bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid Data-Driven and Physics-Based Modelling for Gas-Turbine Prescriptive Analytics
Authors: Belov Sergei , Nikolaev Sergei , Uzhinsky Ighor
Published: September 2020

This paper presents a methodology for predictive and prescriptive analytics of complex engineering systems. The methodology is based on a combination of physics-based and data-driven modeling using machine learning techniques. Combining these approaches results in a set of reliable, fast, and continuously updating models for prescriptive analytics. The methodology is demonstrated with a case study of a jet-engine power plant preventive maintenance and diagnostics of its flame tube.
Quantum Probability's Algebraic Origin
Authors: Niestegge Gerd
Published: September 2020

Max Born's statistical interpretation made probabilities play a major role in quantum theory. Here we show that these quantum probabilities and the classical probabilities have very different origins. While the lat- ter always result from an assumed probability measure, the first include transition probabilities with a purely algebraic origin. Moreover, the gen- eral definition of transition probability introduced here comprises not only the well-known quantum mechanical transition probabilities between pure states or wave functions, but further novel cases. A transition probability that differs from 0 and 1 manifests the typical quantum indeterminacy in a similar way as Heisenberg's and others' un- certainty relations and, furthermore, rules out deterministic states in the same way as the Bell-Kochen-Specker theorem. However, the transition probability defined here achieves a lot more beyond that: it demonstrates that the algebraic structure of the Hilbert space quantum logic dictates the precise values of certain probabilities and it provides an unexpected access to these quantum probabilities that does not rely on states or wave functions.
Single Nucleotide Polymorphisms of Indoleamine 2,3-Dioxygenase 1 Influenced the Age Onset of Parkinson’s Disease
Authors: Török Nóra , Maszlag-Török Rita , Molnár Kinga , Szolnoki Zoltán , Somogyvári Ferenc , Boda Krisztina , Tanaka Masaru , Klivényi Péter , Vécsei László
Published: September 2020

Earlier studies reported alterations of the kynurenine (KYN) pathway of tryptophan (TRP) metabolism in Parkinson’s disease (PD). The first rate-limiting enzymes indoleamine 2,3-dioxygenase (IDO) and tryptophan dioxygenase were observed upregulated, resulting elevated KYN/TRP ratios in the serum and cerebrospinal fluid samples of patients with PD. An increasing number of single nucleotide polymorphisms (SNPs) have been identified in a population of PD. However, little is known if genetic variations of the IDO contribute to disturbance of the KYN metabolism in and the pathogenesis of PD. SNP analysis of IDO1 was performed by allelic discrimination assay with fluorescently labelled TaqMan probes and a subgroup analysis was conducted according to the age of PD onset. The frame shifts variant rs34155785, intronic variant rs7820268, and promotor region variant rs9657182 SNPs of 105 PD patients without comorbidity were analyzed and compared to 129 healthy controls. No significant correlation was found in three SNPs between PD patients and healthy controls. However, the subgroup analysis revealed that A alleles of rs7820268 SNP or rs9657182 SNP carriers contribute to later onset of PD than non-carriers. The study suggested that SNPs of IDO1 influenced the age onset of PD and genotyping of SNPs in certain alleles potentially serves as a risk biomarker of PD.
A Comparative Analysis of Cities and Towns in the Seoul Metropolitan Region: Integrating landscape Metrics and Census Data
Authors: Sim Sunhui , Clarke Keith
Published: September 2020

Urban form is associated with both socio-economic and urban physical properties. This study explores the differences among urban forms in the Seoul Metropolitan Region with a comparison between census-based socioeconomic variables and landscape metrics computed from remotely sensed data. To accomplish this, factor analysis and multi-dimensional scaling were used with the selected variables and metrics. When all of the measures are considered together, four types of cities and towns emerged: 1) exurban-fragmented high growth, 2) exurban-fragmented low growth, 3) compact-extensive urban core and 4) sub-urban compact-high growth. The results indicate that the fusion of knowledge of the physical urban layout and that of socio-economic characteristics is beneficial for a better understanding of urban spatial patterns. However, there remain challenges in delineating each urbanized area and with indicator selection for comparing urban form across cities and towns.
COVID-19 Mortality Risk Assessment among Various Age Groups using Phylogenetic Analysis
Authors: Verma Pawan , Elkaffas Rasha , Shodunke Oluwasefunmi C. , Hrab Pavlo , Adebayo Oluwatobiloba H. , Alam Humaira Marzia , Gbedema Wilson , Agbonyin Mosadoluwa A. , Osman Ahmed M. , Igbokwe Joseph O. , Sudarsanam Harinath , Adepoju Ayodeji , Abass Ohilebo A. , Olorunfemi Sola R. , Oladejo Sarah O. , Semilogo Sonaike , Hurtado Jairo , Ferdousee Shahida , Peter Josiah Aminu , Oluwasanmi Adetutu D. , Agbaje Sheriff T. , Sheen Alexandra , Sharma Mukul , Ibitoye Opeyemi , El-Gammal Ahmed , Olutunde Olaleye T. , Krishna Meera , Ezechukwu Tracy-allen M. , Carl Sarah H.
Published: September 2020

The age-related mortality and morbidity risk of COVID-19 has been considered speculative without enough scientific evidence. This study aimed to collect more evidence on the association between patient age and risk of severe disease state and/or mortality from SARS-CoV-2 infection. Genomic dataset along with metadata (3608 samples) retrieved from GISAID from different geographical regions were grouped into 10 age groups (0-10, 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90, 91-100 years) as well as high-risk or low-risk according to patient clinical status. Genomic sequences were aligned and analyzed using MAFFT and FASTTREE to build a phylogenetic tree in order to identify age-risk associations based on phylogenetic clustering. Case fatality rates (CFR), as well as the Odds ratio (OR) for high-risk outcomes, were calculated for different age groups. Results revealed that individuals aged between 25-50 years have the best immune response to the infection. On the other hand, disease fatality was higher in patients aging above 50 years. We created an application to calculate the OR of being at high risk given a certain age threshold from GISAID datasets. OR values increased between ages 1-10 years (1.271) and 11-20 years (1.313) but reduced at age range 21-30 years (1.290) and increased again for 61-70 years (2.465). CFR calculated for each of the age groups had peak values at 90-100 years (26.8%) and the lowest at 0-10 years (0%). The CFR for ages above 50 years was about twice greater (11.6%-26.8%) than that for ages below (0-6.6%). The phylogenetic analysis revealed that the majority of samples obtained from India showed low-risk among different age groups and were defined as clade GH. Another cluster from Singapore visualization showed unfavorable patient outcome across several age groups and were classified under clade O. To conclude, this study analyses showed a variety of age-risk associations. As scientists from different countries upload more genomes to globally shared databases, more evidence will reinforce mortality risk associations in COVID-19 patients.
Multidrug Resistant Escherichia coli Harboring Extended-spectrum β-lactamase-encoding Genes Isolated from Clinically-healthy Pigs
Authors: Lay Khin Khin , Torio Haidee E. , Bitrus Asinamai Athliamai , Mala Wanida , Nuananong Sinwat , Chuanchuen Rungtip
Published: September 2020

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is a serious-global public health issue. A total of 292 E. coli isolates obtained from fecal samples of pigs in Central (n = 103) and Northeastern (n = 189) provinces of Thailand were included in this study. Eighty-six E. coli isolates were phenotypically confirmed to be β-lactamase producers (29.5%) and screened for the presence of β-lactamase genes. The genes in CTX-M family was most frequently found (90.7%). The blaCTX-M-15 gene (59.3%) was predominantly identified CTX-M genotype, followed by blaCTX-M-14 (31.4%) and blaCTX-M-4 (25.6%). The blaTEM-1 gene was prevalent (75.6%). The blaCTX-M-4 and blaCTX-M-14 genes were located on conjugative plasmid. The results highlight healthy pigs as reservoirs of ESBL-producing E. coli carrying ESBL genes that could be horizontally transferred.
Agency in Human-Smart Device Relationships: An Exploratory Study
Authors: Lelli Francesco , Toivonen 'Heidi
Published: September 2020

In this paper, we investigate the relationship people have with their smart devices. We use the concept of agency to capture aspects of users’ sense of mastery as they relate to their device. This study gives preliminary evidence of the existence of two independent dimensions of agency for modeling the interaction between humans and smart devices: (i) user agency and (ii) device agency. These constructs emerged from an exploratory factorial analysis conducted on a survey data collected from 587 participants. In addition, we investigate the correlation between user agency and device agency with background variables of the respondents. Finally, we argue that mapping the users’ dynamics with their device into user agency and device agency fosters a better understanding of the needs of the users and helps in designing interfaces tailored for the specific capabilities and expectations of the users.
Hill-based dissimilarity indices and null models for analysis of microbial community assembly
Authors: Modin Oskar , Liébana Raquel , Sabeh-Alam Soroush , Wilén Britt-Marie , Suarez Carolina , Hermansson Malte , Persson Frank
Published: September 2020

Background: High-throughput amplicon sequencing of marker genes, such as the 16S rRNA gene in Bacteria and Archaea, provides a wealth of information about the composition of microbial communities. To quantify differences between samples and draw conclusions about factors affecting community assembly, dissimilarity indices are typically used. However, results are subject to several biases and data interpretation can be challenging. The Jaccard and Bray-Curtis indices, which are often used to quantify taxonomic dissimilarity, are not necessarily the most logical choices. Instead, we argue that Hill-based indices, which make it possible to systematically investigate the impact of relative abundance on dissimilarity, should be used for robust analysis of data. In combination with a null model, mechanisms of microbial community assembly can be analyzed. Here, we also introduce a new software, qdiv, which enables rapid calculations of Hill-based dissimilarity indices in combination with null models.Results: Using amplicon sequencing data from two experimental systems, aerobic granular sludge (AGS) reactors and microbial fuel cells (MFC), we show that the choice of dissimilarity index can have considerable impact on results and conclusions. High dissimilarity between replicates because of random sampling effects make incidence-based indices less suited for identifying differences between groups of samples. Determining a consensus table based on count tables generated with different bioinformatic pipelines reduced the number of low-abundant, potentially spurious amplicon sequence variants (ASVs) in the data sets, which led to lower dissimilarity between replicates. Analysis with a combination of Hill-based indices and a null model allowed us to show that different ecological mechanisms acted on different fractions of the microbial communities in the experimental systems.Conclusions: Hill-based indices provide a rational framework for analysis of dissimilarity between microbial community samples. In combination with a null model, the effects of deterministic and stochastic community assembly factors on taxa of different relative abundances can be systematically investigated. Calculations of Hill-based dissimilarity indices in combination with a null model can be done in qdiv, which is freely available as a Python package (https://github.com/omvatten/qdiv). In qdiv, a consensus table can also be determined from several count tables generated with different bioinformatic pipelines.
Characterization of type-2 diacylglycerol acyltransferases in Haematococcus lacustris reveals their functions and engineering potential in triacylglycerol biosynthesis and possible roles in astaxanthin esterification
Authors: Cui Hongli , Zhao Chunchao , Xu Wenxin , Zhang Hongjiang , Hang Wei , Zhu Xiaoli , Ji Chunli , Xue Jinai , Zhang Chunhui , Li Runzhi
Published: September 2020

Background: Haematococcus lacustris is an ideal source of astaxanthin (AST) which is stored at oil bodies containing esterified AST (EAST) and triacylglycerol (TAG). Diacylglycerol acyltransferases (DGATs) catalyze the last step of the acyl-CoA-dependent TAG biosynthesis and are also considered as the crucial enzymes involving in EAST biosynthesis in H. lacustris. Previous studies have identified four putative DGAT2 encoding genes in H. lacustris and only the HpDGAT2D allowed the recovery of TAG biosynthesis, but the engineering potential of HpDGAT2s in TAG biosynthesis, especially possible roles in AST esterification, remains ambiguous.Results: Five putative DGAT2 genes (HpDGAT2A, HpDGAT2B, HpDGAT2C, HpDGAT2D, and HpDGAT2E) were identified in H. lacustris. Transcription analysis showed that the expression levels of HpDGAT2A, HpDGAT2D, and HpDGAT2E genes markedly increased under high light and nitrogen deficient conditions with distinct patterns, which led to significant TAG and EAST accumulation. Functional complementation demonstrated HpDGAT2A, HpDGAT2B, HpDGAT2D, and HpDGAT2E had the capability to restore TAG synthesis in a TAG-deficient yeast strain (H1246) with the large difference in enzymatic activity. Fatty acids (FAs) profiles assays revealed that HpDGAT2A, HpDGAT2D, and HpDGAT2E except for HpDGAT2B preferred monounsaturated fatty acyl-CoAs (MUFAs) for TAG synthesis in yeast cells, and also showed polyunsaturated fatty acyl-CoAs (PUFAs) preference by feeding strategy. The over-expression of HpDGAT2D in Arabidopsis thaliana and Chlamydomonas reinhardtii significantly increased the TAG content and obviously promoted the MUFAs and PUFAs contents. Interestingly, molecular docking analysis implied that HpDGAT2s structures contained AST binding sites, which provides strong evidence for AST esterification function in H. lacustris.Conclusions: Our study represents a pioneering work on the characterization of HpDGAT2s by systematically integrating expression pattern, AST/TAG accumulation, functional complementation, molecular docking, and over-expression in yeast, plants, and algae. These results (1) update the gene models of HpDGAT2s, (2) prove TAG biosynthesis capacity of HpDGAT2s, (3) show the strong preference for MUFAs and PUFAs, (4) offer target genes to modulate TAG biosynthesis by genetic engineering method, and (5) provide new evidence for HpDGAT2s roles in AST esterification.
Outcome of Community- versus Hospital-Acquired Intra-Abdominal Infections in Intensive Care Unit: a Retrospective Study
Authors: Abaziou Timothée , Vardon-Bounes Fanny , Conil Jean-Marie , Rouget Antoine , Ruiz Stéphanie , Grare Marion , Fourcade Olivier , Suc Bertrand , Leone Marc , Minville Vincent , Georges Bernard
Published: September 2020

Background: To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications.Methods: Retrospective study including all patients admitted to 2 ICUs within 48 hours of undergoing surgery for peritonitis.Results: 226 patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7% and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15 – 25] vs. 21 [15 - 24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7 – 36] vs. 6[3 – 12] days, p < 0.001 and 41 [24 – 66] vs. 17 [7 – 32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI. Conclusion: CA-IAI group had higher 28-day mortality rate than HA IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.
Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions
Authors: Aberese-Ako Matilda , Magnussen Pascal , Gyapong Margaret , Ampofo Gifty Dufie , Tagbor Harry
Published: September 2020

Background: Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015.Methods: This ethnographic study explored how healthcare managers dealt with existing MiP policy implementation challenges and the consequences on IPTp-SP uptake and access to maternal healthcare. The study collected date using non-participant observations, conversations, in-depth interviews and case studies in eight health facilities and twelve communities for twelve months in two Administrative regions in Ghana. Results: Healthcare managers addressed frequent stock-outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing and prescribing drugs for women to buy from private pharmacies. This ensured that facilities had funds to pay creditors, purchase drugs and supplies for health service delivery. However, it affected their ability to enforce DOT and to monitor adherence to treatment. Women who could afford maternal healthcare and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Women who could not maternal healthcare services resorted to visiting other sources of health care, delaying ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended 5+ doses of SP, others did not obtain LLINs early and some did not obtain treatment for MiP. Healthcare providers felt frustrated whenever they could not provide comprehensive care to women who could not afford comprehensive maternal and MiP care.Conclusion: For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, regular supply of programme drugs and medical supplies to public, faith-based and private health facilities.
Fetal double aortic arch: prenatal sonographic and postnatal computed tomography angiography features, associated abnormalities and clinical outcomes
Authors: Guo Qiao , Kong Yifan , Zeng Shi , Zhou Jiawei , Wang Xiaofang , Shang Quanliang , Zhou Jia , Yuan Hongxia , Wang Ling , Tong Lili , Yi Aijiao , Zhou Qichang
Published: September 2020

Background: Fetal double aortic arch (DAA) malformation is a rare congenital heart disease with few reported cases in the literature. We aimed to investigate the characteristics of prenatal ultrasound and postnatal computed tomography angiography (CTA) of DAA and to describe the associated anomalies and clinical outcomes to improve prenatal diagnosis and assist in perinatal management. Methods: The obstetric ultrasound imaging databases of seven tertiary referral centers were reviewed retrospectively to identify fetuses with a prenatal diagnosis of DAA between January 2013 and December 2018. Ultrasonographic findings, associated anomalies, genetic abnormalities, postnatal CTA images, and long-term postnatal outcomes were evaluated. Results: A total of 36 cases out of 40 prenatally diagnosed DAA fetuses were confirmed by postnatal diagnosis (fetal autopsy, CTA, and surgery). In this cohort of 36 confirmed cases, 24 (67%) were isolated anomalies, while 12 (33%) were associated with intracardiac or extracardiac anomalies, and 2 (6%) had a 22q11.2 chromosome deletion. Among nine cases of pregnancy termination with a fetal autopsy, 7 had other abnormalities. Among the remaining 27 live births, 16 (59%) were asymptomatic and 11 (41%) received surgical treatment due to tracheal or esophageal compression symptoms, all with satisfactory outcomes. Prenatal echocardiography showed that DAA was mainly characterized by a bifurcation of the ascending aorta into the right and left aortic arch and the formation of a complete O-shaped vascular ring around the trachea on the three-vessel tracheal view. A variant in the aortic arch branching pattern was found for the first time. The airway obstruction, branching pattern, and atretic arch of DAA were clearly shown by postnatal CTA. Conclusions: Fetal DAA has unique features on prenatal echocardiography and postnatal CTA, and systematic prenatal examination and timely postnatal CTA evaluation are required. A certain proportion of intracardiac and extracardiac abnormalities are associated with DAA, but the probability of chromosome abnormalities is low, especially for isolated DAA.The clinical outcomes of isolated DAA are favorable, even if surgery is performed due to symptoms. Determining whether other malformations or chromosomal anomalies exist is crucial for prognosis evaluation and prenatal counseling.
Loss of exosomal miR-146a-5p from cancer-associated fibroblasts after androgen deprivation therapy contributes to prostate cancer metastasis
Authors: Zhang Yu , Zhao Jing , Ding Mao , Su Yiming , Cui Di , Jiang Chenyi , Zhao Sheng , Jia Gaozhen , Wang Xiaohai , Ruan Yuan , Jing Yifeng , Xia Shujie , Han Bangmin
Published: September 2020

Background: Androgen deprivation therapy (ADT) is the backbone of therapy for advanced prostate cancer (PCa). Despite the good initial response, castration resistance and metastatic progression will inevitably occur. Cancer-associated fibroblasts (CAFs) may be implicated in promoting metastasis of PCa after ADT. Our aim is to investigate the role and mechanism of CAFs-derived exosomes involving in metastasis of PCa after ADT. Methods: PCa cells were co-cultured with exosomes derived from 10 nM dihydrotestosterone (DHT)-treated (simulating the high androgen level of prostate cancer microenvironment） or ethanol (ETOH) -treated (simulating the castration level of prostate cancer microenvironment after ADT) CAFs, and their migration and invasion differences under castration condition were examined both in vitro and in vivo. The miRNA profiles of exosomes derived from DHT-treated CAFs and matched ETOH-treated CAFs were analysed via next generation sequencing. The transfer of exosomal miR-146a-5p from CAFs to PCa cells was identified by fluorescent microscopy. The function and direct target gene of exosomal miR-146a-5p in PCa cells were confirmed through Transwell assays, luciferase reporter, and western blot.Results: Compared with DHT-treated CAFs, exosomes derived from ETOH-treated CAFs dramatically increased migration and invasion of PCa cells under castration condition. MiR-146a-5p level in exosomes from ETOH-treated CAFs was significantly reduced. The loss of miR-146a-5p may strengthen the epithelial-mesenchymal transition (EMT) to accelerate cancer cells metastasis by modulating epidermal growth factor receptor (EGFR)/ERK pathway. Conclusions: CAFs-derived exosomal miR-146a-5p confers metastasis in PCa cells under ADT through the EGFR/ERK pathway and it may present a new treatment for PCa.
Hydration Status, Body Composition and Anxiety Status in Aeronautical Military Personnel from Spain: a cross-sectional study
Authors: Carretero-Krug Alejandra , Velasco Carlos , Medina-Font Juan , Laguna Trinidad Trujillo , Varela-Moreiras Gregorio , Úbeda Natalia , Montero Ana
Published: September 2020

BackgroundAn adequate hydration status is critical to ensure efficiency during mental and physical activities. Our goal was to assess the hydration status of a Spanish group of aeronautical military men and to determine the association of hydration status with body composition and anxiety.Methods188 men were evaluated through a validated hydration questionnaire, anthropometric and biochemical parameters, and an anxiety questionnaire. According to that, criteria of hydration was established. Results81% of the total sample met hydration criteria (urine color = Well hydrated, Water Balance ≥ 0 mL, and total water intake/weight ≥35 mL/kg) and 19% did not meet hydration criteria (urine color = Not enough hydrated or Dehydrated, Water Balance < 0 mL, and total water intake/weight < 35 mL/kg). Subjects not meeting the hydration criteria had lower urine pH, negative water balance, and lower water intake. The latter also had higher anxiety status (score= 4 vs 3, p=0.026), weight (84.7 ± 10.5 vs 80.5 ± 10.2 Kg), Body Mass Index (26.3 ± 3.1 vs 25.2 ± 2.8 kg/m2), body fat (22.3 ± 5.6 vs 18.3 ± 6.5 %), urine specific gravity and urine color. The Hydration Status, in a logistic binary regression model was related significantly with the percentage of body fat (p=0.004), but no relation was found with age, comorbidity and medication.Furthermore, total water intake/weight was positively correlated with percentage of body water (rho=0.357, p=0.000) and negatively with body fat (kg) (rho= -0.427, p=0.000), percentage of body fat (rho= -0.405, p=0.000) and waist/hip ratio (rho= -0.223, p=0.002). The total water intake/weight, in a linear regression model was related significantly with the percentages of body fat (p=0.019) and body water (p= 0,035). No relation was found, however, with waist/hip ratio, age, comorbidity and medication.ConclusionAll these findings suggest a relationship between hydration status and body composition, but also set the bases for future studies that relate hydration status and anxiety status. These results can be used to improve the hydration status and body composition of military personnel.
Perioperative Risk Factors for Recovery Room Delirium After Elective Non-Cardiovascular Surgery Under General Anaesthesia
Authors: Wu Jiayi , Gao Shaojie , Zhang Shuang , Yu Yao , Liu Shangkun , Zhang Zhiguo , Mei Wei
Published: September 2020

Background: Although postoperative delirium is a frequent complication of surgery, little is known about risk factors for delirium occurring in the post-anaesthesia care unit (PACU). The aim of this study was to determine pre- and intraoperative risk factors for the development of recovery room delirium (RRD) in patients undergoing elective non-cardiovascular surgery. Methods: RRD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We collected perioperative data in 228 patients undergoing elective non-cardiovascular surgery under general anaesthesia, and performed univariate and multivariate logistic regression to identify risk factors related to RRD. PACU and postoperative events were recorded to assess the outcome of RRD. Results: 57 patients (25%) developed RRD. On multivariate analysis, maintenance of anaesthesia with inhalation anaesthetic agents (OR=6.294, 95%CI 1.4-28.8, p=0.018), malignant primary disease (OR=3.464, 95%CI=1.396-8.592, p=0.007), American Society of Anaesthesiologists Physical Status (ASA-PS) III-V (OR=3.389, 95%CI= 1.401-8.201, p=0.007), elevated serum total or direct bilirubin (OR=2.535, 95%CI=1.006-6.388, p=0.049) and invasive surgery (OR=2.431, 95%CI=1.103-5.357, p=0.028) were identified as independent risk factors for RRD. RRD was associated with higher healthcare costs (31,428 yuan [17,872-43,674] versus 16,555 yuan [12,618-27,788], p<0.001), a longer median hospital stay (17 days [12-23.5] versus 11 days [9-17], p<0.001), and a longer postoperative stay (11 days [7-15] versus 7 days [5-10], p<0.001]).Conclusions: Identifying patients at high risk for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes.
Information Technology for Polypharmacy Appropriateness: What Factors Affect the Use of INTERCheckWEB?
Authors: Catrini Elisabetta , Ferrario Lucrezia , Mazzone Antonino , Varalli Luca , Gatti Federico , Cannavacciuolo Lorella , Ferruzzi Gabriella , Foglia Emanuela
Published: September 2020

Background: INTERCheckWEB is one of the most outstanding IT innovative technology that can be implemented at hospital level, supporting the clinicians in the evaluation of the therapy appropriateness for a patient, specially reducing the potentially inappropriate prescriptions for elderly patients in polytherapy. The present paper aims at investigating the relationship between physicians and support decision system in therapy appropriateness for elderly patients in polytherapy, in order to is to assess the factors that can foster or hamper physicians in using INTERCheckWEB for drug prescription.Methods: A qualitative questionnaire based on a model broadly addressed in literature (Technology Acceptance Model – TAM2), was administered to seventy clinicians referring to Internal Medicine wards, of four Italian medium size hospitals. Based on TAM2, authors assess how perceived usefulness, perceived ease of use, image and output quality, affect INTERCheckWeb intention to use. Inferential analyses were conducted to define the main aspects useful to understand the factors impacting on INTERCheckWeb adoption in clinical practice.Results: The regression analysis reported that image, perceived ease of use and perceived usefulness, as well as the moderator effect of the voluntary use between the perceived usefulness and the intention to use, are the factors that most influenced the use of INTERCheckWEB (Adjusted R2 = 0.870).Conclusions: The analysis has demonstrated that clinicians would effectively use INTERCheckWEB, when available, to identify all the information that could be dangerous for the patient, choosing the proper drug and preventing potential interactions and medical errors.
Urban Growth and Urban Need to Fair Distribution of Healthcare Service, Case Study: Shiraz Metropolitan
Authors: Rezaee Rita , Rahimi Fatemeh , Goli Ali
Published: September 2020

Objective: 1) To analyze urbanization development pattern in Shiraz after the year 1977; 2) To analyze hospital development model in Shiraz after the year 1977; 3) To review and prioritize location allocation criteria for hospitals; and 4) To specify appropriate locations for the establishment of potential future hospitals in Shiraz based on selected criteria.Results: Although a significant expansion is seen from different geographical directions (particularly northwest and southeast of the city) in the urbanization model after the year 1977, the construction of hospitals has been limited to the central parts of the city and the areas around the city lack any hospitals. The “open access path to the hospital during incidents and disasters and a light traffic” criterion has enjoyed the highest priority amongst the 24 selected hospital location allocation criteria. Appropriate locations for establishment of new hospitals in the future have been marked as colored maps. The present study has been able to determine and prioritize a comprehensive list of hospital location allocation criteria. Moreover, the achieved maps from this study can be used by policy makers to develop new hospitals.
Application of accelerated rehabilitation surgery concept in laparoscopic radical gastrectomy cancer for patients aged ≥70 years
Authors: Ma Jun , Shao Hongliang , Wang Yanzhong , Chen Yirui , Mou Yiping
Published: September 2020

Background: To explore the application effect of accelerated rehabilitation surgery on laparoscopic radical gastrectomy cancer for patients aged ≥70 years.Methods: Retrospective analysis of 120 aged ≥70 patients’ clinical data undergoing laparoscopic radical gastrectomy in our hospital from January 2017 to December 2018, which were divided into accelerated rehabilitation group (n = 73) and control group (n = 47). By comparing the postoperative clinical data of the two groups, we explored the application effect of accelerated rehabilitation surgery on laparoscopic radical gastrectomy cancer for patients aged ≥70 years.Results: Compared with the control group, the first time to get out of bed (2.1 ± 0.9 days vs 3.8 ± 1.5 days, P<0.01), the first exhaust time (3.2 ± 0.8 days vs 3.9 ± 1.2 days, P<0.01) and the first time to eat liquid food after surgery (1.8 ± 0.9 days vs 3.2 ± 1.3 days, P<0.01), and postoperative hospital stay (12.7 ± 4.3 days vs 15.8 ± 6.4 days, P<0.01) in the rehabilitation group were significantly lower. There was no significant difference in the overall postoperative complications between the two groups (P<0.05), however, the complications of pulmonary infection in the accelerated rehabilitation group was significantly lower than that in the control group (1.4% vs 10.6%, P = 0.03). Conclusions: The application of accelerated rehabilitation surgery concepts and measures after surgery in laparoscopic radical gastrectomy cancer for patients aged ≥70 years can promote early postoperative rehabilitation, reduce postoperative hospital stay, and reduce the incidence of postoperative pulmonary infection complications.
Protocol for the Development of a Repository of Individual Participant Data From Randomised Controlled Trials Conducted in UK Adult Care Homes (The Virtual International Care Homes Trials Archive (VICHTA))
Authors: Irvine Lisa , Burton Jennifer Kirsty , Ali Myzoon , Quinn Terence J , Goodman Claire
Published: September 2020

Background Approximately 418,000 people live in care homes in the UK, yet accessible, robust data on care home populations and organisation are lacking. This hampers our ability to plan, allocate resources or prevent risk. Large randomised controlled trials (RCTs) conducted in care homes offer a potential solution. The value of detailed data on residents’ demographics, outcomes and contextual information captured in RCTs has yet to be fully realised. Irrespective of the intervention tested, much of the trial data collected overlaps, in terms of structured assessments and descriptive information. Given the time and costs required to prospectively collect data in these populations, pooling anonymised RCT data into a structured repository offers benefit; secondary analyses of pooled RCT data can improve understanding of this under-researched population, and enhance future trial design. This protocol describes the creation of a repository of individual participant data (IPD) from trials conducted in care homes, to address the need for accurate, high quality IPD on this vulnerable population.Methods Informed by scoping of relevant literature, the principal investigators of RCTs conducted in adult care homes in UK since 2010 will be invited to contribute trial IPD. Contributing trialists will form a Steering Committee, who will oversee data sharing and remain gatekeepers of their own trial’s data. IPD will be cleaned and standardised in consultation with the Steering Committee for accuracy. Planned analyses include comparison of pooled IPD with point estimates from administrative sources, to assess generalisability of RCT data to the wider care home population. We will also identify key resident characteristics and outcomes from within the trial repository, which will inform development of a national minimum dataset for care homes. Following project completion, management will migrate to the Virtual Trials Archives, forming a legacy dataset which will be accessible to the wider research community for analyses. Discussion Analysis of pooled IPD has the potential to inform and direct future practice, research and policy at low cost, enhancing the value of existing data and reducing research waste. We aim to create a permanent archive for care home trial data, and welcome the contribution of emerging trial datasets.
Readiness for Hospital Discharge in Primary Caregivers for Children with Acute Lymphoblastic Leukemia
Authors: Feng Lu , Ge Zhang , Xiufang Zhao , Birua Luo
Published: September 2020

Background Readiness for hospital discharge is essential to the treatment and rehabilitation. But until now, little is known about the existing status and affecting factors of readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukemia in China.Methods A cross-sectional study of 253 leukemia patients including their family members from Nov 2016 to Aug 2017 was performed by convenience sampling and questionnaire survey.Results The total score of readiness of primary caregivers is 157.36. Factors including periods of chemotherapy (P<0.001), complications (P=0.019), family economic situation (P=0.023), understanding of leukemia (P<0.001), objective supports (P=0.004), subjective supports (P<0.001), and availability of support (P=0.045) are main influences.Conclusions 1. The readiness for hospital discharge in primary caregivers for childhood lymphoblastic leukemia patients is in an intermediate level, indicate that more efforts should be done in improving present situation, especially on the social support which got the lowest scores.2. In induction remission period of chemotherapy，with complications，with poorer family economic state，lacking knowledge about leukemia and with poor social support are possible factors leading to lower score in readiness for hospital discharge scale, which indicate that providing high quality family and primary caregiver assessment and discharge education throughout the hospitalization is the key to improve the readiness in nursing aspect.
The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review
Authors: Rathnayake Dimuthu , Clarke Mike
Published: September 2020

Background: Long waiting times and lengthy queues for elective surgery are common to many publicly funded health systems. Primary care practitioners play a major role in determining which patients are referred to the consultant surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for interventions within the scope of primary care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December 2019 to January 2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer related surgeries. Randomised trials and non-randomised controlled studies were eligible. The main outcome variable of interest was waiting time for the elective surgery. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.Results: The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.Conclusions: The available studies included a variety of interventions and were of medium to high quality, showing that methods to improve the management of primary care referrals of patients for elective surgery can reduce waiting times and shorten waiting lists for elective surgery for adults.
Detection of Merkel Cell Polyomavirus Using Whole Exome Sequencing Data
Authors: Garcia-Mulero Sandra , Moratalla-Navarro Ferran , Curiel-Olmo Soraya , Moreno Victor , Vaqué José Pedro , Sanz-Pamplona Rebeca , Piulats Josep María
Published: September 2020

BackgroundMerkel cell carcinoma (MCC) is a highly malignant neuroendocrine tumor of the skin in which Merkel cell polyomavirus (MCV) DNA virus insertion can be detected in 75–89% of cases. Etiologic and phenotypic differences exist between MCC tumors with and without the inserted virus, thus it is important to distinguish between MCV+ and MCV- cases.MethodsHere we report a freely available bioinformatics methodology to identify MCV+ MCC tumors using whole exome sequencing (WES) data and to infer the virus insertion site into the tumor genome.ResultsOur method has been validated in a set of MCC samples previously characterized in the laboratory as MCV+ or MCV-. MCV insertions have also been reported in non-smokers lung tumors but no MCV+ was found in two tested datasets using our pipeline.ConclusionsWith our pipeline it is possible to use WES to interrogate for MCV insertions in cancer samples.
Multiscale heterogeneity in gastric adenocarcinoma evolution is an obstacle to precision medicine
Authors: Röcken Christoph , Amallraja Anu , Halske Christine , Opasic Luka , Traulsen Arne , Behrens Hans-Michael , Krüger Sandra , Liu Anne , Haag Jochen , Egberts Jan-Hendrik , Rosenstiel Philip , Meissner Tobias
Published: September 2020

Purpose: Cancer is a somatic evolutionary disease. Using multiregional whole exome sequencing, we tested the effect of somatic evolution on intratumoral heterogeneity and its putative clinical and biological implications in adenocarcinomas of the stomach and gastroesophageal junction (GC). Patients and Methods: The study comprised a prospective discovery cohort of 9 and a validation cohort of 463 GCs. Multiregional whole-exome sequencing was done using 48 tumor samples (range: 3-10 tumor samples/patient) of the discovery cohort.Results: In total, the discovery cohort harbored 16,537 non-synonymous mutations (mutations/sample: median n=159; mutations/patient: median n=369). Intratumoral heterogeneity of somatic mutations and copy number variants were present in all tumors of the discovery cohort. 53-91% of the non-synonymous mutations were not present in each patient’s sample; 399 genes harbored 2-4 different non-synonymous mutations in the same patient; 175 genes showed copy number variations, the majority being heterogeneous, including CD274 (PD-L1). Multi-sample tree-based analyses provided evidence for branched evolution being most complex in a microsatellite instable GC. The analysis of the mode of evolution showed a high degree of heterogeneity in deviation from neutrality within each tumor. Studies on the validation cohort showed that the subclonal loss of SMAD4 is an independent predictor for poor patient outcome in Caucasian patients.Conclusions: Neutral and non-neutral somatic evolution shape the mutational landscape in GC. It leads to complex spatial intratumoral heterogeneity and may have profound effects on patient management. It provides crucial information for an individualized understanding of clinical prognosis and therapeutic options in GC patients.
Do Economic Circumstances and Family Structures Affect Young Girls' Healthy Living Behaviors and Menstrual Symptoms?
Authors: erbaba hulya - , Ciftci Esra - Karaca
Published: September 2020

BackgroundDemographic features such as low income, low education, and living in a crowded or single-parent family increase young girls' premenstrual and menstrual symptoms such as pain, anxiety, and bleeding and negatively affect their healthy lifestyle. The purpose of the study was to analyze the relationship between healthy lifestyle behaviors and menstrual symptoms among young girls and their sociodemographic characteristics. MethodsThis descriptive study was conducted on 1,130 students from four high schools providing full-time education in the Beylikduzu district of Istanbul between February 3, 2020, and March 1, 2020. Volunteer students whose families gave consent participated in the study. A personal identification form, the Menstrual Symptom Scale and the Healthy Lifestyle Behavior Scale-II (HLBS-II) were used to collect data in the study. All statistical analyses were performed using SPSS Statistics version 23.ResultsIt was found that economic status and painful menstruation negatively affected healthy lifestyle behaviors, while living with one’s nuclear family positively affected healthy lifestyle behaviors; furthermore, chronic disease, painful menstruation, and family types other than the nuclear family negatively affected menstrual symptoms. ConclusionsPoor economic status and painful menstruation negatively affected healthy lifestyle behaviors, and chronic disease, painful menstruation and family type other than the nuclear family negatively affected menstrual symptoms.
Associations between depressive symptoms and geriatric syndromes in community-dwelling older adults in Japan: a cross-sectional study
Authors: Imaoka Masakazu , Nakao Hidetoshi , Nakamura Misa , Tazaki Fumie , Hida Mitsumasa , Omizu Tomoko , Imai Ryota , Takeda Masatoshi
Published: September 2020

Background
It is estimated that 7.2% of community-dwelling older adults in worldwide have major depression. This cross-sectional study aimed to investigate the relationship between geriatric syndromes and depressive symptoms.
Methods
Data were obtained from 363 older adults (mean age 73.6 ± 6.6 years; women = 75.8%) who participated in a community-based health check. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Depression was defined as a GDS-15 score of ≥ 5. Further, geriatric syndromes in participants—such as frailty, sarcopenia, and locomotive syndrome—were assessed.
Results
There was a 28.1% prevalence of depressive symptoms. In a logistic regression analysis with depressive symptoms as the dependent variable, both pre-frailty (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.09–3.01) and frailty (OR 5.45, 95% CI 2.23–13.31) were found to be significantly higher in the depressive group.
Conclusions
Our findings suggest that depressive symptoms are associated with frailty and pre-frailty in community-dwelling older adults in Japan.