bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymorphism –509C/T in TGFB1 Promoter Is Associated With Increased Risk and Severity of Persistent Allergic Rhinitis in a Chinese Population
Authors: Zhu Xin-Jie , Lu Mei-Ping , Chen Ruo-Xi , Bu Dong-Yun , Zhu Lu-Ping , Wang Mei-Lin , Yin Min , Zhang Zheng-Dong , Cheng Lei
Published: March 2020

Background

Polymorphism –509C/T in the promoter of transforming growth factor beta1 ( TGFB1) gene is implicated in the pathogenesis of asthma. This polymorphism might also act to regulate the development of allergic rhinitis (AR).

Objectives

To investigate whether –509C/T is associated with AR susceptibility and severity in a Han Chinese population.

Methods

The study enrolled 263 patients with persistent AR and 249 healthy controls. AR patients were classified as mild or moderate/severe AR groups according to the Allergic Rhinitis and its Impact on Asthma classification. TGFB1 gene polymorphism –509C/T was genotyped with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serum total Immunoglobulin E (IgE) and specific IgE levels were determined using an ImmunoCAP.

Results

Significant difference was found in the allele frequency of TGFB1 –509C/T between AR patients and healthy controls ( P = .027) but not in the genotype frequency ( P =.051). However, the genotype frequency of TGFB1 –509C/T showed significant difference between the mild AR group, the moderate/severe AR group, and the control group ( P = .012); between the moderate/severe AR group and the control group ( P =.036); between the mild AR group and the moderate/severe AR group ( P = .038); but not between the mild AR group and the control group ( P =.075).

Conclusion

TGFB1 promoter polymorphism –509C/T may be associated with the susceptibility and the severity of persistent AR of Han Chinese, but the functional relationship still needs clarification.
Suzhi Education and General Education in China
Authors: Pang Haishao , Cheng Meiling , Yu Jing , Wu Jingjing
Published: March 2020

Purpose:

Since the 1980s, suzhi has become a core word in contemporary China. Suzhi education as an education philosophy full of Chinese characteristics has been well known in China for generations. Particularly since 1995, culture-oriented quality education as an anchor and starting point of suzhi education implementation in universities, which integrates with general education and liberal education from Western concepts, triggered great changes in Chinese universities. This article aims to review the concepts of suzhi education, general education, and their practice in China.

Design/Approach/Methods:

This study is based on historical developments of suzhi education and general education, research literature, and some typical practice cases.

Findings:

The analysis finds that suzhi education and general education have consistent goals. Their connotations in China can be understood in three aspects: philosophy, education content, and cultivation mode. They caused three great practices in universities, including general education courses, extracurricular suzhi education activities, and reforms on talent cultivation modes.

Originality/Value:

This article clarifies the localized understanding of suzhi education and general education in three aspects and outlines the overall reforms around suzhi education and general education in Chinese higher education.
Clinical Outcome of Spine Surgery Complicated by Accidental Dural Tears: Meta-Analysis of the Literature
Authors: Alshameeri Zeiad A. F. , Ahmed El-Nasri , Jasani Vinay
Published: March 2020

Study Design:

Systemic review and meta-analysis.

Objectives:

Several studies have reported the impact of accidental dural tears (DT) on the outcome of spinal surgery, some with conflicting results. Therefore, the aim of this study was to carry out a systemic review and meta-analysis of the literature to establish the overall clinical outcome of spinal surgery following accidental DT.

Method:

A systemic literature search was carried out. Postoperative improvement in Oswestry Disability Index (ODI), Short-Form 36 survey (SF36), leg pain visual analogue scale (VAS), and back pain VAS were compared between patients with and without DT at different time intervals.

Results:

Eleven studies were included in this meta-analysis. There was a slightly better improvement in ODI and leg VAS score (standardized mean difference of −0.06, 95% confidence interval [CI] −0.12 to −0.01, and −0.06, 95% CI −0.09 to −0.02, respectively) in patients without DT at 12 months postsurgery, but this effect was not demonstrated at any other time intervals up to 4 years. There were no differences in the overall SF36 (function) score at any time interval or back pain VAS at 12 months.

Conclusion:

Based on this study, accidental DT did not have an overall significant adverse impact on the short-term clinical outcome of spinal surgery. More studies are needed to address the long-term impact and other outcome measures including other immediate complications of DT.
Higher incidence of manipulation under anesthesia following TKA associated with the periarticular infiltration of a liposomal bupivacaine cocktail compared to a modified Ranawat cocktail
Authors: Duensing Ian , Peters Christopher L , Monteiro Priscila , Anderson Mike B , Pelt Christopher E
Published: March 2020

Background:

The purpose of this study was to compare the frequency of postoperative stiffness requiring manipulation under anesthesia (MUA) before and after switching from the intraoperative use of liposomal bupivacaine (LB).

Methods:

This was an institutional review board (IRB)-exempt retrospective cohort study (IRB#71733) on all patients who underwent primary total knee arthroplasty (TKA) by a single surgeon between April 2016 and December 2017. We compared 169 knees that received LB group to 167 knees that received a modified Ranawat cocktail (MR group). Perioperative care pathways remained consistent during the study period, as were requirements for MUA which included flexion range of motion below approximately 90 at 6–12 weeks. To compare the incidence of MUA between the groups, a population-averaged Poisson regression analysis was used.

Results:

The two groups were similar, with mean age of 63 (range 31–91) in the LB group and 64 (range 42–84) in the MR group, a preponderance of females in both groups ( p = 0.866), similar preoperative knee flexion between groups ( p = 0.162), and similar Patient-Reported Outcomes Measurement Information System scores. The frequency of MUA, however, was significantly lower in the MR group (LB: 7.7% [95% CI 3.7–12%] vs. MR: 2.4% [95% CI <1–4.7%] [IRR 3.2, 95% CI 1.08–9.76, p . 0.037]).

Conclusions:

In summary, this is a novel report of a potentially previously unrecognized increased incidence of MUA associated with the use of LB compared with a MR cocktail. Given no other notable changes to the perioperative care or MUA thresholds following TKA, the reasons for these findings are unclear but deserve additional investigation.
Evolution of Governance in a Collaborative University–Industry Program
Authors: Derakhshan Roya , Fernandes Gabriela , Mancini Mauro
Published: March 2020

This article presents the emergence and evolution of actors and institutions in a collaborative program from the strategic planning to the execution and delivery phase. The ethnographic study of a collaboration revealed that, while formal regulations are prerequisites for initiating collaborations, further drivers of the interactions between program participants are oriented by path dependency, cultural familiarities, and goal sharing. This article shows that many microdynamics exist among actors and institutions inside the governance structure, co-evolving in parallel with the transition through the program’s phases. There are, however, two main drivers orienting these dynamics: formal regulations and trust.
Integrin α6 mediates the drug resistance of acute lymphoblastic B-cell leukemia
Authors: Gang Eun Ji , Kim Hye Na , Hsieh Yao-Te , Ruan Yongsheng , Ogana Heather A. , Lee Solomon , Pham Jennifer , Geng Huimin , Park Eugene , Klemm Lars , Willman Cheryl L. , Carroll William L. , Mittelman Steven D. , Orgel Etan , Oberley Matthew J. , Parekh Chintan , Abdel-Azim Hisham , Bhojwani Deepa , Wayne Alan S. , De Arcangelis Adèle , Georges-Labouesse Elisabeth , Wayner Elizabeth , Bonig Halvard , Minasyan Aspram , ten Hoeve Johanna , Graeber Thomas G. , Müschen Markus , Heisterkamp Nora , Kim Yong-Mi
Published: March 2020

Resistance to multimodal chemotherapy continues to limit the prognosis of acute lymphoblastic leukemia (ALL). This occurs in part through a process called adhesion-mediated drug resistance, which depends on ALL cell adhesion to the stroma through adhesion molecules, including integrins. Integrin α6 has been implicated in minimal residual disease in ALL and in the migration of ALL cells to the central nervous system. However, it has not been evaluated in the context of chemotherapeutic resistance. Here, we show that the anti-human α6-blocking Ab P5G10 induces apoptosis in primary ALL cells in vitro and sensitizes primary ALL cells to chemotherapy or tyrosine kinase inhibition in vitro and in vivo. We further analyzed the underlying mechanism of α6-associated apoptosis using a conditional knockout model of α6 in murine BCR-ABL1+ B-cell ALL cells and showed that α6-deficient ALL cells underwent apoptosis. In vivo deletion of α6 in combination with tyrosine kinase inhibitor (TKI) treatment was more effective in eradicating ALL than treatment with a TKI (nilotinib) alone. Proteomic analysis revealed that α6 deletion in murine ALL was associated with changes in Src signaling, including the upregulation of phosphorylated Lyn (pTyr507) and Fyn (pTyr530). Thus, our data support α6 as a novel therapeutic target for ALL.
Venetoclax plus LDAC for newly diagnosed AML ineligible for intensive chemotherapy: a phase 3 randomized placebo-controlled trial
Authors: Wei Andrew H. , Montesinos Pau , Ivanov Vladimir , DiNardo Courtney D. , Novak Jan , Laribi Kamel , Kim Inho , Stevens Don A. , Fiedler Walter , Pagoni Maria , Samoilova Olga , Hu Yu , Anagnostopoulos Achilles , Bergeron Julie , Hou Jing-Zhou , Murthy Vidhya , Yamauchi Takahiro , McDonald Andrew , Chyla Brenda , Gopalakrishnan Sathej , Jiang Qi , Mendes Wellington , Hayslip John , Panayiotidis Panayiotis
Published: March 2020

Effective treatment options are limited for patients with acute myeloid leukemia (AML) who cannot tolerate intensive chemotherapy. Adults age ≥18 years with newly diagnosed AML ineligible for intensive chemotherapy were enrolled in this international phase 3 randomized double-blind placebo-controlled trial. Patients (N = 211) were randomized 2:1 to venetoclax (n = 143) or placebo (n = 68) in 28-day cycles, plus low-dose cytarabine (LDAC) on days 1 to 10. Primary end point was overall survival (OS); secondary end points included response rate, transfusion independence, and event-free survival. Median age was 76 years (range, 36-93 years), 38% had secondary AML, and 20% had received prior hypomethylating agent treatment. Planned primary analysis showed a 25% reduction in risk of death with venetoclax plus LDAC vs LDAC alone (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.52-1.07; P = .11), although not statistically significant; median OS was 7.2 vs 4.1 months, respectively. Unplanned analysis with additional 6-month follow-up demonstrated median OS of 8.4 months for the venetoclax arm (HR, 0.70; 95% CI, 0.50-0.98; P = .04). Complete remission (CR) plus CR with incomplete blood count recovery rates were 48% and 13% for venetoclax plus LDAC and LDAC alone, respectively. Key grade ≥3 adverse events (venetoclax vs LDAC alone) were febrile neutropenia (32% vs 29%), neutropenia (47% vs 16%), and thrombocytopenia (45% vs 37%). Venetoclax plus LDAC demonstrates clinically meaningful improvement in remission rate and OS vs LDAC alone, with a manageable safety profile. Results confirm venetoclax plus LDAC as an important frontline treatment for AML patients unfit for intensive chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT03069352.
Exploiting sequence labeling framework to extract document-level relations from biomedical texts
Authors: Li Zhiheng , Yang Zhihao , Xiang Yang , Luo Ling , Sun Yuanyuan , Lin Hongfei
Published: March 2020

Background

Both intra- and inter-sentential semantic relations in biomedical texts provide valuable information for biomedical research. However, most existing methods either focus on extracting intra-sentential relations and ignore inter-sentential ones or fail to extract inter-sentential relations accurately and regard the instances containing entity relations as being independent, which neglects the interactions between relations. We propose a novel sequence labeling-based biomedical relation extraction method named Bio-Seq. In the method, sequence labeling framework is extended by multiple specified feature extractors so as to facilitate the feature extractions at different levels, especially at the inter-sentential level. Besides, the sequence labeling framework enables Bio-Seq to take advantage of the interactions between relations, and thus, further improves the precision of document-level relation extraction.

Results

Our proposed method obtained an F1-score of 63.5% on BioCreative V chemical disease relation corpus, and an F1-score of 54.4% on inter-sentential relations, which was 10.5% better than the document-level classification baseline. Also, our method achieved an F1-score of 85.1% on n2c2-ADE sub-dataset.

Conclusion

Sequence labeling method can be successfully used to extract document-level relations, especially for boosting the performance on inter-sentential relation extraction. Our work can facilitate the research on document-level biomedical text mining.
Transcriptomic and metabolomic analysis provides insights into anthocyanin and procyanidin accumulation in pear
Authors: Zhang Zhen , Tian Changping , Zhang Ya , Li Chenzhiyu , Li Xi , Yu Qiang , Wang Shuo , Wang Xinyu , Chen Xuesen , Feng Shouqian
Published: March 2020

Background

Pear is one of the most important fruit crops worldwide. Anthocyanins and procyanidins (PAs) are important secondary metabolites that affect the appearance and nutritive quality of pear. However, few studies have focused on the molecular mechanism underlying anthocyanin and PA accumulation in pear.

Results

We conducted metabolome and transcriptome analyses to identify candidate genes involved in anthocyanin and PA accumulation in young fruits of the pear cultivar ‘Clapp Favorite’ (CF) and its red mutation cultivar ‘Red Clapp Favorite’ (RCF). Gene–metabolite correlation analyses revealed a ‘core set’ of 20 genes that were strongly correlated with 10 anthocyanin and seven PA metabolites. Of these, PcGSTF12 was confirmed to be involved in anthocyanin and PA accumulation by complementation of the tt19–7 Arabidopsis mutant. Interestingly, PcGSTF12 was found to be responsible for the accumulation of procyanidin A3, but not petunidin 3, 5-diglucoside, opposite to the function of AtGSTs in Arabidopsis. Transformation with PcGSTF12 greatly promoted or repressed genes involved in anthocyanin and PA biosynthesis, regulation, and transport. Electrophoretic mobility shift and luciferase reporter assays confirmed positive regulation of PcGSTF12 by PcMYB114.

Conclusion

These findings identify a core set of genes for anthocyanin and PA accumulation in pear. Of these, PcGSTF12, was confirmed to be involved in anthocyanin and PA accumulation. Our results also identified an important anthocyanin and PA regulation node comprising two core genes, PcGSTF12 and PcMYB114. These results provide novel insights into anthocyanin and PA accumulation in pear and represent a valuable data set to guide future functional studies and pear breeding.
The role of drug resistance in poor viral suppression in rural South Africa: findings from a population-based study
Authors: Lippman Sheri A. , Mooney Alyssa C. , Puren Adrian , Hunt Gillian , Grignon Jessica S. , Prach Lisa M. , Gilmore Hailey J. , Truong Hong-Ha M. , Barnhart Scott , Liegler Teri
Published: March 2020

Background

Understanding factors driving virological failure, including the contribution of HIV drug resistance mutations (DRM), is critical to ensuring HIV treatment remains effective. We examine the contribution of drug resistance mutations for low viral suppression in HIV-positive participants in a population-based sero-prevalence survey in rural South Africa.

Methods

We conducted HIV drug resistance genotyping and ART analyte testing on dried blood spots (DBS) from HIV-positive adults participating in a 2014 survey in North West Province. Among those with virologic failure (> 5000 copies/mL), we describe frequency of DRM to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI), report association of resistance with antiretroviral therapy (ART) status, and assess resistance to first and second line therapy. Analyses are weighted to account for sampling design.

Results

Overall 170 DBS samples were assayed for viral load and ART analytes; 78.4% of men and 50.0% of women had evidence of virologic failure and were assessed for drug resistance, with successful sequencing of 76/107 samples. We found ≥1 DRM in 22% of participants; 47% were from samples with detectable analyte (efavirenz, nevirapine or lopinavir). Of those with DRM and detectable analyte, 60% showed high–level resistance and reduced predicted virologic response to ≥1 NRTI/NNRTI typically used in first and second-line regimens.

Conclusions

DRM and predicted reduced susceptibility to first and second-line regimens were common among adults with ART exposure in a rural South African population-based sample. Results underscore the importance of ongoing virologic monitoring, regimen optimization and adherence counseling to optimize durable virologic suppression.
The spatiotemporal distribution of human brucellosis in mainland China from 2007-2016
Authors: Liang Peifeng , Zhao Yuan , Zhao Jianhua , Pan Dongfeng , Guo Zhongqin
Published: March 2020

Background

Despite the considerable efforts made to address the issue of brucellosis worldwide, its prevalence in dairy products continues to be difficult to estimate and represents a key public health issue around the world today. The aim of the present study was to better understand the epidemiology of this disease in mainland China. We set out to investigate the yearly spatial distribution and possible hotspots of the disease.

Methods

Human brucellosis data from mainland China between 2007 and 2016 were collected from the China Information System for Disease Control and Prevention. A geographic information system ArcGIS10.3 (ESRI, Redlands) was used to identify potential changes in the spatial and temporal distribution of human brucellosis in mainland China during the study period. These distributions were evaluated using three-dimensional trend analysis and spatial autocorrelation analyse. A gravity-center was used to analyse the migration track of human brucellosis.

Results

A total of 399,578 cases of human brucellosis were reported during the 10-year study period. The monthly incidence of brucellosis in China demonstrates clear seasonality. Spring and summer are the peak seasons, while May is the peak month for brucellosis. Three-dimensional trend analysis suggests that brucellosis is on the rise from south to north, and that the epidemic situation in northern China is more severe. Between 2007 and 2016, the overall migration distance of the brucellosis incidence gravity-center was 906.43 km, and the direction was southwest. However, the overall gravity center of brucellosis was still in the northern part of China. In the global autocorrelation analysis, brucellosis in China demonstrated a non-random distribution between 2013 and 2014, with spatial autocorrelation (Z > 1.96,P < 0.05) and a clustering trend, while no clustering trend was found from 2007 to 2012 or from 2015 to 2016. In the local autocorrelation analysis, a Low-Low cluster phenomenon was found in the south of China in 2013 and 2014.

Conclusion

Human brucellosis remains a widespread challenge, particularly in northern China. The hotspots highlight potential high-risk areas which may require special plans and resources for monitoring and controlling the disease.
A novel splice site indel alteration in the EIF2AK3 gene is responsible for the first cases of Wolcott-Rallison syndrome in Hungary
Authors: Sümegi Andrea , Hendrik Zoltán , Gáll Tamás , Felszeghy Enikő , Szakszon Katalin , Antal-Szalmás Péter , Beke Lívia , Papp Ágnes , Méhes Gábor , Balla József , Balla György
Published: March 2020

Background

Wolcott-Rallison Syndrome (WRS) is a rare autosomal recessive disease that is the most common cause of neonatal diabetes in consanguineous families. WRS is caused by various genetic alterations of the Eukaryotic Translation Initiation Factor 2-Alpha Kinase 3 (EIF2AK3) gene.

Methods

Genetic analysis of a consanguineous family where two children were diagnosed with WRS was performed by Sanger sequencing. The altered protein was investigated by in vitro cloning, expression and immunohistochemistry.

Results

The first cases in Hungary, − two patients in one family, where the parents were fourth-degree cousins - showed the typical clinical features of WRS: early onset diabetes mellitus with hyperglycemia, growth retardation, infection-induced multiple organ failure. The genetic background of the disease was a novel alteration in the EIF2AK3 gene involving the splice site of exon 11– intron 11–12 boundary: g.53051_53062delinsTG. According to cDNA sequencing this created a new splice site and resulted in a frameshift and the development of an early termination codon at amino acid position 633 (p.Pro627AspfsTer7). Based on in vitro cloning and expression studies, the truncated protein was functionally inactive. Immunohistochemistry revealed that the intact protein was absent in the islets of pancreas, furthermore insulin expressing cells were also dramatically diminished. Elevated GRP78 and reduced CHOP protein expression were observed in the liver.

Conclusions

The novel genetic alteration causing the absence of the EIF2AK3 protein resulted in insufficient handling of severe endoplasmic reticulum stress, leading to liver failure and demise of the patients.
Risk factor analysis for inaccurate pre-operative MRI staging in rectal cancer
Authors: Cai Zerong , Xie Xiaoyu , Chen Yufeng , Chen Zexian , Cao Wuteng , Saad Khamis Salem Saeed , Zou Yifeng , Lan Ping , Wu Xiaojian
Published: March 2020

Background

Various tumor characteristics might lead to inaccurate local MRI-defined stage of rectal cancer and the purpose of this study was to explore the clinicopathological factors that impact on the precision pre-treatment MRI-defined stage of rectal cancer.

Methods

A retrospectively analysis was conducted in non-metastatic rectal cancer patients who received radical tumor resection without neoadjuvant treatment during 2007–2015 in the Sixth Affiliated Hospital of Sun Yat-sen University. Clinical T stage and N stage defined by pelvic enhanced MRI and pathological stage were compared and patients were subdivided into accurate-staging, over-staging and under-staging subgroups. Logistic regressions were used to explore risk factors for over-staging or under-staging.

Results

Five hundred fifty-one cases of patients were collected. Among them, 109 cases (19.4%) of patients were over-T-staged and 50 cases (8.9%) were under-T-staged, while 78 cases (13.9%) were over-N-staged and 75 cases (13.3%) were under-N-staged. Logistic regression suggested that pre-operative bowel obstruction was risk factor for over-T-staging (OR = 3.120, 95%CI: 1.662–5.857, P < 0.001) as well as over-N-staging (OR = 3.494, 95%CI: 1.797–6.794, P < 0.001), while mucinous adenocarcinoma was a risk factor for under-N-staging (OR = 4.049, 95%CI: 1.876–8.772, P < 0.001). Patients with larger tumor size were at lower risk for over-T-staging (OR = 0.837, 95%CI: 0.717–0.976, P = 0.024) and higher risk for over-N-staging (OR = 1.434, 95%CI: 1.223–1.680, P < 0.001).

Conclusion

Bowel obstruction, mucinous adenocarcinoma and tumor size might have impact on the pre-operative MRI T staging or N staging of rectal cancer. Our results reminded clinicians to assess clinical stage individually in such rectal cancer patients.
The disappearance of white matter in an adult-onset disease: a case report
Authors: Ho Cyrus SH , Mangelsdorf Simone , Walterfang Mark
Published: March 2020

Background

Vanishing white matter disease (VWMD) is one of the most prevalent hereditary white matter diseases in childhood, but it is increasingly recognised in adulthood with high phenotypic variation and severity.

Case presentation

We report a case of an adult female presenting with emotional lability and cognitive impairment, in addition to progressive dystonia, ataxia, postural instability and recurrent falls. Magnetic resonance imaging (MRI) of the brain and genetic testing confirmed the diagnosis of VWMD.

Conclusions

VWMD has a broad clinical presentation in adulthood, and the age at onset of symptoms is one of its most important prognostic factors. It is crucial to recognize the pathognomonic MRI patterns and consider VWMD as a differential diagnosis when assessing patients presenting with psychiatric, cognitive and non-specific neurological symptoms.
Social and economic variables related with Paraquat self-poisoning: an ecological study
Authors: Buendía Jefferson Antonio , Restrepo Chavarriaga Gabriel Jaime , Zuluaga Andres F.
Published: March 2020

Background

Paraquat self-poisonings constitute a significant contributor to the global burden of suicide. Our aim was to evaluate the relationship between social and economic variables with the incidence of self-poisoning with Paraquat in the northeast of Colombia.

Methods

Records of 154 cases of self-poisoning with Paraquat and several socio-economic variables of six regions of northeast of Colombia were analyzed.

Results

Most of the cases were mestizos, farmworkers, between 20 and 29 years, with intentional exposure using the oral route. Multivariate analyses revealed significant associations among the incidence of self-poisoning with PQ with the ecological factors such as poverty greater than 30% (IRR 15.9 IC95% 5.56–44.72), land Gini index < 0.7 (IRR 7.11 IC95% 3.58–14.12), private health insurance < 40% (IRR 3.39 IC95% 1.30–8.82) and planted area > 10% (IRR 2.47 IC95% 1.60–3.80).

Conclusion

There is a relationship between ecological factors and, as such, this study opens the way to further developments in the field.
Recognizing and responding to women experiencing homelessness with gendered and trauma-informed care
Authors: Milaney Katrina , Williams Nicole , Lockerbie Stacy Lee , Dutton Daniel J. , Hyshka Elaine
Published: March 2020

Background

The purpose of this study is to highlight the experiences of women who are often hidden in what we know and understand about homelessness, and to make policy and practice recommendations for women-centred services including adaptations to current housing interventions.

Methods

Three hundred survey interviews were conducted with people experiencing homelessness in Calgary, Alberta, Canada. The survey instrument measured socio-demographics, adverse childhood experiences, mental and physical health, and perceived accessibility to resources. Eighty-one women participants were identified as a subsample to be examined in greater depth. Descriptive statistics and logistic regressions were calculated to provide insight into women respondents’ characteristics and experiences of homelessness and how they differed from men’s experiences.

Results

Women’s experiences of homelessness are different from their male counterparts. Women have greater mental health concerns, higher rates of diagnosed mental health issues, suicidal thoughts and attempts, and adverse childhood trauma. The results should not be considered in isolation, as the literature suggests, because they are highly interconnected.

Conclusion

In order to ensure that women who are less visible in their experiences of homelessness are able to access appropriate services, it is important that service provision is both gender specific and trauma-informed. Current Housing First interventions should be adapted to ensure women’s safety is protected and their unique needs are addressed.
Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis: an observational retrospective study of 94 cases
Authors: Song Diyu , Zheng Guoquan , Wang Tianhao , Qi Dengbin , Wang Yan
Published: March 2020

Background

Ankylosing spondylitis (AS) patients with kyphosis have an abnormal spinopelvic alignment and pelvic morphology. Most studies focus on the relationship of pelvic tilt (PT) or sacral slope (SS) and deformity, and relatively few studies have addressed the relationship between pelvic incidence (PI) and kyphosis in AS patients. The purpose of this study is to analyze the correlation between pelvic incidence (PI) and the spinopelvic parameters describing local deformity or global sagittal balance in AS patients with thoracolumbar kyphosis.

Methods

A total of 94 patients with AS (91 males and 3 females) and 30 controls (27 males and 3 females) were reviewed. The mean age was 36.8 years in AS patients and 34.4 years in controls. Gender ratios and mean age were similar in both group. Sagittal spinopelvic parameters, including PI, PT, SS, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA), the first thoracic vertebra pelvic angle (TPA), spinosacral angle (SSA) and spinopelvic angle (SPA) were measured. The same spine surgeons measured all the parameters of the AS and control group. All the sagittal spinopelvic parameters were compared between the groups. The relationship between PI and other spinopelvic parameters was analyzed with Pearson correlation (r) and unary linear regression model.

Results

All the sagittal parameters were found to be significantly different between AS patients and controls. Compared with the control group, the AS patients had significantly higher PI(47.4° vs. 43.2°, P < 0.001). Correlation analysis revealed that PI in AS patients was significantly positively correlated with TPA(r = 0.533, R2 = 0.284, P < 0.001), and negatively correlated with SPA(r = − 0.504, R2 = 0.254, P < 0.001). However, no correlations were found between PI and SVA, SSA, TK, TLK or LL in AS patients.

Conclusion

This study revealed that increasing PI was significantly correlated with more global sagittal imbalance, not with the local deformity in AS patients with thoracolumbar kyphosis.
Implementation of palliative care consult Service in Hungary – integration barriers and facilitators
Authors: Zemplényi Antal T. , Csikós Ágnes , Csanádi Marcell , Mölken Maureen Rutten-van , Hernandez Carmen , Pitter János G. , Czypionka Thomas , Kraus Markus , Kaló Zoltán
Published: March 2020

Background

The Palliative Care Consult Service (PCCS) programme was among the first initiations in Hungary to provide palliative care for patients admitted to hospital. The PCCS team provides palliative care for mainly cancer patients and their family members and manages the patient pathway after being discharged from the hospital. The service started in 2014 with 300–400 patient visits per year. The aim of this study is to give a comprehensive overview of the PCCS programme guided by a conceptual framework designed by SELFIE (“Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE”), a Horizon2020 funded EU project and to identify the facilitators and barriers to its wider implementation.

Methods

PCCS has been selected by the SELFIE consortium for in-depth evaluation as one of the Hungarian integrated care models for persons with multi-morbidity. The qualitative analysis of the PCCS programme was based on available documents of the care provider and interviews with different stakeholders related to the programme.

Results

The integrated, multidisciplinary and patient-centred approach was well-received among the patients, family members and clinical departments, as verified by the increasing number of requests for consultations. As a result of the patient pathway management across providers (e.g. from inpatient care to homecare) a higher level of coordination could be achieved in the continuity of care for seriously-ill patients. The regulatory framework has only partially been established, policies to integrate care across organizations and sectors and adequate financial mechanism to support the enhancement and sustainability of the PCCS are still missing.

Conclusions

The service integration of palliative care could be implemented successfully in an academic hospital in Hungary. However, the continuation and enhancement of the programme will require further evidence on the performance of the integrated model of palliative care and a more systematic approach particularly regarding the evaluation, financing and implementation process.
Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England
Authors: Holmes Richard D. , Burford Bryan , Vance Gillian
Published: March 2020

Background

To help promote a flexible and sustainable workforce in dentistry, it is necessary to access accurate and timely data about the structure and nature of the evolving dental team. This paper considers the results and learning from a region-wide dental workforce survey conducted in one area of Health Education England and how the team has changed since the last survey a decade earlier.

Methods

A mixed-methods approach comprised two phases. In Phase 1 a customised workforce questionnaire was sent to all dental practices registered with the Care Quality Commission in the North East of England and North Cumbria in March 2016. Findings then informed Phase 2, a regional symposium held in October 2016, where interactive workshops generated qualitative data that elaborated on factors influencing workforce development.

Results

Of 431 primary dental care practices identified, 228 questionnaires were returned - a 53% response rate. The largest professional groups were dental nurses (n = 1269, 53% by headcount; 50% of fte) and dentists (34% by headcount; 42% by fte), though there had been increases in numbers of all staff groups over the decade, which was most marked for dental therapists (from 1 per 39 dentists to 1 per 8 dentists). The dental team predominantly fell into ‘younger’ age groups (< 46 years age), with evidence of a significant increase in the number of dentists reporting part-time working in a practice since the last survey. Around one third of dental practices reported employing dental nurses with additional skills (n = 74, 32.5%) or dental therapists (n = 73, 32%), and nearly half employed a dental hygienist (n = 104, 46%). However, there was considerable variability in whether these staff actually carried out the range of skills within their scope of practice. Factors shaping workforce development were identified as, the national context, loss of expertise, patients’ health needs and expectations, surgery premises and financial constraints.

Conclusions

The composition and work patterns of the primary care dental workforce have changed markedly over the last decade, though utilisation of skill-mix continues to be constrained. Consideration of factors determining career progression of dentists and dental care professionals is needed to optimise a sustainable future workforce.
Correction to: Pathophysiology of and therapeutic options for a GABRA1 variant linked to epileptic encephalopathy
Authors: Bai Yun-Fei , Chiu Michelle , Chan Elizabeth S. , Axerio-Cilies Peter , Lu Jie , Huh Linda , Connolly Mary B. , Guella Ilaria , Farrer Matthew J. , Xu Zhi-Qing David , Liu Lidong , Demos Michelle , Wang Yu Tian
Published: March 2020

Following publication of the original article [1], the authors reported errors in Figure 4.
Top-ten tips for managing nutritional issues and gastrointestinal symptoms in children with neurological impairment
Authors: Dipasquale Valeria , Gottrand Frederic , Sullivan Peter B. , Romano Claudio
Published: March 2020

The prevalence of children with neurological impairment (NI) presenting feeding difficulties and gastrointestinal symptoms is rising. The most recent guidelines recommend early nutritional assessment and intervention in order to prevent undernutrition and growth failure, along with the proper diagnosis and treatment of some frequent gastrointestinal symptoms, such as gastroesophageal reflux disease (GERD) and constipation, which can further worsen the feeding process and nutritional status. Nonetheless, the nutritional issues and growth deficits of children with NI are often considered to be of low priority or under recognised by healthcare providers. The present article proposes ten top tips that highlight the major points along the nutritional management pathway of NI children. The implementation of these tips in all healthcare settings could potentially improve patient outcomes and reduce morbidity and mortality.
Traumatic brain injury—needs and treatment options in the chronic phase: Study protocol for a randomized controlled community-based intervention
Authors: Borgen Ida Maria H. , Løvstad Marianne , Andelic Nada , Hauger Solveig , Sigurdardottir Solrun , Søberg Helene L. , Sveen Unni , Forslund Marit V. , Kleffelgård Ingerid , Lindstad Marte Ørud , Winter Laraine , Røe Cecilie
Published: March 2020

Background

Traumatic brain injury (TBI) is often associated with life-long medical, cognitive, emotional, and behavioral changes. Although long-lasting disabilities are expected, research on effective treatment options in the chronic phase of TBI is scarce.

Methods/design

This study protocol describes a randomized controlled trial (RCT) aimed at evaluating the effectiveness of a goal-oriented and community-based intervention for increasing community integration, quality of life, and functional independence in the chronic phase of complicated mild to severe TBI. Participants will be recruited from Oslo University Hospital, Norway. Patients aged 18–72 years living at home with MRI/CT-verified intracranial abnormalities, a TBI diagnosis, a time since injury of ≥ 2 years, and who experience either current TBI-related problems or restrictions in community integration will be included. The 120 participants will be randomized 1:1 to either (a) an intervention group, which will receive an in-home intervention program over 4 months, or (b) a control group receiving standard care in the municipalities. The intervention will consist of six home visits and two telephone contacts with a rehabilitation professional. A SMART-goal approach will be adopted to target the individual’s self-reported TBI difficulties in everyday life. Primary outcomes will be self-reported quality of life and participation. Secondary outcomes include symptom burden, emotional functioning, and clinician-assessed global outcome and need for rehabilitation services. Outcomes will be evaluated at baseline and 4–5 and 12 months after baseline. Caregiver burden and general health will be assessed in participating family members. Goal attainment and acceptability will be evaluated in the intervention group. A process evaluation will be carried out to evaluate protocol adherence, and a cost-effectiveness analysis will be applied if the intervention is found to be effective.

Discussion

The current study provides an innovative approach to rehabilitation in the chronic phase of TBI evaluated using an RCT design that may inform treatment planning, health policies, and coordination of patient care. Further, the study may demonstrate new modes of establishing collaboration and knowledge transition between specialized rehabilitation facilities and local rehabilitation services that may improve patient outcomes.

Trial registration

ClinicalTrials.gov,NCT03545594. Registered on June 4th, 2018.
Biological potential alterations of migratory chondrogenic progenitor cells during knee osteoarthritic progression
Authors: Wang Yu-Xing , Zhao Zhi-Dong , Wang Qian , Li Zhong-Li , Huang Ya , Zhao Sen , Hu Wei , Liang Jia-Wu , Li Pei-Lin , Wang Hua , Mao Ning , Wu Chu-Tse , Zhu Heng
Published: March 2020

Background

Although increasing studies have demonstrated that chondrogenic progenitor cells (CPCs) remain present in human osteoarthritic cartilage, the biological alterations of the CPCs from the less diseased lateral tibial condyle and the more diseased medial condyle of same patient remain to be investigated.

Methods

CPCs were isolated from paired grade 1–2 and grade 3–4 osteoarthritic cartilage by virtue of cell migratory capacities. The cell morphology, immunophenotype, self-renewal, multi-differentiation, and cell migration of these CPCs were evaluated. Additionally, the distributions of CD105+/CD271+ cells in OA osteochondral specimen were determined. Furthermore, a high-throughput mRNA sequencing was performed.

Results

Migratory CPCs (mCPCs) robustly outgrew from mildly collagenases-digested osteoarthritic cartilages. The mCPCs from grade 3–4 cartilages (mCPCs, grades 3–4) harbored morphological characteristics, cell proliferation, and colony formation capacity that were similar to those of the mCPCs from the grade 1–2 OA cartilages (mCPCs, grades 1–2). However, the mCPCs (grades 3–4) highly expressed CD271. In addition, the mCPCs (grades 3–4) showed enhanced osteo-adipogenic activities and decreased chondrogenic capacity. Furthermore, the mCPCs (grades 3–4) exhibited stronger cell migration in response to osteoarthritis synovial fluids. More CD105+/CD271+ cells resided in grade 3–4 articular cartilages. Moreover, the results of mRNA sequencing showed that mCPCs (grades 3–4) expressed higher migratory molecules.

Conclusions

Our data suggest that more mCPCs (grades 3–4) migrate to injured articular cartilages but with enhanced osteo-adipogenic and decreased chondrogenic capacity, which might explain the pathological changes of mCPCs during the progression of OA from early to late stages. Thus, these dysfunctional mCPCs might be optional cell targets for OA therapies.
The social health impact of Eritrean refugees on the host communities: the case of May-ayni refugee camp, Northern Ethiopia
Authors: Gebrehiwet Kahsay , Abrha Fitsum , Gebreyesus Hailay , Teweldemedhin Mebrahtu
Published: March 2020

Objective

Migration is a contemporary global issue and the exodus of refugees may potentially posit new social health challenges in the host communities. Ethiopia is a host to the second largest refugee population in Africa. The aim of this study was to explore the health impacts by the Eritrean refugees in May-ayni camp, North West Tigrai on the host community. The research used a qualitative exploratory approach. Participants were recruited using a purposive sampling technique. The primary sources of the data were in-depth interviews of 20 key informants, and focus group discussions with 30 refugees and 30 members of the host community. Transcription and translation was done verbatim and finally thematic analysis was done using an inductive approach.

Results

The findings of this research indicated that the refugees in the May-ayni camp created actual social and health threats to the members of the host communities. The socio-cultural norms of the host peoples were disrupted in terms of their social insecurity and introduction of health related challenges such as the spread of sexually transmitted infections and other reproductive health problems.
Dynamic adaptation of service-based applications: a design for adaptation approach
Authors: De Sanctis Martina , Bucchiarone Antonio , Marconi Annapaola
Published: March 2020

A key challenge posed by the Next Generation Internet landscape is that modern service-based applications need to cope withopenandcontinuously evolvingenvironments and to operate under dynamic circumstances (e.g., changes in the users requirements, changes in the availability of resources). Indeed, dynamically discover, select and compose the appropriate services in such environment is a challenging task. Self-adaptation approaches represent effective instruments to tackle this issue, because they allow applications to adapt their behaviours based on their execution environment. Unfortunately, although existing approaches support run-time adaptation, they tend to foresee the adaptation requirements and related solutions at design-time, while working under a "closed-world" assumption. In this article our objective is that of providing a new way of approaching thedesign,operationandrun-time adaptationof service-based applications, by considering the adaptivity as an intrinsic characteristic of applications and from the earliest stages of their development. We propose anovel design for adaptation approachimplementing a complete lifecycle for the continuous development and deployment of service-based applications, by facilitating (i) the continuous integration of new services that can easily join the application, and (ii) the operation of applications under dynamic circumstances, to face theopennessanddynamicityof the environment. The proposed approach has been implemented and evaluated in a real-world case study in the mobility domain. Experimental results demonstrate the effectiveness of our approach and its practical applicability.
Johannes Vermeer’s Mistress and Maid: new discoveries cast light on changes to the composition and the discoloration of some paint passages
Authors: Mahon Dorothy , Centeno Silvia A. , Iacono Margaret , Carό Federico , Stege Heike , Obermeier Andrea
Published: March 2020

Among the thirty-six paintings ascribed to the Dutch seventeenth century artist Johannes Vermeer (1632–1675), Mistress and Maid, in The Frick Collection, stands out for the large-scale figures set against a rather plain background depicting a barely discernible curtain. Although generally accepted as among the late works of the artist and dated to 1667–1668, for decades scholars have continued to puzzle over aspects of this portrayal. When the painting was cleaned and restored in 1952, attempts to understand the seeming lack of finish and simplified composition were hampered by the limited technical means available at that time. In 1968, Hermann Kühn included Mistress and Maid in his groundbreaking technical investigation ‘A Study of the Pigments and the Grounds Used by Jan Vermeer.’ In the present study, imaging by infrared reflectography and macro-X-ray fluorescence (MA-XRF) revealed significant compositional changes and drew focus to areas of suspected color change. Three of the samples taken by Hermann Kühn, and now in the archive of the Doerner Institut in Munich, were re-analyzed, along with a few paint samples taken from areas not examined in the 1968 study, using scanning electron microscopy–energy dispersive X-ray spectroscopy (SEM–EDS) and Raman spectroscopy. These analyses made it possible to further visualize detailed compositional elements in the background of the painting that were later painted out, and to characterize darkening and color changes in different paint passages.