bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of climate change on marine dumped munitions and possible consequence for inhabiting biota
Authors: Scharsack Jörn Peter , Koske Daniel , Straumer Katharina , Kammann Ulrike
Published: August 2021

Marine environments are contaminated with enormous amounts of warfare agents due to military activity and exercise, and the disposal of unused ordnance. Due to corrosion of munition shells, substances are leaking from the warfare materials into the environment. It has to be expected that climate change will influence munition corrosion and distribution of their content. Although there is no doubt about the principle toxicity of many of the munition compounds, including their transformation/degradation products, the impact of munition compounds on marine environments, including their biota are yet only at the beginning to be understood. Recently the intake of munition compounds has been confirmed in mussels and fish collected from contaminated areas. It has become clear that dumped munitions are a continuous source of toxic substances leaking into the environment and that ongoing corrosion will worsen the problem. The present review intends to evaluate the available literature on how climate change might influence the contamination of marine environments and inhabiting biota with munition compounds. Direct testing (or modelling) of climate change scenarios in the context of the marine munition problems has yet not been undertaken. Nevertheless, it can be predicted that climate change effects such as rising temperature and higher frequencies of extreme weather events will accelerate the rates at which disposed ordnance corrodes and consequently accelerate the rate at which munition compounds are leaking out. Climate change will cause elevated stress to biota, ranging from temperature stress and lower availability of oxygen to shifts in salinity and pH. In combination, elevated release of munition related compounds and elevated environmental stress, will put biota under threat, in particular in areas with high munition contamination and limited water exchange, such as the Baltic Sea. On a positive side, biodegradation of organic munition compounds by biota and microorganisms is likely to be accelerated with rising temperature.
The miR-200 family in normal mammary gland development
Authors: Roth Majesta J. , Moorehead Roger A.
Published: August 2021

The miR-200 family of microRNAs plays a significant role in inhibiting mammary tumor growth and progression, and its members are being investigated as therapeutic targets. Additionally, if future studies can prove that miR-200s prevent mammary tumor initiation, the microRNA family could also offer a preventative strategy. Before utilizing miR-200s in a therapeutic setting, understanding how they regulate normal mammary development is necessary. No studies investigating the role of miR-200s in embryonic ductal development could be found, and only two studies examined the impact of miR-200s on pubertal ductal morphogenesis. These studies showed that miR-200s are expressed at low levels in virgin mammary glands, and elevated expression of miR-200s have the potential to impair ductal morphogenesis. In contrast to virgin mammary glands, miR-200s are expressed at high levels in mammary glands during late pregnancy and lactation. miR-200s are also found in the milk of several mammalian species, including humans. However, the relevance of miR-200s in milk remains unclear. The increase in miR-200 expression in late pregnancy and lactation suggests a role for miR-200s in the development of alveoli and/or regulating milk production. Therefore, studies investigating the consequence of miR-200 overexpression or knockdown are needed to identify the function of miR-200s in alveolar development and lactation.
Genomic bases underlying the adaptive radiation of core landbirds
Authors: Wu Yonghua , Yan Yi , Zhao Yuanqin , Gu Li , Wang Songbo , Johnson David H.
Published: August 2021

Background

Core landbirds undergo adaptive radiation with different ecological niches, but the genomic bases that underlie their ecological diversification remain unclear.

Results

Here we used the genome-wide target enrichment sequencing of the genes related to vision, hearing, language, temperature sensation, beak shape, taste transduction, and carbohydrate, protein and fat digestion and absorption to examine the genomic bases underlying their ecological diversification. Our comparative molecular phyloecological analyses show that different core landbirds present adaptive enhancement in different aspects, and two general patterns emerge. First, all three raptorial birds (Accipitriformes, Strigiformes, and Falconiformes) show a convergent adaptive enhancement for fat digestion and absorption, while non-raptorial birds tend to exhibit a promoted capability for protein and carbohydrate digestion and absorption. Using this as a molecular marker, our results show relatively strong support for the raptorial lifestyle of the common ancestor of core landbirds, consequently suggesting a single origin of raptors, followed by two secondary losses of raptorial lifestyle within core landbirds. In addition to the dietary niche, we find at temporal niche that diurnal birds tend to exhibit an adaptive enhancement in bright-light vision, while nocturnal birds show an increased adaption in dim-light vision, in line with previous findings.

Conclusions

Our molecular phyloecological study reveals the genome-wide adaptive differentiations underlying the ecological diversification of core landbirds.
Comparative genomic analysis of a naturally born serpentized pig reveals putative mutations related to limb and bone development
Authors: Jiang Yankai , Cao Xinyue , Wang Haibin
Published: August 2021

Background

It is believed that natural selection acts on the phenotypical changes caused by mutations. Phenotypically, from fishes to amphibians to reptiles, the emergence of limbs greatly facilitates the landing of ancient vertebrates, but the causal mutations and evolutionary trajectory of this process remain unclear.

Results

We serendipitously obtained a pig of limbless phenotype. Mutations specific to this handicapped pig were identified using genome re-sequencing and comparative genomic analysis. We narrowed down the causal mutations to particular chromosomes and even several candidate genes and sites, such like a mutation-containing codon in geneBMP7(bone morphogenetic protein) which was conserved in mammals but variable in lower vertebrates.

Conclusions

We parsed the limbless-related mutations in the light of evolution. The limbless pig shows phenocopy of the clades before legs were evolved. Our findings might help deduce the emergence of limbs during vertebrate evolution and should be appealing to the broad community of human genetics and evolutionary biology.
Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery; statistical challenges in comparison
Authors: Sheikhy Ali , Fallahzadeh Aida , Sadeghian Saeed , Forouzannia Khalil , Bagheri Jamshid , Salehi-Omran Abbas , Tajdini Masih , Jalali Arash , Pashang Mina , Hosseini Kaveh
Published: August 2021

Background

Despite several studies comparing off- and on-pump coronary artery bypass grafting (CABG), the effectiveness and outcomes of off-pump CABG still remain uncertain.

Methods

In this registry-based study, we assessed 8163 patients who underwent isolated CABG between 2014 and 2016. Propensity score matching (PSM), inverse probability of weighting (IPW) and covariate adjustment were performed to correct for and minimize selection bias.

Results

The overall mean age of the patients was 62 years, and 25.7% were women. Patients who underwent off-pump CABG had shorter length of hospitalization (p < 0.001), intubation time (p = 0.003) and length of ICU admission (p < 0.001). Off-pump CABG was associated with higher risk of 30-days mortality (OR: 1.7; 95% CI 1.09–2.65; p = 0.019) in unadjusted analysis. After covariate adjustment and matching (PSM and IPW), this difference was not statistically significant. After an average of 36.1 months follow-up, risk of MACCE and all-cause mortality didn’t have significant differences in both surgical methods by adjusting with IPW (HR: 1.03; 95% CI 0.87–1.24; p = 0.714; HR: 0.91; 95% CI 0.73–1.14; p = 578, respectively).

Conclusion

Off-pump and on-pump techniques have similar 30-day mortality (adjusted, PSM and IPW). Off-pump surgery is probably more cost-effective in short term; however, mid-term survival and MACCE trends in both surgical methods are comparable.
Health status measured by Kansas City Cardiomyopathy Questionnaire-12 in primary prevention implantable cardioverter defibrillator patients with heart failure
Authors: Mattsson Gustav , Wallhagen Marita , Magnusson Peter
Published: August 2021

Background

Self-reported health status as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with primary prevention implantable cardioverter defibrillators (ICDs) has mainly been reported from randomized trials. However, these studies are often limited to short follow-up and are subject to selection bias. The aim of this study was to assess KCCQ-12 in patients with primary prevention ICD due to either ischemic or nonischemic heart failure.

Methods

This cross-sectional observational study included all patients in Region Gävleborg, Sweden, who because of primary prevention due to heart failure, had an ICD or underwent device replacement between 2007 and 2017. After validation using medical records patients were sent and returned the KCCQ-12 by regular mail.

Results

A total of 118 questionnaires were analyzed (response rate 71.1%). The mean age was 70.9 ± 9.8 years, and a minority was female (n = 20, 16.9%). The mean overall summary score was 71.5 ± 22.4, there was no significant difference between ischemic and nonischemic heart failure (69.5 ± 23.1 vs. 74.4 ± 21.3; p = 0.195). Atrial fibrillation at baseline was associated with lower score for the domains Symptom frequency (70.2 ± 23.2 vs. 82.2 ± 19.2; p = 0.006) and Social limitation (62.1 ± 26.0 vs. 75.6 ± 26.6; p = 0.006) as well as the overall summary score (63.9 ± 21.3 vs. 74.8 ± 22.2; p = 0.004).

Conclusion

In a real-world setting, primary prevention ICD patients with heart failure report an acceptable disease-specific health status at long-term follow-up. Ischemic and nonischemic etiology showed similar health status whereas atrial fibrillation was associated with worse outcome.
Prehospital assessment and management of postpartum haemorrhage- healthcare personnel’s experiences and perspectives
Authors: Leonardsen Ann-Chatrin Linqvist , Helgesen Ann Karin , Ulvøy Linn , Grøndahl Vigdis Abrahamsen
Published: August 2021

Background

Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH assessment and management is essential in prehospital personnel. The objective was to explore prehospital personnel’s competence in PPH and AC, utilizing different tools.

Methods

The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n = 250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as tool developed utilizing the Delphi technique. Descriptive statistics were used to analyze the quantitative data, while quantitative content analysis was used to analyse free-text responses.

Results

A total of 87 prehospital personnel responded to the questionnaire, 57.5% male, mean age 37.9 years. In total, 80.4% were ambulance workers and/or paramedics, and 96.6 and 97.7% respectively reported to need more education or training in PPH. Moreover, 82.8% reported having managed patient(s) with PPH, but only 2.9% had performed AC. Prehospital personnels’ responses varied extensively regarding knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8.

Conclusions

This study indicates that prehospital personnel lack knowledge about PPH and AC, due to various responses to the developed questionnaire. Even though AC is an acknowledged intervention in PPH, few participants reported that this was utilized. Our findings emphasize the need for education and training in PPH and PPH handling generally, and in AC specifically.
Evaluation of statistical methods used in the analysis of interrupted time series studies: a simulation study
Authors: Turner Simon L. , Forbes Andrew B. , Karahalios Amalia , Taljaard Monica , McKenzie Joanne E.
Published: August 2021

Background

Interrupted time series (ITS) studies are frequently used to evaluate the effects of population-level interventions or exposures. However, examination of the performance of statistical methods for this design has received relatively little attention.

Methods

We simulated continuous data to compare the performance of a set of statistical methods under a range of scenarios which included different level and slope changes, varying lengths of series and magnitudes of lag-1 autocorrelation. We also examined the performance of the Durbin-Watson (DW) test for detecting autocorrelation.

Results

All methods yielded unbiased estimates of the level and slope changes over all scenarios. The magnitude of autocorrelation was underestimated by all methods, however, restricted maximum likelihood (REML) yielded the least biased estimates. Underestimation of autocorrelation led to standard errors that were too small and coverage less than the nominal 95%. All methods performed better with longer time series, except for ordinary least squares (OLS) in the presence of autocorrelation and Newey-West for high values of autocorrelation. The DW test for the presence of autocorrelation performed poorly except for long series and large autocorrelation.

Conclusions

From the methods evaluated, OLS was the preferred method in series with fewer than 12 points, while in longer series, REML was preferred. The DW test should not be relied upon to detect autocorrelation, except when the series is long. Care is needed when interpreting results from all methods, given confidence intervals will generally be too narrow. Further research is required to develop better performing methods for ITS, especially for short series.
Predicting postoperative surgical site infection with administrative data: a random forests algorithm
Authors: Petrosyan Yelena , Thavorn Kednapa , Smith Glenys , Maclure Malcolm , Preston Roanne , van Walravan Carl , Forster Alan J.
Published: August 2021

Background

Since primary data collection can be time-consuming and expensive, surgical site infections (SSIs) could ideally be monitored using routinely collected administrative data. We derived and internally validated efficient algorithms to identify SSIs within 30 days after surgery with health administrative data, using Machine Learning algorithms.

Methods

All patients enrolled in the National Surgical Quality Improvement Program from the Ottawa Hospital were linked to administrative datasets in Ontario, Canada. Machine Learning approaches, including a Random Forests algorithm and the high-performance logistic regression, were used to derive parsimonious models to predict SSI status. Finally, a risk score methodology was used to transform the final models into the risk score system. The SSI risk models were validated in the validation datasets.

Results

Of 14,351 patients, 795 (5.5%) had an SSI. First, separate predictive models were built for three distinct administrative datasets. The final model, including hospitalization diagnostic, physician diagnostic and procedure codes, demonstrated excellent discrimination (C statistics, 0.91, 95% CI, 0.90–0.92) and calibration (Hosmer-Lemeshow χ2 statistics, 4.531, p = 0.402).

Conclusion

We demonstrated that health administrative data can be effectively used to identify SSIs. Machine learning algorithms have shown a high degree of accuracy in predicting postoperative SSIs and can integrate and utilize a large amount of administrative data. External validation of this model is required before it can be routinely used to identify SSIs.
Evaluating the impact of covariate lookback times on performance of patient-level prediction models
Authors: Hardin Jill , Reps Jenna M.
Published: August 2021

Background

The goal of our study is to examine the impact of the lookback length when engineering features to use in developing predictive models using observational healthcare data. Using a longer lookback for feature engineering gives more insight about patients but increases the issue of left-censoring.

Methods

We used five US observational databases to develop patient-level prediction models. A target cohort of subjects with hypertensive drug exposures and outcome cohorts of subjects with acute (stroke and gastrointestinal bleeding) and chronic outcomes (diabetes and chronic kidney disease) were developed. Candidate predictors that exist on or prior to the target index date were derived within the following lookback periods: 14, 30, 90, 180, 365, 730, and all days prior to index were evaluated. We predicted the risk of outcomes occurring 1 day until 365 days after index. Ten lasso logistic models for each lookback period were generated to create a distribution of area under the curve (AUC) metrics to evaluate the discriminative performance of the models. Calibration intercept and slope were also calculated. Impact on external validation performance was investigated across five databases.

Results

The maximum differences in AUCs for the models developed using different lookback periods within a database was < 0.04 for diabetes (in MDCR AUC of 0.593 with 14-day lookback vs. AUC of 0.631 with all-time lookback) and 0.012 for renal impairment (in MDCR AUC of 0.675 with 30-day lookback vs. AUC of 0.687 with 365-day lookback ). For the acute outcomes, the max difference in AUC across lookbacks within a database was 0.015 (in MDCD AUC of 0.767 with 14-day lookback vs. AUC 0.782 with 365-day lookback) for stroke and < 0.03 for gastrointestinal bleeding (in CCAE AUC of 0.631 with 14-day lookback vs. AUC of 0.660 with 730-day lookback).

Conclusions

In general the choice of covariate lookback had only a small impact on discrimination and calibration, with a short lookback (< 180 days) occasionally decreasing discrimination. Based on the results, if training a logistic regression model for prediction then using covariates with a 365 day lookback appear to be a good tradeoff between performance and interpretation.
Recruitment principles and strategies for supportive care research in pediatric oncology
Authors: Bradford Natalie , Cashion Christine , Condon Paula , Rumble Shelley , Bowers Alison
Published: August 2021

Background

Variations in clinical practice contribute to negative outcomes for children with cancer. Research in this area is imperative to standardise practice, yet such research is challenging to undertake, and a significant proportion of studies fail. A common reason for failure is poor recruitment, yet little information is available to support researchers and clinicians planning such research.

Methods

Our primary aim was to describe the recruitment strategies and outcomes in a tertiary children’s hospital across multiple observational supportive care studies. Secondary aims were to establish principles to improve both recruitment strategies and the reporting of recruitment. We undertook a retrospective descriptive analysis of the recruitment logs and data from three studies in pediatric oncology. The mean time to recruit one participant was calculated. Common reasons for not approaching eligible participants and reasons potential participants declined are described.

Results

Of the 235 potential candidates across all studies, 186 (79%) were approached and of these 125 (67%) provided consent, with 117 (63%) completing baseline measures. We estimated recruitment per participant required an average 98 min of experienced research nurse time. Four factors are described that influence recruitment and six principles are outlined to maximise recruitment and the generalisability of research findings.

Conclusions

We highlight the recruitment experiences across three different projects in children’s cancer supportive care research and provide a roadmap for other researchers planning to undertake clinical research in pediatrics.
Impact of a non-constant baseline hazard on detection of time-dependent treatment effects: a simulation study
Authors: Jachno Kim , Heritier Stephane , Wolfe Rory
Published: August 2021

Background

Non-proportional hazards are common with time-to-event data but the majority of randomised clinical trials (RCTs) are designed and analysed using approaches which assume the treatment effect follows proportional hazards (PH). Recent advances in oncology treatments have identified two forms of non-PH of particular importance - a time lag until treatment becomes effective, and an early effect of treatment that ceases after a period of time. In sample size calculations for treatment effects on time-to-event outcomes where information is based on the number of events rather than the number of participants, there is crucial importance in correct specification of the baseline hazard rate amongst other considerations. Under PH, the shape of the baseline hazard has no effect on the resultant power and magnitude of treatment effects using standard analytical approaches. However, in a non-PH context the appropriateness of analytical approaches can depend on the shape of the underlying hazard.

Methods

A simulation study was undertaken to assess the impact of clinically plausible non-constant baseline hazard rates on the power, magnitude and coverage of commonly utilized regression-based measures of treatment effect and tests of survival curve difference for these two forms of non-PH used in RCTs with time-to-event outcomes.

Results

In the presence of even mild departures from PH, the power, average treatment effect size and coverage were adversely affected. Depending on the nature of the non-proportionality, non-constant event rates could further exacerbate or somewhat ameliorate the losses in power, treatment effect magnitude and coverage observed. No single summary measure of treatment effect was able to adequately describe the full extent of a potentially time-limited treatment benefit whilst maintaining power at nominal levels.

Conclusions

Our results show the increased importance of considering plausible potentially non-constant event rates when non-proportionality of treatment effects could be anticipated. In planning clinical trials with the potential for non-PH, even modest departures from an assumed constant baseline hazard could appreciably impact the power to detect treatment effects depending on the nature of the non-PH. Comprehensive analysis plans may be required to accommodate the description of time-dependent treatment effects.
How are reasons for encounter associated with influenza-like illness and acute respiratory infection diagnoses and interventions? A cohort study in eight Italian general practice populations
Authors: Buono Nicola , Harris Michael , Farinaro Carmine , Petrazzuoli Ferdinando , Cavicchi Angelo , D’Addio Filippo , Scelsa Amedeo , Mirra Baldassarre , Napolitano Enrico , Soler Jean K.
Published: August 2021

Background

Influenza-like illness (ILI) and Acute Respiratory Infections (ARI) are a considerable health problem in Europe. Most diagnoses are made by family physicians (FPs) and based on symptoms and clinical signs rather than on diagnostic testing. The International Classification of Primary Care (ICPC) advocates that FPs record patients’ ‘Reasons for Encounters’ (RfEs) as they are presented to them.

This study analyses the association of patients’ RfEs with FPs’ diagnoses of ILI and ARI diagnoses and FPs’ management of those patients.

Methods

Cohort study of practice populations. Over a 4-month period during the winter season 2013–14, eight FPs recorded ILI and ARI patients’ RfEs and how they were managed. FPs recorded details of their patients using the ICPC format, collecting data in an Episode of Care (EoC) structure.

Results

There were 688 patients diagnosed as having ILI; between them they presented with a total of 2,153 RfEs, most commonly fever (79.7%), cough (59.7%) and pain (33.0%).

The 848 patients with ARI presented with a total of 1,647 RfEs, most commonly cough (50.4%), throat symptoms (25.9%) and fever (19.9%). For patients with ILI, 37.0% of actions were related to medication for respiratory symptoms; this figure was 38.4% for patients with ARI. FPs referred six patients to specialists or hospitals (0.39% of all patients diagnosed with ILI and ARI).

Conclusions

In this study of patients with ILI and ARI, less than half received a prescription from their FPs, and the illnesses were mainly managed in primary care, with few patients’ needing referral. The ICPC classification allowed a standardised data collection system, providing documentary evidence of the management of those diseases.
Heparin-binding protein is significantly increased in acute pancreatitis
Authors: Sjöbeck Martina , Sternby Hanna , Herwald Heiko , Thorlacius Henrik , Regnér Sara
Published: August 2021

Background

Most patients with acute pancreatitis (AP) experience mild, self-limiting disease with little or no need for hospital care. However, 20–25% of patients develop a more severe and potentially life-threatening condition with progressive systemic inflammatory response syndrome (SIRS) and multiorgan failure, resulting in high morbidity and mortality rates. Predicting disease severity at an early stage is important, as immediate supportive care has been demonstrated to reduce the incidence of SIRS and organ failure, improving patient outcome. Several studies have demonstrated elevated levels of heparin-binding protein (HBP) in patients with sepsis and septic shock, and HBP is believed to play a part in endothelial dysfunction leading to vascular leakage. As HBP levels increase prior to other known biomarkers, HBP has emerged as a promising early predictor of severe sepsis with organ dysfunction.

Methods

Patients admitted to Skåne University Hospital in Malmö between 2010 and 2013 fulfilling the criteria for AP were identified in the emergency department and prospectively enrolled in this study. The primary outcome was measured levels of HBP upon hospital admission in patients with confirmed AP. Correlations among HBP concentrations, disease severity and fluid balance were considered secondary endpoints. The correlation between HBP levels and fluid balance were analysed using Pearson correlation, and the ability of HBP to predict moderately severe/severe AP was assessed using a receiver operating characteristic (ROC) curve.

Results

The overall median HBP level in this study was 529 (307–898) ng/ml. There were no significant group differences in HBP levels based on AP severity. Fluid balance differed significantly between patients with mild versus moderately severe and severe pancreatitis, but we found no correlation between HBP concentration and fluid balance.

Conclusions

HBP levels are dramatically increased in patients with AP, and these levels far exceed those previously reported in other conditions. In this study, we did not observe any significant correlation between HBP levels and disease severity or the need for intravenous fluid. Additional studies on HBP are needed to further explore the role of HBP in the pathogenesis of AP and its possible clinical implications.
The intersectional impact of sex and social factors on subjective health: analysis of the Canadian longitudinal study on aging (CLSA)
Authors: Vafaei Afshin , Yu Janelle , Phillips Susan P.
Published: August 2021

Background

Self-rated health (SRH) is a widely validated measure of the general health of older adults. Our aim was to understand what factors shape individual perceptions of health and, in particular, whether those perceptions vary for men and women and across social locations.

Methods

We used data from the Canadian Longitudinal Study on Aging (CLSA) of community-dwelling adults aged 45 to 85. SRH was measured via a standard single question. Multiple Poisson regression identified individual, behavioural, and social factors related to SRH. Intersections between sex, education, wealth, and rural/urban status, and individual and joint cluster effects on SRH were quantified using multilevel models.

Results

After adjustment for relevant confounders, women were 43% less likely to report poor SRH. The strongest cluster effect was for groupings by wealth (21%). When wealth clusters were subdivided by sex or education the overall effect on SRH reduced to 15%. The largest variation in SRH (13.6%) was observed for intersections of sex, wealth, and rural/urban status. In contrast, interactions between sex and social factors were not significant, demonstrating that the complex interplay of sex and social location was only revealed when intersectional methods were employed.

Conclusions

Sex and social factors affected older adults’ perceptions of health in complex ways that only became apparent when multilevel analyses were carried out. Utilizing intersectionality analysis is a novel and nuanced approach for disentangling explanations for subjective health outcomes.
Short daytime napping reduces the risk of cognitive decline in community-dwelling older adults: a 5-year longitudinal study
Authors: Kitamura Kaori , Watanabe Yumi , Nakamura Kazutoshi , Takano Chikako , Hayashi Naomi , Sato Hisami , Someya Toshiyuki
Published: August 2021

Background

Beneficial effects of napping on cognition have been suggested in cross-sectional studies. This study aimed to clarify longitudinal associations between cognitive decline and sleep characteristics, particularly daytime napping, over a 5-year period in older adults.

Methods

Study participants were 389 community-dwelling individuals aged ≥65 years living in Ojiya City, Niigata, Japan. Baseline and follow-up examinations were conducted in 2011–2013 and 2016–2018, respectively. Trained nurses visited and interviewed participants to collect the following information at baseline and follow-up: demographic characteristics, disease history, lifestyle habits including bedtime, sleeping hours, and daytime nap duration, and cognitive function. The assessment of cognitive function was performed using the revised Hasegawa’s dementia scale (HDS-R), with cognitive decline defined as a change in the HDS-R of ≤ − 3 over 5 years. Odds ratios (ORs) for cognitive decline were calculated using multiple logistic regression analysis.

Results

Mean age of participants was 74.6 years (SD 6.4), and the cumulative incidence of cognitive decline was 106/389 (27.3%). The adjusted OR for 1–29 min daytime napping was significantly lower compared to that for no napping (OR = 0.47, 95%CI: 0.23–0.96). Earlier bedtime was associated with cognitive decline (adjusted P for trend = 0.0480).

Conclusion

Short daytime napping (< 30 min) reduces the risk of cognitive decline over 5 years for community-dwelling older people. A future study will be necessary to confirm the effect of short napping on the reduction of risk for clinically diagnosed dementia.
Vaccine preferences driving vaccine-decision making of different target groups: a systematic review of choice-based experiments
Authors: Diks Marilyn Emma , Hiligsmann Mickael , van der Putten Ingeborg Maria
Published: August 2021

Background

Choice-based experiments have been increasingly used to elicit preferences for vaccines and vaccination programs. This study aims to systematically identify and examine choice-based experiments assessing (differences in) vaccine preferences of vaccinees, representatives and health advisors.

Methods

Five electronic databases were searched on choice-based conjoint analysis studies or discrete choice experiments capturing vaccine preferences of children, adolescents, parents, adults and healthcare professionals for attributes of vaccines or vaccine settings up to September 2020. Data was extracted using a standardized form covering all important aspects of choice experiments. A quality assessment was used to assess the validity of studies. Attributes were categorized into outcome, process, cost and other. The importance of attributes was assessed by the frequency of reporting and statistical significance. Results were compared between high-quality studies and lower-quality studies.

Results

A total of 42 studies were included, with the majority conducted in high-income countries after 2010 (resp. n = 34 and n = 37). Preferences of representatives were studied in nearly half of the studies (47.6%), followed by vaccinees (35.7%) and health advisors (9.5%). Sixteen high-quality studies passed the quality assessment. Outcome- and cost- related attributes such as vaccine effectiveness, vaccine risk, cost and protection duration were most often statistically significant across both target groups, with vaccine effectiveness being the most important. Risks associated with vaccination, such as side effects, were more often statistically significant in studies targeting vaccinees, while cost-related attributes were more often statistically significant in studies of representatives. Process-related attributes such as vaccine accessibility and time were least important across both target groups.

Conclusion

To our knowledge, this is the first systematic review in which vaccine preferences of different target groups were assessed and compared. The same attributes were most important for vaccine decisions of vaccinees and representatives, with only minor differences in level of evidence for vaccine risk and cost. Future research on vaccine preferences of health advisors and/or among target groups in low-resource settings would give insight into the generalizability of current findings.
Streptococcus oralis MitraClip endocarditis following a dental procedure: a case report
Authors: Papamanoli Aikaterini , Rahman Tahmid , Kalogeropoulos Andreas P. , Lobo Zeena , Diggs Paul , Hamik Anne , Psevdos George
Published: August 2021

Background

Transcatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism.

Case presentation

An 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later.

Conclusions

Despite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward.
Malaria vector dynamics and utilization of insecticide-treated nets in low-transmission setting in Southwest Ethiopia: implications for residual transmission
Authors: Zemene Endalew , Belay Denekew Bitew , Tiruneh Abebaw , Lee Ming-Chieh , Yewhalaw Delenasaw , Yan Guiyun
Published: August 2021

Background

Understanding the behaviour of local malaria vectors is essential as effectiveness of the commonly used vector-targeted malaria control tools heavily relies on behaviour of the major malaria vectors. This study was conducted to determine species composition, biting behaviour, host preference and infectivity of anopheline mosquitoes, and assess utilization of insecticide-treated nets (ITNs) in a low transmission setting in Southwest Ethiopia.

Methods

Adult anopheline mosquitoes were collected using human landing catches (HLCs), Centers for Disease Control and Prevention (CDC) light traps (LTs) and Pyrethrum Spray Catches (PSCs) from June 2016 to May 2018 in Kishe, Jimma Zone, Southwest Ethiopia. The anopheline mosquitoes were morphologically identified. Moreover, sub-sample of An. gambiae s.l. was identified to species using polymerase chain reaction (PCR). Circum-sporozoite proteins (CSPs) and blood meal sources of the anopheline mosquitoes were tested using enzyme-linked immunosorbent assay (ELISA). In addition, a cross-sectional survey was conducted to assess ITN utilization by the inhabitants.

Results

A total of 3659 anopheline mosquitoes comprising An. coustani complex (84.4%), An. gambiae s.l. (11.3%), and An. pharoensis and An. squamosus comprising less than 5% were collected. The anopheline mosquitoes showed marked outdoor (67%) and early evening (63%) biting behaviour. An. coustani complex and An. gambiae s.l. were predominantly zoophilic and anthropophilic, respectively. None of the sampled anopheline were CSP-positive. Most of the households (97.8%) owned at least one ITN, with modest usage by the inhabitants (73.4%). ITN usage was significantly higher among under-five children (AOR = 7.9, 95% CI: 4.41–14.03), household heads and spouses (AOR = 4.8, 95% CI: 3.0–7.59), those with sufficient access to ITNs (AOR = 1.8, 95% CI: 1.39–2.35), and who were not utilizing alternative mosquito repellents (AOR = 2.2, 95% CI: 1.58–2.99).

Conclusion

The anopheline mosquito species exhibited predominantly outdoor and early evening biting activity. Household ITN coverage was high with slight gap in usage. Vector control interventions should target outdoor and early biting vectors to further suppress the local mosquito population. Moreover, sensitization of the community on consistent use of ITNs is required.
Spatiotemporal epidemiology of cryptosporidiosis in the Republic of Ireland, 2008–2017: development of a space–time “cluster recurrence” index
Authors: Boudou M. , Cleary E. , ÓhAiseadha C. , Garvey P. , McKeown P. , O’Dwyer J. , Hynds Paul
Published: August 2021

Background

Ireland frequently reports the highest annual Crude Incidence Rates (CIRs) of cryptosporidiosis in the EU, with national CIRs up to ten times the EU average. Accordingly, the current study sought to examine the spatiotemporal trends associated with this potentially severe protozoan infection.

Methods

Overall, 4509 cases of infection from January 2008 to December 2017 were geo-referenced to a Census Small Area (SA), with an ensemble of geo-statistical approaches including seasonal decomposition, Local Moran’s I, and space–time scanning used to elucidate spatiotemporal patterns of infection.

Results

One or more confirmed cases were notified in 3413 of 18,641 Census SAs (18.3%), with highest case numbers occurring in the 0–5-year range (n = 2672, 59.3%). Sporadic cases were more likely male (OR 1.4) and rural (OR 2.4), with outbreak-related cases more likely female (OR 1.4) and urban (OR 1.5). Altogether, 55 space–time clusters (≥ 10 confirmed cases) of sporadic infection were detected, with three “high recurrence” regions identified; no large urban conurbations were present within recurrent clusters.

Conclusions

Spatiotemporal analysis represents an important indicator of infection patterns, enabling targeted epidemiological intervention and surveillance. Presented results may also be used to further understand the sources, pathways, receptors, and thus mechanisms of cryptosporidiosis in Ireland.
Intelligent localization and quantitative evaluation of anterior talofibular ligament injury using magnetic resonance imaging of ankle
Authors: Yan Wen , Meng Xianghong , Sun Jinglai , Yu Hui , Wang Zhi
Published: August 2021

Background

There is a high incidence of injury to the lateral ligament of the ankle in daily living and sports activities. The anterior talofibular ligament (ATFL) is the most frequent types of ankle injuries. It is of great clinical significance to achieve intelligent localization and injury evaluation of ATFL due to its vulnerability.

Methods

According to the specific characteristics of bones in different slices, the key slice was extracted by image segmentation and characteristic analysis. Then, the talus and fibula in the key slice were segmented by distance regularized level set evolution (DRLSE), and the curvature of their contour pixels was calculated to find useful feature points including the neck of talus, the inner edge of fibula, and the outer edge of fibula. ATFL area can be located using these feature points so as to quantify its first-order gray features and second-order texture features. Support vector machine (SVM) was performed for evaluation of ATFL injury.

Results

Data were collected retrospectively from 158 patients who underwent MRI, and were divided into normal (68) and tear (90) group. The positioning accuracy and Dice coefficient were used to measure the performance of ATFL localization, and the mean values are 87.7% and 77.1%, respectively, which is helpful for the following feature extraction. SVM gave a good prediction ability with accuracy of 93.8%, sensitivity of 88.9%, specificity of 100%, precision of 100%, and F1 score of 94.2% in the test set.

Conclusion

Experimental results indicate that the proposed method is reliable in diagnosing ATFL injury. This study may provide a potentially viable method for aided clinical diagnoses of some ligament injury.
Validation of quantitative gait analysis systems for Parkinson’s disease for use in supervised and unsupervised environments
Authors: Alberto Sara , Cabral Sílvia , Proença João , Pona-Ferreira Filipa , Leitão Mariana , Bouça-Machado Raquel , Kauppila Linda Azevedo , Veloso António P. , Costa Rui M. , Ferreira Joaquim J. , Matias Ricardo
Published: August 2021

Background

Gait impairments are among the most common and impactful symptoms of Parkinson’s disease (PD). Recent technological advances aim to quantify these impairments using low-cost wearable systems for use in either supervised clinical consultations or long-term unsupervised monitoring of gait in ecological environments. However, very few of these wearable systems have been validated comparatively to a criterion of established validity.

Objective

We developed two movement analysis solutions (3D full-body kinematics based on inertial sensors, and a smartphone application) in which validity was assessed versus the optoelectronic criterion in a population of PD patients.

Methods

Nineteen subjects with PD (7 female) participated in the study (age: 62 ± 12.27 years; disease duration: 6.39 ± 3.70 years; HY: 2 ± 0.23). Each participant underwent a gait analysis whilst barefoot, at a self-selected speed, for a distance of 3 times 10 m in a straight line, assessed simultaneously with all three systems.

Results

Our results show excellent agreement between either solution and the optoelectronic criterion. Both systems differentiate between PD patients and healthy controls, and between PD patients in ON or OFF medication states (normal difference distributions pooled from published research in PD patients in ON and OFF states that included an age-matched healthy control group). Fair to high waveform similarity and mean absolute errors below the mean relative orientation accuracy of the equipment were found when comparing the angular kinematics between the full-body inertial sensor-based system and the optoelectronic criterion.

Conclusions

We conclude that the presented solutions produce accurate results and can capture clinically relevant parameters using commodity wearable sensors or a simple smartphone. This validation will hopefully enable the adoption of these systems for supervised and unsupervised gait analysis in clinical practice and clinical trials.
Perinatal outcomes of high dose versus low dose oxytocin regimen used for labor induction and factors associated with adverse perinatal outcome in four hospitals of Ethiopia: a multicenter comparative study
Authors: Tesemma Melese Gezahegn , Sori Demisew Amenu , Gemeda Desta Hiko
Published: August 2021

Background

There is limited evidence on effect of high and low dose oxytocin used for labor induction on perinatal outcomes. We compared perinatal outcomes among pregnant mothers who received the two different oxytocin regimens and identified risk factors associated with adverse perinatal outcomes.

Methods

Facility based comparative cross-sectional study was conducted in four hospitals of Ethiopia over eight month’s period during 2017/2018 year with 216 pregnant women who received high and low dose oxytocin for labor induction. Socio-demographics, reproductive characteristics of mothers and perinatal outcomes data were collected and entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to see the effect of different oxytocin regimens on perinatal outcome. The result was presented using 95 % confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance.

Result

Higher adverse perinatal outcomes (29 % vs. 13.9 %, p = 0.005) and higher non-reassuring fetal heart rate pattern (23.1 % vs. 7.4 %, p = 0.001) was observed among mothers who received high dose oxytocin compared to mothers who received low dose oxytocin. Using high oxytocin dose [AOR = 2.4, 95 % CI: 1.1, 5.5], caesarean birth [AOR = 9.3, 95 %CI: 3.8, 22.5], instrumental birth [AOR = 7.7, 95 % CI: 2.1, 27.8], and antepartum hemorrhage [AOR = 17.8, 95 %CI: 1.9, 168.7] were risk factors of adverse perinatal outcomes.

Conclusions

There was significance difference in the occurrence of adverse perinatal outcomes among pregnant mothers who received high and low dose of oxytocin. Using high dose oxytocin, antepartum hemorrhage, caesarean birth and instrumental birth were associated with increased risk of adverse perinatal outcomes. We recommend using low dose oxytocin for better perinatal outcomes.