approximations are especially of interest as they require few degrees of freedom to represent smooth solutions accurately. This reduced memory consumption is attractive on modern computing systems where the memory bandwidth is a limiting factor. Due to their low dissipation and dispersion they are also of particular interest for aeroacoustic problems. However, a major problem for the high-order discretization is the appropriate representation of wall geometries. In this work we look at the Brinkman penalization technique, which addresses this problem and allows the representation of geometries without modifying the computational mesh. The geometry is modelled as an artificial porous medium and embedded in the equations. As the mesh is independent of the geometry with this method, it is not only well suited for highorder discretizations but also for problems where the obstacles are moving.We look into the deployment of this strategy by briefly discussing the Brinkman penalization technique and its application in our solver and investigate its behavior in fundamental one-dimensional setups, such as shock reflection at a moving wall and the formation of a shock in front of a piston. This is followed by the application to setups with two and three dimensions, illustrating the method in the presence of curved surfaces.
Factors Associated with Tobacco Smoking in HIV Infected Persons, Brazil: A Cross Sectional Survey
Authors: Sorensen William , Pereira-Caldeira Natalia Maria Vieira , Boyle Julianna , Fleck-Reinato Lilian Andreia , Gir Elucir
Published: October 2020

Background: The purpose of this study was to assess differences in factors between smoking status of Brazilians living with HIV, as well as assess whether secondhand smoke exposure or sexual orientation was associated with smoking status. Methods: Over 200 HIV infected individuals were convenience sampled. Permission was granted by the Universidade de São Paulo, and trained HIV care nurses conducted the interviews. Results: Two-hundred and five participants were interviewed of whom 39% currently smoked tobacco. Sexual orientation did not associate with smoking categories, but secondhand smoke exposure did. In the ever-smoking model lower education level was more likely to induce smoking behavior and women were 70% more likely to have smoked. In the current-smoking model, attitudes were significant, and women were 75% more likely to be currently smoking. Conclusion: Smoking prevalence is high in HIV-infected persons in Brazil. Comprehensive attention is needed to help individuals successfully quit, including emphasis on secondhand smoking risk awareness and offering coping strategies to prevail over stigma and stress, especially for women.
Pregnancy Intentions and Its Associated Factors Among Married Women in Resunga, Gulmi, Nepal
Authors: Karki Rita , Maharjan Surendra , Khatiwada Ganesh , Shrestha Junu
Published: October 2020

BackgroundPregnancy intention refers to a women’s thinking at the time she became aware that she was pregnant. Pregnancy intentions can be categorized as intended and unintended. It is an important public health concern in every corner of the world, especially in developing countries. The study was carried out with an objective of determining the pregnancy intentions among married women in Resunga municipality, Gulmi, Nepal and test the association of pregnancy intentions with various socio-demographic, and reproductive health-related variables.MethodsThe community based cross-sectional study design was used to achieve the objective of the study. Married women of reproductive age of the Resunga municipality, Gulmi were selected and a multistage random sampling technique was adopted. Total 406 participants were involved in this study. Pretested semi-structured interview schedule adapted from Demographic and Health Survey of Nepal was used for data collection. All the statistical tests were performed in SPSS, version 25.0. The p -value was set at 5% level of significance. Descriptive and data exploratory analysis were performed. Bivariate and multivariate logistic regression analysis technique were conducted to explore the association between pregnancy intentions and predictor variables.ResultsThe study showed that out of total 410 pregnancies, 248 (60.5%) pregnancies were unintended, of which 78(19.05%) were unplanned and 170 (41.5%) were ambivalent. The remaining 162 (39.5%) pregnancies were considered intended. The chi-square analysis and bivariate analysis showed that women age, socioeconomic status, husband opposition, methods used before pregnancy, and intention of using contraception in the future were significantly associated with pregnancy intentions. When these variables were subjected for multivariate analysis, only socioeconomic status, and method of family planning used before pregnancy were found to be significantly associated with pregnancy intentions.ConclusionsThe study showed that unintended pregnancy is very high. The factors that were found to be associated with an unintended pregnancy were socioeconomic status and method of family planning used before pregnancy. The findings of this research work could be useful while providing different reproductive and family planning related services to women by considering predictors of unintended pregnancy that might increase planned pregnancy ultimately.
The Predictive Value of Creatinine Clearance for Mortality in Patients Undergoing Revascularization
Authors: Ram Eilon , Beckerman Pazit , Segev Amit , Shlomo Nir , Atlas-Lazar Abigail , Sternik Leonid , Raanani Ehud
Published: October 2020

BackgroundRenal function plays a significant role in the prognosis and management of patients with multi-vessel coronary artery disease (CAD) referred for revascularization. Current data lack precise risk stratification using estimated glomerular filtration rate (eGFR) and creatinine clearance. MethodsThis prospective study includes a three-year follow-up of 1112 consecutive patients with multi-vessel CAD enrolled in the 22 hospitals in Israel that perform coronary angiography. ResultsThe Mayo formula yielded the highest mean eGFR (90±26 mL/min per 1.73m2) and chronic kidney disease-epidemiology collaboration (CKD-EPI) the lowest (76±24 mL/min per 1.73m2). Consequently, the Mayo formula classified more patients (56%) as having normal renal function. There was a significant and strong correlation between the values obtained from all five formulas using Cockcroft-Gault as the reference formula: Mayo: r=0.80, p<0.001; CKD-EPI: r=0.87, p<0.001; modification of diet in renal disease (MDRD): r=0.84, p<0.001; inulin clearance-based: r=0.99, p<0.001). Multivariable analysis demonstrated that decreased renal function is an independent predictor of 3-year mortality in all five formulas, with risk increasing by 15-25% for each 10-unit decrease in eGFR. Despite the similarities between the formulas, the ability to predict mortality was highest in the Mayo formula and lowest in MDRD.ConclusionsOur data suggest that the Mayo and CKD-EPI formulas may be superior to other formulas, including the widely used MDRD, in prognosticating mortality in CAD patients.
Analysis of Patient Access to Orphan Drugs in Turkey
Authors: KOÇKAYA GÜVENÇ , Atalay Sibel , Oguzhan Gulpembe , Kurnaz Mustafa , Okcun Selin , Gedik Cigdem Sar , Saylan Mete , Sencan Nazlı
Published: October 2020

Background: Rare diseases are life-threatening, serious, and chronic genetic conditions that require complex care and have a low prevalence. An estimated one in 15 people worldwide are affected by rare diseases. This study aims to analyze the accessibility, reimbursement status, licensed status, and Anatomical Therapeutic Chemical (ATC) codes of drugs that the European Medicines Agency (EMA) in Turkey considers to be “orphan” pharmaceuticals. Methods: The drugs included in this analysis were obtained from the list of orphan drugs published by the EMA. Orphan drugs’ accessibility and licensing status in Turkey were obtained from the Health Implementation Communiqué published by the Social Security Institution (SGK) and the List of Abroad Active Substance and List of Licensed Products published by the Turkey Pharmaceuticals and Medical Devices Agency (TİTCK). Descriptive analysis was applied to determine the accessibility status of orphan drugs identified by the EMA in Turkey.Results: Based on the EMA, 105 pharmaceuticals were approved with “orphan drug” status by January 2020. Of the 105 rare drugs on the EMA list, 34 were inaccessible in Turkey. Of the 71 available drugs, 23 (32%) were licensed and 48 (68%) were unlicensed in Turkey. Seventeen licensed products (74%) and 17 unlicensed products (35%) were covered by reimbursement. When orphan drugs’ ATC codes were examined, the most common ATC group was found to be “L –Antineoplastic and Immunomodulatory” agents.Conclusion: An orphan drug incentive policy is very important to ensure early access to the drugs used to treat rare diseases. It is obvious that such a policy must prepare for the regulation of orphan drugs in Turkey.
Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data From the German Registry for Congenital Hypothyroidism (HypoDok)
Authors: Thomann Julia , Tittel Sascha R. , Voß Egbert , Oeverink Rudolf , Palm Katja , Fricke-Otto Susanne , Kapelari Klaus , Holl Reinhard W. , Woelfle Joachim , Bettendorf Markus
Published: October 2020

Background: Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the multicentre database HypoDok was analysed to evaluate the implementation of evidence-based guidelines in the care of children with CH and to assess the number of patients in this registry of the German society of paediatric endocrinology and diabetology (DGKED).Methods: HypoDok includes the prospective documentation of 1,630 patients with CH from 50 centres in Germany and Austria. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased TSH at screening and/or confirmation. Parameters regarding diagnosis, therapy and follow-up were extracted. The number of registered patients was compared to the number in the report of the German Society for Neonatal Screening (DGNS). The cohort was divided into 2 groups, before (A) and after (B) guideline publication in 02/2011, to assess guideline’s influence on medical care.Results: 659 patients (62% female) were eligible and analysed as group A (n=327) and group B (n=332) representing 17.5% and 6.7% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxin doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented in both groups including five appointments in the first and three in the second year of life. Ultrasound of the thyroid gland was performed in 92.6% (A) and 92.1% (B) of the patients. In the first three years of life, 46.4% (A) and 40.0% (B) of the patients underwent audiometry, EQ/IQ testing was performed in 49.3% (A) and 24.8% (B) (p<0.01), respectively.Summary: While documentation of care for patients with CH by paediatric endocrinologists seems to be established, only a minority of all affected patients is included in HypoDok. Thus, the care and outcome of the majority of patients with CH remains uncertain. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend and optimize care and outcome in patients with rare diseases such as CH, irrespective of treatment provider.
Effect of Endoscope Flexibility on Tissue Dissection Profile Assessed With Pulsed Water Jet Device: Ensuring Safety, Efficacy, and Handling of Thin Devices for Neuroendoscopic Surgery
Authors: Kusunoki Tetsuya , Kawaguchi Tomohiro , Nakagawa Atsuhiro , Noguchi Yuta , Osawa Shinichiro , Endo Hidenori , Endo Toshiki , Saito Ryuta , Kanamori Masayuki , Niizuma Kuniyasu , Tominaga Teiji
Published: October 2020

Objective: We developed an actuator-driven pulsed water jet device (ADPJ) for flexible neuroendoscopy to achieve effective tissue dissection with vasculature preservation. Although flexibility is a strong advantage for minimally invasiveness, the effect of the ductile curvature on the dissection profiles remains unknown. The purpose of this study was to clarify the impact of the curvature change of the ADPJ connecting tube on the dissection safety and efficacy.Results: Three ADPJ connecting tubes with different inner diameters (1.0, 0.75, 0.5 mm) were used to dissect the brain phantom. They were bent at 3 angles: 0 °, 60 °, and 120 °. The dissection profiles were evaluated using the mean depth and coefficient of variation (CV) for efficacy and safety, respectively.The larger inner diameter connecting tube dissected more deeply. The dissection depth was not changed regardless of the curvature degree in each tube. There was no significant difference in CVs regardless of inner diameter and curvature. The ductile curvature of the flexible neuroendoscope did not affect the efficacy and safety of the ADPJ dissection profile. Among the numerous instruments, tube-formed devices, including suction and injecting devices such as ADPJ, can be used safely and effectively without flexibility-related limitations.