bluuebunny/crossref_metadata_2025 huggingface dataset:
Baseline Cognition Is the Best Predictor of 4-year Cognitive Change in Cognitively Intact Older Adults
Authors: Schaeverbeke Jolien , Gabel Silvy , Luckett Emma , Meersmans Karen , De Meyer Steffi , Adamczuk Katarzyna , Nelissen Natalie , Goovaerts Valerie , Radwan Ahmed , Sunaert Stefan , Dupont Patrick , Laere Koen Van , Vandenberghe Rik
Published: December 2020

BackgroundWe examined in cognitively intact older adults the relative weight of cognitive, genetic, structural and amyloid brain imaging variables for predicting cognitive change over a 4-year time course. MethodsHundred-eighty community-recruited cognitively intact older adults (mean age 68 years, range 52-80 years, 81 women) belonging to the Flemish Prevent Alzheimer's Disease KU Leuven (F-PACK) longitudinal observational cohort underwent a baseline evaluation consisting of detailed cognitive assessment, structural MRI and 18F-flutemetamol PET. At inclusion, subjects were stratified based on Apolipoprotein E (APOE) epsilon4 and Brain Derived Neurotrophic Factor (BDNF) val66met polymorphism according to a factorial design. At inclusion, 15% were amyloid PET positive (Centiloid > 23.4). All subjects underwent 2-yearly follow-up of cognitive performance for a 4-year time period. Baseline cognitive scores were analysed using factor analysis. The slope of cognitive change over time was modelled using latent growth curve analysis. Using correlation analysis, hierarchical regression and mediation analysis, we examined the effect of demographic (age, sex, education) and genetic variables, baseline cognition, MRI volumetric (both voxelwise and region-based) as well as amyloid imaging measures on the longitudinal slope of cognitive change. ResultsA base model of age and sex explained 18% of variance in episodic memory decline. This increased to 41.6\% by adding baseline episodic memory scores. Adding amyloid load or volumetric measures explained only a negligible additional amount of variance (increase to 42.2%). A mediation analysis indicated that the effect of age on episodic memory scores was partly direct and partly mediated via hippocampal volume. Amyloid load did not play a significant role as mediator between age, hippocampal volume and episodic memory decline. ConclusionIn cognitively intact older adults, the strongest baseline predictor of subsequent episodic memory decline was the baseline episodic memory score. When this score was included, only very limited explanatory power was added by brain volume or amyloid load measures. The data warn against classifications that are purely biomarker-based and highlight the value of baseline cognitive performance levels in predictive models.
A Smartphone Ocular Alignment Measurement App in School Screening for Strabismus
Authors: Cheng Wenbo , Lynn Marissa H. , Pundlik Shrinivas , Almeida Cheryl , Luo Gang , Houston Kevin
Published: December 2020

Background: Strabismus is the leading risk factor for amblyopia, which should be early detected for minimized visual impairment. However, traditional school screening for strabismus can be challenged due to several factors, most notably training, mobility and cost. The purpose of our study is to evaluate the feasibility of using a smartphone application in school vision screening for detection of strabismus.Methods: The beta smartphone application, EyeTurn, can measure ocular misalignment by computerized Hirschberg test. The application was used by a school nurse in a routine vision screening for 133 elementary school children. All app measurements were reviewed by an ophthalmologist to assess the rate of successful measurement and were flagged for in-person verification with prism alternating cover test (PACT) using a 2.4Δ threshold (root mean squared error of the app). A receiver operating characteristic (ROC) curve was used to determine the best sensitivity and specificity for an 8Δ threshold (recommended by AAPOS) with the PACT measurement as ground truth.Results: The nurse obtained at least one successful app measurement for 93% of children (125/133). 40 were flagged for PACT, of which 6 were confirmed to have strabismus, including 4 exotropia (10△, 10△, 14△ and 18△), 1 constant esotropia (25△) and 1 accommodative esotropia (14△). Based on the ROC curve, the optimum threshold for the app to detect strabismus was determined to be 3.0△, with the best sensitivity (83.0%), specificity (76.5%). With this threshold the app would have missed one child with accommodative esotriopia, whereas conventional screening missed 3 cases of intermittent extropia.Conclusions: Results support feasibility of use of the app by personnel without professional training in routine school screenings to improve detection of strabismus.
Effect of 150 kHz Electromagnetic Radiation on the Development of Polycystic Ovaries Induced by Estradiol Valerate in Sprague Dawley Rats.
Authors: Mohammed Stephanie , Sundaram Venkatesan , Zyuzikov Nikolay
Published: December 2020

Background: Polycystic ovary syndrome (PCOS) is the most common complex endocrine disorder affecting approximately 2-20% of reproductive aged females. Tumour Treating Fields (100-300 kHz) is a recent innovative, non-invasive therapeutic approach to cancer therapy. This frequency as an alternative therapy for the management of polycystic ovaries has not yet been explored.Objectives: To explore the effect of full-body exposure of 150 kHz Electromagnetic Radiation (EMR), on the development of polycystic ovaries in an estradiol valerate-induced PCOs rats’ model.Method: Twenty-one female adult rats were divided into three groups (n=7 each): control, Estradiol Valerate (EV) and EV + EMR groups. The EV + EMR group was subjected to full body exposure at 150 kHz EMR continuously for eight consecutive weeks. Estradiol valerate was administered orally to induce polycystic ovaries in EV and EV+EMR groups. Body and ovarian weights were recorded and analysed. The regularity of the estrous cycle was assessed in all three groups. The histological study of ovarian tissue was carried out by haematoxylin and eosin staining. The serum concentration levels of Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH) and testosterone were measured using the ELISA method.Results: The body and ovary weights did not differ significantly between the EV and EV + EMR groups. The estrous cycle was found to be irregular in both the EV and EV + EMR groups. Ovarian histology revealed near normal morphology with little or no degenerative and morphological changes in developing follicles in the exposed group. Histometrical analysis showed an increased number of developing follicles and a significant reduction in the number and size of follicular cysts (p < 0.05) in the EV+EMR group. Hormonal analysis revealed no significant difference in the testosterone and FSH levels between the EV+EMR and EV groups. However, the LH, LH/FSH ratio decreased significantly in the EV+EMR group compares to the EV group.Conclusion: The 150 kHz EMR appear to have little or no degenerative and morphological changes in the developing follicles, an increased number of typical developing follicles and a significant reduction in the number and size of the follicular cysts (p < 0.05).Subject Classification codes: Electromagnetic Radiation, Polycystic Ovary
Health Related Quality of Life and Psychological Parameters in Different Polycystic Ovary Syndrome Phenotypes: A Comparative Cross-Sectional Study
Authors: Bahadori Fatemeh , Sadatmahalleh shahideh Jahanian , Mirzaei Negin
Published: December 2020

Background: Polycystic ovary syndrome (PCOS) is associated with high levels of phsychological implications and detriments to quality of life (QoL). The aim of this study was to assess the quality of life (QoL), health related quality of life (HRQoL), depression, and anxiety in Iranian women with different PCOS phenotypes.Methods: The observational, cross-sectional study was carried out on 239 PCOS women PCOS which had been classified on the basis of Rotterdam criteria into four categories. Then they were classified into four groups according to the Rotterdam criteria: A (n=77), B (n=38), C (n=68), and D (n=56).Results: No significant differences were observed between the four PCOS phenotypes for anxiety, depression and QoL, likewise, HRQoL domains related to infertiliy, weight and emotional problems (P>0.05). Phenotypes A and B had worse HRQoL related to hirsutism (13.98±5.22, 14.13±6.23, P<0.001), also no significant differences were observed between them for HRQoL’s domains. While the score of acne in phenotype D (19.60±5.12, P=0.003) and menstrual score in phenotype C were significantly higher compare with the other PCOS groups (16.82±3.87, P<0.001). Conclusion: Presenting similar psychological profile in all phenotypes unveils the importance of pychological well-being screening, even in milder reproductive phenotypes.
A Comparison of the Analgesic Efficacy of Serratus Anterior Plane Block Vs Paravertebral Nerve Block for Video-assisted Thoracic Surgery: a Randomized Controlled Trial
Authors: Zhang Yi , Fu Ze , Fang Te , Wang Kexin , Liu Zimeng , Li Hongqing , Jiang Wenwen , Cao Xuezhao
Published: December 2020

Background: Patients who undergo video-assisted thoracic surgery (VATS) that impair the integrity of the chest wall frequently experience moderate to severe postoperative pain. Serratus anterior plane block (SAPB) is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve. Methods: Our study aimed to evaluate the analgesic efficiency of deep serratus plane block (DSPB) and superficial serratus anterior plane block (SSPB) as well as paravertebral nerve block (PVB) in the patients undergoing VATS. A total of 74 patients aged from 20-80 undergoing VATS were randomized to receive either DSPB or SSPB as well as PVB. Ultrasound (US) guided DSPB or SSPB as well as PVB with 20ml 0.5% ropivacaine was performed preoperatively to the patients according to their groups. All patients were provided with patient-controlled intravenous analgesia (PCIA) for postoperative analgesia. The primary outcomes were the levels of postoperative pain at rest and on coughing evaluated by visual analog scale (VAS), intraoperative and postoperative opioids consumption. The secondary outcomes included PCIA pressed times, side effects and satisfaction of analgesia, duration of nerve block, intraoperative hemodynamic changes and vasoactive drug dosage. Results: No significant differences of VAS score were found in the three groups at each time points. During operation, PVB reduced consumption of opioids (27.23±5.10mg) compared to DSPB (31.20±3.80mg) and SSPB (32.61±5.28mg) (p<0.05). The effective pressed times of PCIA in SSPB group (0.18±0.65) was significantly lower compared to PVB group (1.09±1.50) (p=0.009) at postoperative 12h. Accordingly, SSPB group reduced the dosage of PCIA (26.55±4.72ml) than PVB group (31.45±7.60ml) (p=0.046). Time consuming of PVB procedure was longer (11.14±1.66min) than DSPB (5.68±1.10min) and SSPB (4.77±1.04min) (p<0.001, respectively). PVB group was associated with more intraoperative atropine consumption (0.14±0.24mg) than DSPB group (0mg) (P=0.043). Conclusion: DSPB and SSPB are easy to perform and can serve as a promising alternative technique to PVB that may offer comparable analgesic effectiveness and a better side-effect profile for patients who undergoing VATS. Trial registration: This study was registered to Chinese Clinical Trials Registry on July 20, 2019. (Registration No: ChiCTR1900024678)
miR-144-3p and miR-425-5p are Negatively Associated With Atrial Fibrosis and Promote Atrial Remodeling by Targeting CREB1 in Atrial Fibrillation
Authors: Wei Feiyu , Lv Li , Kuang Xiaohui , Ren Wenjun , Fan Jie
Published: December 2020

Background: Progression of atrial fibrosis is vital for atrial remodeling in atrial fibrillation (AF). The main objective of this study was to explore the association between miR-144-3p and miR-425-5p, and atrial fibrosis as well as the resultant impact on atrial remodeling in AF.Methods and Results: Through miRNAs sequencing and qRT-PCR, we demonstrated that miR-144-3p and miR-425-5p were downregulated in plasma and atrial tissue among the patients who suffered from AF. We confirmed that the plasma’s miRNAs level was negatively correlated with left atrial fibrosis, which was evaluated with the left low voltage area using left atrial voltage matrix mapping. Catheter ablation restored decreased plasma miR-144-3p and miR-425-5p. Besides, ROC curve analysis revealed that the miRNAs not only differentiated AF from healthy control of AUC 0.928 and 0.921, respectively, but also discriminated persistent AF from paroxysmal AF of AUC 0.906 and 0.888, respectively. Furthermore, the downregulated miR-144-3p and miR-425-5p promoted atrial fibroblast proliferation by CCK-8. CREB1 was realized to be a common direct target for miR-144-3p and miR-425-5p by western blot and luciferase assay.Conclusions: Our findings suggested that miR-144-3p and miR-425-5p could serve as novel atrial fibrosis biomarkers and hence contribute to atrial remodeling in AF.
Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis
Authors: Li Jianbo , Liao Xuelian , Zhou Yue , Wang Luping , Yang Hang , Zhang Wei , Zhang Zhongwei , Kang Yan
Published: December 2020

BackgroundThe response to glucocorticoids treatment may be different between Covid-19 and SARS. MethodsIn this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, ICTRP from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively.ResultsTen trials and 71 observational studies, with a total of 45935 patients, were identified. Glucocorticoids treatment, was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88; 95% confidence interval, 0.82 to 0.94; I2=26%) and SARS (0.48; 0.29 to 0.79; 10%), based on high quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89; 0.82 to 0.98; 0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids and taking dexamethasone or methylprednisolone; but for SARS, lower mortality were observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking dexamethasone or prednisolone. ConclusionsGlucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity; however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses and use timing of glucocorticoids.
High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure
Authors: Artigas Ricard Mellado , Ferreyro Bruno L. , Angriman Federico , Hernández-Sanz María , Arruti Egoitz , Torres Antoni , Villar Jesús , Brochard Laurent , Ferrando Carlos
Published: December 2020

Purpose
Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high flow nasal oxygen on ventilator free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19.
Methods
We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units. Main exposure was the use of high flow nasal oxygen (conservative group), while early invasive mechanical (within the first day of critical care admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. Intensive care unit length of stay and all-cause in hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding.
Results
A total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in intensive care unit length of stay (mean difference: -8.2 days; 95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64).
Conclusions
The use of high flow nasal oxygen upon intensive care admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in intensive care unit length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.
Are associations between home environment and preschool children’s sedentary time influenced by parental educational level in a cross-sectional survey?
Authors: Lehto Elviira , Lehto Reetta , Ray Carola , Pajulahti Riikka , Sajaniemi Nina , Erkkola Maijaliisa , Roos Eva
Published: December 2020

Background: Childhood obesity is a major public health concern, especially in low socioeconomic groups. Sedentary time (SED) is an important predictor of obesity. To be able to diminish SED it is important to find modifiable predictors of sedentary behavior. The home environment associated with children’s SED may vary by parental socioeconomic status. This study aims to clarify the association between parental educational level (PEL) and the home environment of 3–6-year-old children, and to examine how home environment associates with children’s SED, and whether PEL modifies these associations. Methods: A cross-sectional Increased health and wellbeing in preschools (DAGIS) study was conducted in 2015–2016 in Finland. The parents (n=809) filled in questionnaires assessing PEL, and the home physical and social environment related to children’s SED. Children’s SED was measured with accelerometers, which the children (n=745) wore for one week. Results: High PEL was associated with a home environment restraining sedentary behaviour compared with low PEL. Stricter descriptive norms about screen time, considering it important to limit the child’s screen time, and satisfaction about the child’s screen time associated with children’s lower SED. The association with parental psychological control and SED was influenced by PEL. In the PEL stratified analyses, however, the associations between psychological control and SED did not reach statistical significance. Conclusions: Future interventions aiming to decrease SED should pay attention to relevant factors in children’s sedentary behaviour home environment. It is important to acknowledge the possible PEL differences in these factors.
Effect of mindfulness on physical activity in primary healthcare patients: a randomised controlled trial pilot study.
Authors: Nymberg Peter , Calling Susanna , Stenman Emelie , Palmér Karolina , Hansson Eva Ekvall , Sundquist Kristina , Sundquist Jan , Zöller Bengt
Published: December 2020

Increased physical activity can have health benefits among inactive individuals. In Sweden, the healthcare system uses Physical Activity on Prescription (PAP) to motivate patients to increase their physical activity level. Mindfulness may further heighten the internal motivation to engage in physical activity. However, previous research has not demonstrated clear evidence of such associations.Aim: Examine the feasibility of the study design as a preparation for a full-scale study, and examine the differences, between three interventions, in change over time in physical activity levels and in related variables. Method: Comparison between three different interventions in an ordinary primary health care setting: PAP, mindfulness, and a combination of PAP and mindfulness. Physical activity was measured with self-report and ACTi Graph GT1X activity monitor. Statistical analysis was performed with a mixed effect model to account for repeated observations and estimate differences between groups at three- and six-months follow-up.Results: Between September 2016 and December 2018, a total of 88 participants were randomised into three groups. The total dropout rate was 20.4%, the attendance rate to the mindfulness courses (52% > 6 times) and the web-based mindfulness training (8% > 800 minutes) was low according to the stated feasibility criteria. Eleven participants were excluded from analysis due to low activity monitor wear time. Neither the activity monitor data nor self-reported physical activity showed any significant differences between the groups.Conclusion: The study design needs adjustment for the mindfulness intervention design before a fully scaled study can be conducted. A combination of PAP and mindfulness may increase physical activity and self-rated health more than PAP or mindfulness alone. Trial registration: ClinicalTrials.gov, registration number NCT02869854. Regional Ethical Review Board in Lund registration number 2016/404.
CNFE-SE: A novel approach combining complex network-based feature engineering and stacked ensemble to predict the success of Intrauterine Insemination and ranking the features
Authors: Ranjbari Sima , Khatibi Toktam , Dizaj Ahmad Vosough Taghi , Sajadi Hesamoddin , Totonchi Mehdi , Ghaffari Firouzeh
Published: December 2020

Background: Intrauterine Insemination (IUI) outcome prediction is a challenging issue which the assisted reproductive technology (ART) practitioners are dealing with. Predicting the success or failure of IUI based on the couples' features can assist the physicians to make the appropriate decision for suggesting IUI to the couples or not and/or continuing the treatment or not for them. Many previous studies have been focused on predicting the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcome using machine learning algorithms. But, to the best of our knowledge, a few studies have been focused on predicting the outcome of IUI. The main aim of this study is to propose an automatic classification and feature scoring method to predict intrauterine insemination (IUI) outcome and ranking the most significant features. Methods: For this purpose, a novel approach combining complex network-based feature engineering and stacked ensemble (CNFE-SE) is proposed. Three complex networks are extracted considering the patients' data similarities. The feature engineering step is performed on the complex networks. The original feature set and/or the features engineered are fed to the proposed stacked ensemble to classify and predict IUI outcome for couples per IUI treatment cycle. Our study is a retrospective study of a 5-year couples' data undergoing IUI. Data is collected from Reproductive Biomedicine Research Center, Royan Institute describing 11255 IUI treatment cycles for 8,360 couples. Our dataset includes the couples' demographic characteristics, historical data about the patients' diseases, the clinical diagnosis, the treatment plans and the prescribed drugs during the cycles, semen quality, laboratory tests and the clinical pregnancy outcome Results: Experimental results show that the proposed method outperforms the compared methods with Area under receiver operating characteristics curve (AUC) of 0.84 ± 0.01, sensitivity of 0.79 ± 0.01, specificity of 0.91 ± 0.01, and accuracy of 0.85 ± 0.01 for the prediction of IUI outcome. Conclusions: The most important predictors for predicting IUI outcome are semen parameters (sperm motility and concentration) as well as female body mass index (BMI).
Association between serum markers of the humoral immune system and inflammation in the Swedish AMORIS study
Authors: santaolalla aida , Sollie Sam , Rislan Ali , Josephs Debra H. , Hammar Niklas , Walldius Goran , Jungner Ingmar , Garmo Hans , Karagiannis Sophia N. , Hemelrijck Mieke Van
Published: December 2020

Background: Although the onset of inflammatory cascades may profoundly influence the nature of antibody responses, the interplay between inflammatory and humoral (antibody) immune markers remains unclear. Thus, we explored the reciprocity between the humoral immune system and inflammation and assessed how external socio-demographic factors may influence these interactions.Methods: From the AMORIS cohort, 5,513 individuals were identified with baseline measurements of serum humoral immune (immunoglobulin G, A & M (IgG, IgA, IgM)) and inflammation (C-reactive protein (CRP), albumin, haptoglobin, white blood cells (WBC), iron and total iron-binding capacity) markers measured on the same day. Correlation analysis, principal component analysis and hierarchical clustering were used to evaluate biomarkers correlation, variation and associations. Multivariate analysis of variance was used to assess associations between biomarkers and educational level, socio-economic status, sex and age.Results: Frequently used serum markers for inflammation, CRP, haptoglobin and white blood cells, correlated together. Hierarchical clustering and principal component analysis confirmed the interaction between these main biological responses, showing an acute response component (CRP, Haptoglobin, WBC, IgM) and adaptive response component (Albumin, Iron, TIBC, IgA, IgG). A socioeconomic gradient associated with worse health outcomes was observed, specifically low educational level, older age and male sex were associated with serum levels that indicated infection and inflammation.Conclusions: These findings indicate that serum markers of the humoral immune system and inflammation closely interact in response to infection or inflammation. Clustering analysis presented two main immune response components: an acute and an adaptive response, comprising markers of both biological pathways. Future studies should shift from single internal marker assessment to multiple humoral and inflammation serum markers combined, when assessing risk of clinical outcomes such as cancer.
Impact of a multimedia website with patient experiences of multiple sclerosis (PExMS) on immunotherapy decision-making: study protocol for a pilot randomised controlled trial in a mixed-methods design
Authors: Barabasch Anna , Riemann-Lorenz Karin , Kofahl Christopher , Scheiderbauer Jutta , Eklund Desiree , Kleiter Ingo , Kasper Jürgen , Köpke Sascha , Lezius Susanne , Zapf Antonia , Rahn Anne Christin , Heesen Christoph
Published: December 2020

Background: A variety of management options (e.g. immunotherapies, lifestyle interventions, and rehabilitation) are available for people with relapsing-remitting multiple sclerosis (RRMS). Besides coping with the diagnosis, people with MS (pwMS) have to make complex decisions such as deciding about immunotherapies. In addition to factual information, reports of patient experiences (PEx) may support patients in decision-making. The added value of PEx in decision-making is not clear and controlled studies are rare. Therefore, systematic methods are necessary to develop and analyse PEx. As there are no evaluated PEx for MS in Germany, we are currently creating a website presenting PEx structured according to topics and illustrated by video, audio and text files. We aim to determine the feasibility of an intervention using PEx and evaluate whether PEx may help pwMS in their immunotherapy decision-making processes as a supplement to evidence-based information.Methods: This project will follow the Medical Research Council framework for development and evaluation of complex interventions. After the development of a website with PEx, a randomised controlled pilot trial (pilot RCT) will be conducted in 2-3 MS centres, clinics or rehabilitation centres including 55 pwMS and accompanied by a process evaluation. Patients with a RRMS diagnosis considering immunotherapy are eligible. The primary outcome is decision self-efficacy. Secondary outcomes include preparation for decision-making, decisional conflict, risk knowledge, confidence in active participation, affective forecasting, social support and self-reported impact of eHealth on its users. Participants will be randomly assigned either to i) an intervention group with a four weeks access to an evidence-based patient information resource and the PExMS-website as an adjunct or to ii) the control group with access to evidence-based information alone. A 6-members advisory panel involving representatives of pwMS, researchers, and neurologists, who accompany the whole project will mentor this pilot RCT.Discussion: The intervention was developed with systematic methods, created with active patient involvement and in critical appraisal by an expert advisory panel. The study is innovative as it contributes to the controversial evidence on the use of PEx in the context of evidence-based patient information.
Explanation and Prediction of Clinical Data with Imbalanced Class Distribution Based on Pattern Discovery and Disentanglement
Authors: Zhou Peiyuan , Wong Andrew K.C.
Published: December 2020

Background: Statistical data analysis, especially the advanced machine learning (ML) methods, have attracted considerable interest in clinical practices. We are looking for interpretability of the diagnostic/prognostic results that will bring confidence to doctors, patients and their relatives in therapeutics and clinical practice. When datasets are imbalanced in diagnostic categories, we notice that the ordinary ML methods might produce results overwhelmed by the majority classes diminishing prediction accuracy. Hence, it needs methods that could produce explicit transparent and interpretable results in decision-making, without sacrificing accuracy, even for data with imbalanced groups. Methods: In order to interpret the clinical patterns and conduct diagnostic prediction of patients with high accuracy, we develop a novel method, Pattern Discovery and Disentanglement for Clinical Data Analysis (cPDD), which is able to discover patterns (correlated traits/indicants) and use them to classify clinical data even if the class distribution is imbalanced. In the most general setting, a relational dataset is a large table such that each column represents an attribute (trait/indicant), and each row contains a set of attribute values (AVs) of an entity (patient). Compared to the existing pattern discovery approaches, cPDD can discover a small succinct set of statistically significant high-order patterns from clinical data for interpreting and predicting the disease class of the patients even with groups small and rare.Results: Experiments on synthetic and thoracic clinical dataset showed that cPDD can 1) discover a smaller set of succinct significant patterns compared to other existing pattern discovery methods; 2) allow the users to interpret succinct sets of patterns coming from uncorrelated sources, even the groups are rare/small; and 3) obtain better performance in prediction compared to other interpretable classification approaches. Conclusions: In conclusion, cPDD discovers fewer patterns with greater comprehensive coverage to improve the interpretability of patterns discovered. Experimental results on synthetic data validated that cPDD discovers all patterns implanted in the data, displays them precisely and succinctly with statistical support for interpretation and prediction, a capability which the traditional ML methods lack. The success of cPDD as a novel interpretable method in solving the imbalanced class problem shows its great potential to clinical data analysis for years to come.
Leadership, governance and management for improving district capacity and performance: the case of USAID Transform: Primary Health Care
Authors: Desta Binyam Fekadu , Abitew Azeb , Beshir Ismael Ali , Argaw Mesele Damite , Abdlkader Sualiha
Published: December 2020

Background: Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC – primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. Methods: This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. Results: Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8±121.45 standard deviation (SD) compared to non-LMG districts 56.89±110.39 SD, with t (282243) = -3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. Conclusion: District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.
Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction
Authors: Li Bing , Cai Shi-Lun , Lv Zhen-Tao , Zhou Ping-Hong , Yao Li-Qing , Shi Qiang , Qi Zhi-Peng , Sun Di , Yalikong Ayimukedisi , Xu En-Pan , Xu Jian-Min , Zhong Yunshi
Published: December 2020

Background: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC.Methods: Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups.Results: In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041).Conclusion: Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.
Genetic Determinants of Clinical Phenotype in Hypertrophic Cardiomyopathy
Authors: Velicki Lazar , Jakovljevic Djordje G , Preveden Andrej , Golubovic Miodrag , Bjelobrk Marija , Ilic Aleksandra , Stojsic Snezana , Barlocco Fausto , Tafelmeier Maria , Okwose Nduka , Tesic Milorad , Brennan Paul , Ristic Arsen , Popovic Dejana , MacGowan Guy A , Filipovic Nenad , Maier Lars S. , Olivotto Iacopo
Published: December 2020

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease that affects approximately one in 500 people. HCM is a recognized genetic disorder most often caused by mutations involving myosin-binding protein C (MYBPC3) and β-myosin heavy chain (MYH7) which are responsible for approximately three-quarters of the identified mutations.Methods: As a part of the international multidisciplinary SILICOFCM project (www.silicofcm.eu) the present study evaluated the association between underlying genetic mutations and clinical phenotype in patients with HCM. Only patients with confirmed single pathogenic mutations in either MYBPC3 or MYH7 genes were included in the study and divided into two groups accordingly. The MYBPC3 group was comprised of 48 patients (76%), while the MYH7 group included 15 patients (24%). Each patient underwent clinical examination and echocardiography.Results: The most prevalent symptom in patients with MYBPC3 was dyspnea (44%), whereas in patients with MYH7 it was palpitations (33%). The MYBPC3 group had a significantly higher number of patients with a positive family history of HCM (46% vs. 7%; p=0.014). There was a numerically higher prevalence of atrial fibrillation in the MYH7 group (60% vs. 35%, p=0.085). Laboratory analyses revealed normal levels of creatinine (85.5±18.3 vs. 81.3±16.4 µmol/l; p=0.487) and blood urea nitrogen (10.2±15.6 vs. 6.9±3.9 mmol/l; p=0.472) which were similar in both groups. The systolic anterior motion presence was significantly more frequent in patients carrying MYH7 mutation (33% vs. 10%; p=0.025), as well as mitral leaflet abnormalities (40% vs. 19%; p=0.039). Calcifications of mitral annulus were registered only in MYH7 patients (20% vs. 0%; p=0.001). The difference in diastolic function, i.e. E/e’ ratio between the two groups was also noted (MYBPC3 8.8±3.3, MYH7 13.9±6.9, p=0.079).Conclusions: Major findings of the present study corroborate the notion that MYH7 gene mutation patients are presented with more pronounced disease severity than those with MYBPC3.
Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients
Authors: Yeheyis Ephraim Teffera , Kassa Seyoum , Yeshitila Hiwot , Bekele Abebe
Published: December 2020

Background

The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.

Methods

Prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak and prolonged hospital stay were analyzed as outcome variables

Result

A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 % (n=29) of patients. Anastomotic leak occurred in 7% (n=4) (OR 1.2, 95% CI 0.26-6.3; p=0.76) . In-hospital mortality was 5 % (n=3) (OR 1.44, 95% CI 0.22- 9.3; p =0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34 ).The overall anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p=0.16)

Conclusion

In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 minutes during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
Characteristics of patients who access zero, one or multiple General Practices and reasons for their choices: a study in regional Australia.
Authors: Glenister Kristen Maree , Guymer John , Bourke Lisa , Simmons David
Published: December 2020

Background: Most Australians visit a General Practitioner annually and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care such as older people or those with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year. Methods: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate. Results: Compared with utilisation of a single general practice, multiple general practice attendance in the past year (14.3%) was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p<0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p=0.006) than single practice attendees. Conclusions: Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Adsorbed leucaena protein on citrate modified Fe3O4 nanoparticles: synthesis, characterization, and its application as magnetic coagulant
Authors: Kristianto Hans , Reynaldi Edwin , Prasetyo Susiana , Sugih Asaf K
Published: December 2020

Natural coagulants from plants resources have gained a lot of attention as it is renewable, biodegradable, non-hazardous, lower cost, and less sludge generated compared to chemical coagulants. However there are still some drawbacks, namely long settling time and possible increase of dissolved organic carbon in the treated water. In this paper we tried to address these drawbacks by utilizing citrate modified Fe3O4 to adsorb protein from Leucaena leucocephala as the active coagulating agent. The effect of trisodium citrate concentration and protein adsorption pH to the adsorbed protein was investigated. It was found that the trisodium citrate concentration of 0.5 M and pH 4.0 gave the highest protein adsorption. The obtained magnetic coagulant was furthermore characterized using Scanning Electron Microscopy, X-ray Diffraction, Fourier Transform Infrared Spectroscopy, and Transmission Electron Microscopy to observe the characteristics before and after protein adsorption. Furthermore, the effect of pH (2 to 10) and coagulant dosage (60 to 600 mg L-1) to the removal of synthetic Congo red wastewater and sludge volume formation was investigated. It was found that pH 3 was the best pH for coagulation due to charge neutralization mechanism of leucaena protein. Furthermore the highest removal was obtained at dosage 420 mg L-1 with 80% removal. This result was comparable with crude extract of leucaena with half settling time (20 min) and lower increase of permanganate value, indicating lower increase of dissolved organics in the treated water.
Age trajectories of disability in instrumental activities of daily living and disability-free life expectancy among middle-aged and older adults in Taiwan: an 11-year longitudinal study
Authors: Liao Wen-Ling , Chang Yu-Hung
Published: December 2020

Background: This study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults. Methods: We included 3,118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996-2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages. Results: We identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63) , diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6% and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5% and 27.2% of remaining life. Conclusions: Early-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.