bluuebunny/crossref_metadata_2025 huggingface dataset:
Continental-slope instability triggered by seepage: An experimental approach
Authors: Boffo Carolina H. , de Oliveira Tiago A. , da Silva Daniel Bayer , Manica Rafael , Borges Ana Luiza de O.
Published: September 2020

Mass-transport complexes (MTCs), mass-transport deposits (MTDs), and associated facies and features are widely recognized in continental slopes around the world. In most current stratigraphic models of MTCs and MTDs, these submarine sediment failures are related to aquifer outflow (sapping, seepage) along continental slope fronts that originated during relative sea-level fall. We test a hypothetical scenario that is favored during early forced regression using reduced-scale physical simulation. A major underground subaerial hydraulic gradient is assumed to flow towards the basin depocenter as a function of relative sea-level fall. We developed an experimental apparatus with slope angles varying between 15 and 30° to test this concept. Hydraulic gradients, aquifer outflow velocities, and triggered collapses induced by the seepage effect were recorded at various positions of the slope. Analysis shows that steeper slope gradients require lower seepage velocities (and shear stresses) to trigger collapse, but gentler slopes remain unchanged. Experimental data are compatible with a seepage effect that could potentially trigger mass failure and the formation of MTCs during relative sea-level fall. The features produced in the experiment have geometries comparable to natural environments, and the experimental seepage velocities are of an order of magnitude similar to those monitored in submarine aquifers. The experimental results advance understanding of mass transport in continental slopes by introducing and testing new methods, and also provide new insights into potential submarine geohazard risks where tectonic uplift operates along some coastal regions.
Determination of Flow Characteristics in Technological Processes with Controlled Pressure
Authors: Reader T. , Tenenev V. A. , Chernova A. A.
Published: September 2020

Assessment of the environmental and economic performance of a safety valve requires information about the flow of the substance through the valve when it is actuated. The goal of this paper was to determine the flow rate of the discharged substance and the mass flow rate of the substance entering the safety valve when it is actuated.

Proposed a mathematical model to describe the processes occurring in the valve. The model includes a system of differential equations describing the physical laws of conservation in the internal volume of the valve and differential equations, which link the value of gas flow through the valve with the pressure and the amount of movement of the shut-off disk. Used a modified method by S.K. Godunov to solve gasdynamic equations.

Established that the determination of the flow and power characteristics of the valve requires the preliminary construction of a mathematical model of the safety valve operation. Based on this, proposed a method for determining the flow rate of the discharged substance and the mass rate of the substance entering the safety valve when it is actuated.

Obtained the flow characteristics of the valves under review and the dynamics of movement of the shutoff disc of the valve, as well as the dependence of the pressure change on the opening time of the valve. Comparison of the calculated values with available experimental data gives good agreement of results (no more than 5.6 % for a gas flow rate, under 10 % for the movement of the valve and change the arrival of gas in time using the standard deviation function of the flow characteristics of 0.6 %), confirms the correctness of the defined mathematical model, used numerical schemes and algorithms, as well as the proposed method and recoverability of the arrival of gas in a pressure–time curve.
Repetitive Negative Thinking is associated with Subjective Cognitive Decline in older adults: a cross-sectional study
Authors: Schlosser Marco , Demnitz-King Harriet , Whitfield Tim , Wirth Miranka , Marchant Natalie L.
Published: September 2020

Background: In the absence of a cure or effective treatment for dementia, attention has shifted towards identifying risk factors for prevention. Subjective Cognitive Decline (SCD) describes self-perceived worsening of cognition despite unimpaired performance on neuropsychological tests. SCD has been associated with an increased dementia risk and steeper memory decline. Repetitive negative thinking (RNT) is a transdiagnostic process that manifests across several mental health disorders associated with increased vulnerability to dementia. RNT has thus been proposed as a candidate marker of risk for dementia and, relatedly, could contribute to the manifestation of SCD. We aimed to investigate the relationship between SCD and RNT alongside other proposed psychological risk/protective factors for dementia and cognitive decline. Methods: In a cross-sectional online survey, 491 older adults (mean=64.9 years, SD=4.2; 63.1% female) completed measures of RNT, personality traits, purpose in life, worry, rumination, and meditation practice. SCD was assessed continuously via self-perceived cognitive function (Neuro-QoL) and categorically via endorsement (yes/no) of memory complaints. Regression models, using a stepwise backwards elimination, were built to assess associations between SCD, demographics, and all risk/protective factors.Results: A total of 24.2% of participants reported memory complaints. In the final prediction models, RNT was the only psychological variable associated with lower self-perceived cognitive function and with a higher likelihood of memory complaints. Conclusions: This study empirically corroborates the theoretical relationship between SCD and RNT. Longitudinal studies are needed to establish whether RNT is a prodromal symptom or an independent risk factor, and whether RNT can be a promising construct for future research on SCD and dementia risk.
Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a multi-center parallel controlled trial
Authors: Liu Fang , Zhang Jing , Zhu Yuan , Su Lianjiu , Li Yiming , He Li , Yu Li , Peng Zhiyong
Published: September 2020

Background: Previous study drew different conclusions on significant differences between saline and balanced crystalloid solution infused in critical illness but both the statistical difference in sepsis subgroup. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion.Methods/design: The investigators designed a pragmatic, multi-center parallel controlled trial recruiting 312 patients who are diagnosed as sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer’s solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrollment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events within 28 days (MAKE28), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay.Results and conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration.Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15th, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214
Timing of Antiretroviral Therapy for HIV-Infected Patients with Cytomegalovirus Retinitis: Study Protocol of a Multi-Center Prospective Randomized Controlled Trial
Authors: He Xiao-Qing , Huang Yin-Qiu , Zeng Yan-Ming , Qin Yuan-Yuan , Tang Sheng-Quan , Xu Xiao-Lei , Harypursat Vijay , Lu Yan-Qiu , Liu Min , Yuan Jing , Chen Yaokai
Published: September 2020

Background: Cytomegalovirus retinitis (CMVR) is an important opportunistic infection (OI) occurring mainly in patients with acquired immunodeficiency syndrome (AIDS), and has the potential to cause severe visual impairment and blindness among AIDS patients. Subsequent to the adoption and implementation of widespread antiretroviral therapy (ART), the prognosis of AIDS-associated CMVR has been substantially improved. Nevertheless, there remains some controversy with regards to the optimal timing for ART initiation in patients with an established CMVR diagnosis. We therefore designed the present study in order to investigate the optimal timing for ART initiation in AIDS/CMVR patients.Methods: This will be a prospective, randomized controlled trial to be performed at 17 hospitals in mainland China. A total of 300 participants with CMVR will be randomly assigned to an early ART initiation group (ART initiation within 2 weeks after anti-CMV therapy), or a deferred ART initiation group (initiation of ART more than 2 weeks after anti-CMV therapy) at a 1:1 ratio. All participants will receive 48-weeks of follow-up after anti-CMV therapy initiation. Our primary outcome will be the incidence of visual loss (to a visual acuity worse than 20/40 or 20/200) in the two groups during the 48-week follow-up period. Secondary outcomes will include changes in HIV virological suppression and serum CD4+ T-cell counts, the incidence of mortality, retinitis progression (movement of the peripheral border of a CMV lesion ≥ ½ disc diameter, or occurrence of a new CMV lesion), retinal detachment, immune recovery uveitis (IRU), and other OIs and adverse events between the two study groups during the 48 weeks of follow-up. Discussion:The study aims to investigate the optimal timing for ART initiation in AIDS/CMVR patients. We hope to be able to extract robust clinical evidence for use in optimal AIDS/CMVR management should our trial be successful.Trial registration: This research was registered as one of the twelve clinical trials under the name of a general project “A study for precision diagnosing and treatment strategies in difficult-to-treat AIDS cases and HIV-infected patients with highly fatal or highly disabling opportunistic infections”, ChiCTR1900021195. Registered 1 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35362.
Community Intervention for Child Tuberculosis Active Contact Investigation and Management: Study Protocol for A Cluster Randomized Trial
Authors: Vasiliu Anca , Eymard-Duvernay Sabrina , Tchounga Boris , Atwine Daniel , de Carvalho Elisabete , Ouedraogo Sayouba , Kakinda Michael , Tchendjou Patrice , Turyahabwe Stavia , Kuate Albert Kuate , Tiendrebeogo Georges , Dodd Peter J , Graham Stephen M , Cohn Jennifer , Casenghi Martina , Bonnet Maryline
Published: September 2020

Background: There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings.Methods/design: This multicenter cluster-randomized trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community based models; and III, explanatory phase including endpoint data analysis, cost effectiveness analysis and post-intervention acceptability assessment by heath care providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contact with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e. all young (<5 years) child contacts or older (5-14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm.Discussion: This study will provide evidence of the impact of a community-based intervention on household child contact screening, and management of TB preventive therapy in order to improve care and prevention of childhood TB in high low resource high-burden settings.Trial registration: the study has been registered on the 6th of February 2019 on ClinicalTrials.gov with the number NCT03832023 (https://clinicaltrials.gov/ct2/show/NCT03832023?term=CONTACT&cond=Tuberculosis&cntry=UG&draw=2&rank=1 )
Transcription strategies related to photosynthesis and nitrogen metabolism of wheat in response to nitrogen deficiency
Authors: Liu Xin , Yin Chengmiao , Xiang Li , Jiang Weitao , Xu Shaozhuo , Mao Zhiquan
Published: September 2020

Background: Agricultural yield is closely associated with nitrogen application. Thus, reducing the application of nitrogen without affecting agricultural production remains a challenging task. To understand the metabolic, physiological, and morphological response of wheat (Triticum aestivum) to nitrogen deficiency, it is crucial to identify the genes involved in the activated signaling pathways.Results: We conducted a hydroponic experiment using a complete nutrient solution (N1) and a nutrient solution without nitrogen (N0). Wheat plants under nitrogen-deficient conditions (NDC) showed decreased crop height, leaf area, root volume, photosynthetic rate, crop weight, and increased root length, root surface area, root/shoot ratio. It indicates that nitrogen deficiency altered the phenotype of wheat plants. Furthermore, we performed a comprehensive analysis of the phenotype, transcriptome, GO pathways, and KEGG pathways of DEGs identified in wheat grown under NDC. It showed up-regulation of Exp (24), and Nrt (9) gene family members, which increased the nitrogen absorption and down-regulation of Pet (3), Psb (8), Nar (3), and Nir (1) gene family members hampered photosynthesis and nitrogen metabolism. Conclusions: We identified 48 candidate genes that were involved in improved photosynthesis and nitrogen metabolism in wheat plants grown under NDC. These genes may serve as molecular markers for genetic breeding of crops.
Susceptibility Loci for Pancreatic Cancer in the Brazilian Population
Authors: Aoki Mateus , Stein Angelika , de Oliveira Jaqueline Carvalho , Chammas Roger , Uno Miyuki , Canzian Federico
Published: September 2020

Background: Pancreatic adenocarcinoma (PA) is a very aggressive cancer and has one of the poorest prognoses. Usually the diagnosis is late and resistant to conventional treatment. Environmental and genetic factors contribute to the etiology, such as tobacco and alcohol consumption, chronic pancreatitis, diabetes and obesity. Somatic mutation in pancreatic cancer cells are known and SNP profile by GWAS could access novel genetic risk factors for this disease in different population context. Here we describe a SNP panel for Brazilian pancreatic cancer, together with clinical and epidemiological data. Methods: 78 pancreatic adenocarcinoma and 256 non-pancreatic cancer subjects had 25 somatic SNP genotyped by real-time PCR. Unconditional logistic regression methods were used to assess the main effects on PA risk, using allelic, co-dominant and dominant inheritance models. Results: 9 SNPs were nominally associated with pancreatic adenocarcinoma risk, with 5 of the minor allele conferring protective effect while 4 related as risk factor. In epidemiological and clinical data, tobacco, diabetes and pancreatitis history were significant related to pancreatic adenocarcinoma risk. Conclusion: We could assess for the first time some SNPs related with PA in Brazilian populations, a result that could be used for genetic screening in risk population such as familial pancreatic cancer, smokers, alcohol users and diabetes patients.
Transcriptomic Biomarker Pathways Associated with Death in HIV-infected Patients with Cryptococcal Meningitis
Authors: Louis Irina St. , Musubire Abdu K , Meya David B , Nabeta Henry W , Mohei Hesham , Boulware David R , Bohjanen Paul R
Published: September 2020

Background: Cryptococcal meningitis (CM) is a major cause of death in HIV-infected patients in sub-Saharan Africa. Many CM patients experience cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS), which is often fatal. We sought to identify transcriptomic biomarker pathways in peripheral blood that are associated with, or, predict the development of death or fatal C-IRIS among patients with CM who were enrolled in the Cryptococcal Optimal ART Timing (COAT) Trial. Methods: We assessed peripheral blood gene expression using next-generation RNA sequencing in 4 groups of patients with CM: 1) no C-IRIS or Death; 2) C-IRIS survivors; 3) fatal C-IRIS; 4) Death without C-IRIS. Gene expression was assessed at the time of ART initiation, at 1, 4, and 8 weeks on ART, and at the time of C-IRIS events. Results: We identified 12 inflammatory and stress response pathways, including interferon type 1 signaling, that were upregulated at the time of ART initiation in patients with future fatal C-IRIS, as compared with survivors. The upregulation of transcripts involved in innate immunity (inflammasome, Toll-like receptor signaling), was observed at the time of fatal or nonfatal C-IRIS events. At the time of fatal C-IRIS events, numerous transcripts within fMLP, Rho family GTPases, HMGB1, and other acute phase response signaling pathways were upregulated, which reflect the severity of inflammation and systemic oxidative stress. Those who died without recognized C-IRIS also had increased expression of pathways associated with oxidative stress and tissue damage. The Partial Least Squares model estimated above mentioned pathways as predictors of fatal outcome.Conclusions: Our results showed that overactivated innate immunity, involving Toll-like receptor/inflammasome, and inflammation-induced oxidative stress, are associated with fatal outcomes. The results of this study provide insight into the molecular drivers of death and fatal C-IRIS to inform future diagnostic test development or guide targeted treatments.
Assessment of The ACG System in Dutch Primary Care Using GP’s Electronic Health Records: A Retrospective Cross-Sectional Study
Authors: Girwar Shelley-Ann M , Fiocco Marta , Sutch Stephen P , Numans Mattijs E , Bruijnzeels Marc A
Published: September 2020

Background Within the Dutch health care system the focus is shifting from a disease oriented approach to a more population based approach. Since every inhabitant in the Netherlands is registered with one general practice, this offers a unique possibility to perform Population Health Management analyses based on general practitioners’ (GP) registries. The Johns Hopkins Adjusted Clinical Groups (ACG) System is an internationally used method for predictive population analyses. The model categorizes individuals based on their complete health profile, taking into account age, gender, diagnoses and medication. However, the ACG system was developed with non-Dutch data. Consequently, for wider implementation in Dutch general practice, the system needs to be validated in the Dutch healthcare setting. In this paper we show the results of the first use of the ACG system on Dutch GP data. The aim of this study is to explore how well the ACG system can distinguish between different levels of GP healthcare utilization. Methods To reach our aim, two variables of the ACG System, the Aggregated Diagnosis Groups (ADG) and the mutually exclusive ACG categories were explored. The population for this pilot analysis consisted of 23,618 persons listed with five participating general practices within one region in the Netherlands. ACG analyses were performed based on historical Electronic Health Records data from 2014 consisting of primary care diagnoses and pharmaceutical data. Logistic regression models were estimated and AUC’s were calculated to explore the diagnostic value of the models including ACGs and ADGs separately with GP healthcare utilization as the dependent variable. The dependent variable was categorized using four different cut-off points: zero, one, two and three visits per year.Results The ACG and ADG models performed as well as models using International Classification of Primary Care chapters, regarding the association with GP utilization. AUC values were between 0.79 and 0.85. These models performed better than the base model (age and gender only) which showed AUC values between 0.64 and 0.71. Conclusion The results of this study show that the ACG system is a useful tool to stratify Dutch primary care populations with GP healthcare utilization as the outcome variable.
Enablers, Constraints and Extent of Implementation of the Elimination of Mother-to-child Transmission of HIV Policy Guidelines in Lira district; Application of a Policy Implementation Barometer
Authors: Namuhani Noel , Kainga Hamiliton , Obafemi Olufemi , Adelabu Adeyemi , Mukuru Moses , Tuhebwe Doreen , Ssennyonjo Aloysious
Published: September 2020

Background; Despite the adoption of Elimination of mother to child transmission (EMTCT) strategy in 2012, mother to child transmission of HIV remains one of the significant forms of new HIV infections among children in Uganda, accounting for 20% of new infections. However, the implementation of the EMTCT strategy in Uganda remains unclear and an under researched field. This study aimed at assessing the extent of implementation of EMTCT strategy, barriers and constraints in Lira district using the adapted Policy Implementation Barometer (PIB) approach. Methods; This was a cross sectional study that employed both quantitative and qualitative data collection methods. A Policy Implementation Barometer tool developed by a project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda was adopted to assess the extent of implementation of EMTCT strategy. A total of 32 interviews with health facility managers were purposively conducted from a random sample of 20 health facilities offering Antenatal clinic (ANC) services in Lira district. Quantitative data was analyzed using STATA 14. Qualitative data was analyzed using thematic content analysis approach. Results; Majority 17/32 (53.1%) of the respondents were health facility in charges, 14/32 (43.8%) were midwives and half 16/32 (50.0%) had been in service for more than five years. Half of the respondents perceived their facilities to have fully established programs for implementing EMTCT and only 2/32 (6.2%) perceived the EMTCT programs to be functioning optimally. The perceived level of EMTCT implementation was 80%. Almost all the respondents perceived the funding for EMTCT activities to be inadequate, untimely, and not sustainable. Only 4/32 (12.5%) of the respondents believed that the health workforce size was adequate to support EMTCT activities, 13/32 (40.6%) believed that health workers lacked the skills to provide EMTCT services.Conclusion/Recommendation; Overall, the perceived extent of EMTCT policy implementation was high, however slow progress was reported in some of the key policy objectives due to a number of hindrances including inadequate staff and funding. Therefore, there is a need for strategies to increase the number of health workers for EMTCT and solicit for more funding for the implementation of EMTCT strategy.
Molecular detection of Staphylococcal enterotoxins and mecA genes products in food samples collected from different areas in Khartoum state.
Authors: Yahya Mohammed , Ali Hashim Abdalbagi , Gorish Babbiker Mohammed Taher , Ali Sara Omer , Abdalrhim Eman Saif Aldein , Mergani Mawada Hamza , Elgadir Asmaa Abass Abd , Mohammed Somaya Khalid , Ahmed Salma Omer , Musa Naglaa Alsaeid , Ahmed Alaa Saeed , Abdalla Wafaa Mohammed , Hamedelnil Yousif Fadlallah , Hashim Ahmed Ibrahim , Altayeb Hisham N.
Published: September 2020

Background: Staphylococcal Food Poisoning is an intoxication that results from the consumption of improperly prepared or stored foods containing sufficient amounts of one or more preformed S. aureus enterotoxins. Now days many researchers worldwide noted an emerging of resistant strains Staphylococci especially for the antibiotic Methicillin. Therefore, this study was aimed to determine the existence of Staphylococcus aureus and its enterotoxins, mecA genes in food samples.Results: A total of 400 samples were collected from different areas in Khartoum state. The type of foods included Cheese, Meat products, Fish and Raw milk, 100 samples for each. out of 400 samples cultivated 137 (34.25 %) isolates were identified as S. aureus, 126 (31.5%) were identified as bacteria other than S. aureus and 137 (34.25%) were yield no growth. Of 137 S. aureus isolates, 84 were randomly selected and examined for the presence mecA and enterotoxin genes products. Oxacillin sensitivity test showed that 15(11%) of 137 S.aureus isolates were Oxacillin resistant. The PCR assay showed that mecA gene was detected in 15 of 84 (17%) S. aureus isolates. While only 2 (2.385%) out of 84 S. aureus isolates were show an enterotoxin B gene product. Conclusion: There was a relatively moderate prevalence of Methicillin resistant staphylococcus aureus with very low frequency of enterotoxin B gene in different kinds of food samples which collected from Khartoum state. These findings highlight the high potential risk for consumers of meat and dairy products especially in the absence of strict hygienic and preventive measures to avoid Staphylococcus aureus enterotoxins production in foods.
Transmission Dynamics of SARS-CoV-2 in a Mid-size City of China
Authors: Zhao Hongjun , Lu Xiaoxiao , Lun Wenhui , Li Tiegang , Rao Boqi , Wang Dedong , Wu Di , Qiu Fuman , Yang Zhicong , Jiachun Lu
Published: September 2020

Background: An outbreak of pneumonia associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan city and then spread to other cities. It is very urgent to delineate the epidemiological and clinical characteristics of these affected patients. Methods: To investigate the epidemiological characteristics of the COVID-19, we describe a case series of 473 patients with confirmed COVID-19 in Wenzhou of China from January 27 to March 2, 2020.Results: The median age of all patients was 47.6 years, 48.4% of which were female. 33.8% of the patients had a history of residence in Wuhan. Fever (71.7%) and cough (43.1%) were the most common symptoms. In addition, three kinds of unconventional cases were observed, namely 4.9% asymptomatic patients, 7.6% confirmed patients who had no link to Wuhan city but contact with individuals from Wuhan without any symptoms at the time of contact, and 12.9% confirmed patients who had an unknown source of transmission. We estimated that the basic reproductive number (R0) was 2.75 (95%CI: 2.37-3.23). The effective reproduction number (Rt) fluctuated within the range of 2.50 to 3.74 from January 11 to January 16 while gradually reached the peak of 3.74 on January 16. Rt gradually decreased after January 16 and decreased to 1.00 on January 30. Rt continually decreased and reached the lowest point (0.03) on February 21, 2020.Conclusion: Our findings presented the possibility of asymptomatic carriers affected with SARS-CoV-2, and this phenomenon suggested that chances of uncontrollable transmission in the larger population might be higher than formerly estimated, and transmission by these three kinds of unconventional patients in Wenzhou may be an important characteristic of infection in other mid-sized cities in the world. This study evaluated the epidemic characteristics of Wenzhou after having cases imported from Hubei Province and the effects after adopting a series of strict prevention and control strategy.
An Alternative Model in The Provision of CPAP in Sleep Apnea: A Comparative Cost Analysis
Authors: Vergara Demetrio Gonzalez , Peláez Sergio Márquez , Arias Jose David Alfonso , Ramos Julia Perez , Box Jose Luis Rojas , Nosea Manuel Aumesquet
Published: September 2020

Background. To conduct a pilot study on an alternative model for the provision of respiratory therapies in sleep apnea-hypopnea syndrome (SAHS) by internalizing the service with the purchase, monitoring and control of continuous positive airway pressure (CPAP) equipment by the hospital.Methods. An observational, prospective pilot study of comparative cost analysis by internalizing the service to include all patients up to a budget limit of 5000 euros. The cost of internalizing the service included the acquisition of CPAP equipment and all the necessary accessories in addition to the nursing days necessary to track the patients. Patient satisfaction was assessed by a survey of the hospital service.Results. Twenty-one patients with 23,046 patient-days of follow-up were included. The cost of the internalized system was 6,825.11 €. The cost of the outsourced system over the same period would have been 22,781.18 €; thus, the direct saving was 15,956.07 €. The cost per device per day of the internalized system was 0.30 € versus the 0.99 € that the outsourced system would have cost during the study period. In the satisfaction survey, 12 (70.6%) patients indicated that they preferred the service of the hospital over that of the external company. No patient preferred the outsourced system.Conclusions. The internalization of CPAP service represents significant cost savings from a hospital perspective and an improvement in patients’ perceptions of the quality of service.
Empathy and burden in caregivers of patients with schizophrenia spectrum disorders
Authors: Lorenzo Rosaria Di , Girone Anna , Panzera Nunzio , Fiore Gianluca , Pinelli Margherita , Venturi Giulia , Magarini Federica , Ferri Paola
Published: September 2020

Background
The caregiver of patients loads different kind of burdens, including emotional distress. Aims of this study were to evaluate the burden and empathy of caregivers of patients with schizophrenic spectrum disorders and to evaluate if these dimensions are correlate between them and/or with selected variables of caregivers and assisted patients.
Methods
We selected a sample of 60 caregivers (34 women and 26 men), who assisted patients with schizophrenia spectrum disorders treated in our local Community Mental Health Center for a 1-year minimum period. We administered to our sample two scales, Zarit Burden Interview (ZBI) and Balanced Emotional Empathy Scale (BEES) and collected data of caregivers and their assisted patients in a 3-month period.
Results
We reported a mean ZBI score of 49.68 (± 15.03 SD) and a mean BEES score of 14.35 (± 9.05 SD), indicating the perception of moderate-severe burden and a low level of empathy, respectively. The analysis of internal consistency confirmed the good reliability of both ZBI (Cronbach's alpha = 0.90) and BEES (Cronbach's alpha = 0.77). The correlation between the two scales was not statistically significantly at Spearman test. Only a few variables, the living environment ("do not live with the patient") indirectly, and the Clinical Global Impression-Severity (CGI-S) score of assisted patients, in a direct way, were statistically significantly correlated with ZBI score. We highlighted only a positive statistically significant correlation between the fifth dimension score of BEES ("Tendency to avoid emotional involvement with fragile people") and CGI-S and GAF (Global Assessment of Functioning) scores of assisted patients.
Conclusions
Our study highlights that the burden of caregivers of patients with severe psychiatric disorders is similarly high to that of organic or neurologic disorders and is associated with low emotional empathy experienced by caregivers, probably due to a defensive psychological mechanism.
Development of an Ehealth and GP Assisted Programme for Persistent Physical Symptoms: Qualitative Exploration of Users’ Needs
Authors: Jakobsen Pernille Ravn , Rask Mette Trøllund , Clemensen Jane , Rosendal Marianne , Frostholm Lisbeth
Published: September 2020

BackgroundThe prevalence of patients with persistent physical symptoms (PPS) in general practice is estimated to be 17%. Hence, general practitioners (GPs) play a central role in both diagnostic assessment and management of PPS. However, a large body of literature indicates a need to improve GP strategies and ways to support patient self-help. Additionally, the use of eHealth in the field of general practice is growing. Therefore, this study aims to explore users’ needs in order to understand their requirements to an eHealth and GP assisted self-help programme for PPS in general practice. MethodsSeven days of field studies in general practice and twenty semi-structured interviews (6 GPs and 14 patients with PPS) were conducted in the Region of Southern Denmark. Interviews were audiotaped, transcribed verbatim and analysed using a five-step thematic analysis. Analysis was done inductively and separately for patients and GPs. The identified themes were mapped to the COM-B behaviour change model to allow translation from GPs´ and patients´ needs to the development of an eHealth intervention. ResultsThe analysis identified 11 subthemes in the patient interviews and 7 subthemes in the GP interviews. They were mapped into the three COM-B components: capability, opportunity and motivation. The main themes from patients and GPs corresponded and focused on understanding and explanation of symptoms, timing of this, uncertainty and consultation premises. Furthermore, important motivational elements for an eHealth programme were identified – especially the need for hope was emphasised.ConclusionsThe identified themes provide insight into potential behavioural interventions to facilitate self-care among patients with PPS in primary care settings through eHealth. Key learnings include: 1) a need to bring PPS into play early on in the consultation and take a more bio-psycho-social approach in the management of PPS. 2) Patients and GPs need better skills to manage uncertainty. 3) Patients need guidance from their GP in how to self-manage their PPS. Our design of a new eHealth and GP assisted self-help program for patients with PPS will target these identified key factors.
Airway Gene-Expression Classifiers for Respiratory Syncytial Virus (RSV) Disease Severity in Infants
Authors: Wang Lu , Chu Chin-Yi , McCall Matthew N , Slaunwhite Christopher , Holden-Wiltse Jeanne , Corbett Anthony , Falsey Ann R. , Topham David J. , Caserta Mary T. , Mariani Thomas J. , Walsh Edward E. , Qiu Xing
Published: September 2020

BackgroundA substantial number of infants infected with RSV develop severe symptoms requiring hospitalization. We currently lack accurate biomarkers that are associated with severe illness. MethodWe defined airway gene expression profiles based on RNA sequencing from nasal brush samples from 106 full-tem previously healthy RSV infected subjects during acute infection (day 1-10 of illness) and convalescence stage (day 28 of illness). All subjects were assigned a clinical illness severity score (GRSS). Using AIC-based model selection, we built a sparse linear correlate of GRSS based on 41 genes (NGSS1). We also built an alternate model based upon 13 genes associated with severe infection acutely but displaying stable expression over time (NGSS2). ResultsNGSS1 is strongly correlated with the disease severity, demonstrating a naïve correlation (ρ) of ρ=0.935 and cross-validated correlation of 0.813. As a binary classifier (mild versus severe), NGSS1 correctly classifies disease severity in 89.6% of the subjects following cross-validation. NGSS2 has slightly less, but comparable, accuracy with a cross-validated correlation of 0.741 and classification accuracy of 84.0%. ConclusionAirway gene expression patterns, obtained following a minimally-invasive procedure, have potential utility for development of clinically useful biomarkers that correlate with disease severity in primary RSV infection.
Nebulized ivermectin for COVID-19 and other respiratory diseases, a proof of concept, dose-ranging study in rats
Authors: Chaccour Carlos , Abizanda Gloria , Irigoyen-Barrio Ángel , Casellas Aina , Aldaz Azucena , Martínez-Galán Fernando , Hammann Felix , Gil Ana Gloria
Published: September 2020

Background: Ivermectin is a widely used antiparasitic drug with known efficacy against several single-strain RNA viruses. Recent data shows significant reduction of SARS-CoV-2 replication in vitro by ivermectin concentrations not achievable with safe doses orally. Inhaled therapy has been used with success for other antiparasitics. Methods: An ethanol-based ivermectin formulation was administered once to 14 rats using a nebulizer capable of delivering particles with alveolar deposition. Rats were randomly assigned into three target dosing groups, lower dose (80-90 mg/kg), higher dose (110-140 mg/kg) or ethanol vehicle only. A toxicology profile including behavioral and weight monitoring, full blood count, biochemistry, necropsy and histological examination of the lungs was conducted. The pharmacokinetic profile of ivermectin in plasma and lungs was determined in all animals. Results: There were no relevant changes in behavior or body weight. There was a delayed elevation in muscle enzymes compatible with rhabdomyolysis, that was also seen in the control group and has been attributed to the ethanol dose which was up to 11 grams/kg in some animals. There were no histological anomalies in the lungs of any rat. Male animals received a higher ivermectin dose adjusted by adipose weight and reached higher plasma concentrations than females in the same dosing group (mean Cmax 86.2 ng/ml vs 26.2 ng/ml in the lower dose group and 152 ng/ml vs 51.8 ng/ml in the higher dose group). All subjects had detectable ivermectin concentrations in the lungs at seven days post intervention, up to 524.3 ng/g for high-dose male and 27.3 ng/g for low-dose females. Conclusion: nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats, additional experiments are required to assess the safety of this formulation in larger animals.
Psychosocial Risk Factors for Postpartum Depression in Chinese Women: A Meta-Analysis
Authors: Weijing Qi , Fuqing Zhao , Yutong Liu , Qing LI , Jie Hu
Published: September 2020

Background: Postpartum depression (PPD) has been identified as a recognized public health problem that may adversely affect mothers, infants, and family units. Recent research has identified risk factors for this disease in Westerners; however, a comprehensive study has yet to pool all evidence to provide estimates of psychological and social risk factors in China. Therefore, this study aimed to quantitatively assess all qualified studies and identify the psychological and social risk factors for postpartum depression in Chinese women.Methods: The following databases were used in the literature search from their inception until June 2019: PubMed, Embase, FMRS, China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and China Biology Medicine disc (CBM). Meta-analysis was conducted by RevMan software. Study heterogeneity and publication bias were estimated.Results: From a total of 887 identified studies, 48 were included in the analysis. Prenatal depression (OR 7.70; 95% CI 6.02-9.83) and prenatal anxiety (OR 7.07; 95% CI 4.12-12.13) were major risk factors for PPD. A poor economic foundation (OR 3.50; 95% CI 2.92-4.20) and a poor relationship between husband and wife (OR 3.42; 95% CI 2.82-4.13) were moderate risk factors. Minor risk factors included a poor relationship between mother-in-law and daughter-in-law (OR 2.89; 95% CI 2.12-3.95), a lack of social support (OR 2.57; 95% CI 2.32-2.85), unplanned pregnancy (OR 2.55; 95% CI 2.08-3.14), mother-in-law as the caregiver (OR 2.5; 95% CI 1.67-3.74) and poor living conditions (OR 2.44; 95% CI 1.92-3.10).Conclusions: This study demonstrated a number of psychological and social risk factors for postpartum depression in Chinese women. The major and moderate risk factors are prenatal depression, prenatal anxiety, a poor economic foundation and a poor relationship between husband and wife. These findings suggest that prenatal prevention aimed at these risk factors is important due to the presence of many of these factors during the prenatal period.
Work Motivation and Belief in One’s Capabilities to Continue Working Among Ageing Home Care Nurses: A Qualitative Study With a Mixed Methods Approach
Authors: Wallin Stina , Fjellman-Wiklund Anncristine , Fagerström Lisbeth
Published: September 2020

Background The need for home care services is increasing. Therefore, it is important to support an ageing home care workforce to remain in work for longer. Personal resources such as work motivation are important in maintaining home care services, and the belief in one’s capabilities contribute to work ability. Few studies have targeted the ageing workers’ personal resources to manage their final working years. This study explore ageing home care nurses’ (HCNs) experiences of what positively and negatively affects their work motivation, and their beliefs in their capabilities to work until the expected retirement age, and to what extent. Methods This qualitative study was part of a cross-sectional survey answered by ageing HCNs. In four open-ended questions, aspects regarding work motivation and beliefs in one’s own capabilities to continue working until the expected retirement age were asked. Data was analysed using manifest qualitative content analysis. Through a quantification of the qualitative data analysis, the quantifiable focus among the responses was explored. Results The open-ended questions yielded 2339 utterances from 235 HCNs. The categories that gathered the most utterances positively affecting work motivation were named “Work environment”, “Significance of work”, “Stimulating challenges”, and “External response”. Correspondingly, categories mainly negatively affected work motivation were, “Organizational work environment”, Time constraints”, “Job characteristics”, and “Work community”. Factors that mostly provided the belief in one’s own capability to continue working yielded the categories “Own health”, “Workplace resources”, “Meaning of the work”, and “Nature of the work”. “Health related decline”, “Multifaceted work”, “Organizational resources”, and “Work related strain” mainly negatively affected the belief in own capabilities. Ageing itself was not seen as a concern. Conclusions When the factors that concurrently affected work motivation and one’s belief to continue working were well-functioning, they positively affected both motivation and belief. When they were insufficient they negatively affected either or both motivation and/or belief. Through highlighting the positive aspects of home care nursing, both work motivation and the belief to continue working might be facilitated among ageing HCNs. Meaningfulness of work should be addressed, together with strengthening the work community, a supporting leadership and offering challenging but overcoming demands.
Shock response and degassing reactions of calcite at planetary impact conditions
Authors: Umeda Yuhei , Fukui Keiya , Sekine Toshimori , Guarguaglini Marco , Benuzzi-Mounaix Alessandra , Kamimura Nobuki , Katagiri Kento , Kodama Ryosuke , Matsuoka Takeshi , Miyanishi Kohei , Ravasio Alessandra , Sano Takayoshi , Ozaki Norimasa
Published: September 2020

Calcite (CaCO3) as a planetary material is a source to the atmospheric carbon dioxide through degassing by high-velocity impact events. Revealing the behavior of calcite in the extreme pressure and temperature conditions is required to understand the impact-induced degassing phenomena. Here we report laboratory investigations of shock- compressed calcite beyond the impact velocity of 12 km/s (faster than escape velocity from the Earth). The present precise shock measurements elucidate the shape of the calcite Hugoniot curve continuously passing through the melting and metallization states up to a pressure of 1000 GPa (= 10-million atmospheres) or a corresponding impact velocity of 30 km/s, allowing us to predict the post-shock residual temperatures and the dominant carbon oxide species in the impact aftermath. These predictions suggest that CO emission is much more dominant than CO2 at the impact velocities of ∼10 km/s and above, affecting the planetary atmospheric chemistry, greenhouse processes, and environmental changes during planetary evolution.
Does Physical Activity Lower the Risk for Metabolic Syndrome: A Longitudinal Study of Physically Active Elderly Women
Authors: Zając-Gawlak Izabela , Pelclová Jana , Groffik Dorota , Pridalová Miroslava , Nawrat-Szołtysik Agnieszka , Kroemeke Aleksandra , Gába Aleš , Sadowska-Krępa Ewa
Published: September 2020

Background: There are few studies assessing the health of older women with respect to their physical activity. This study sought to determine whether changes in the physical activity of 59 women aged 60+ measured seven years apart and the risk of the participants developing the metabolic syndrome (MetS) were related to each other. Methods: The physical activity of the participants was measured using the accelerometers in 2009 and 2016. Their risk for the MetS was assessed as per the NCEP-ATP III criteria. Results: The number of steps the participants took daily increased between 2009 and 2016 from 10.944±3,560 to 11.652±4865. Women who maintained a high level of physical activity between the measurements, or increased it, had a significantly higher mean concentration of high-density cholesterol in 2016 (80.3 vs. 64.5 mg/dL and 79.2 vs. 66.9mg/dL, respectively). In the latter, a lower concentration of triglycerides (TG) (123.8 vs. 158.3mg/dL) was also observed. In 2016, only 7 women met 3 or more criteria for MetS compared with 24 in 2009; at the same time, the mean number of the MetS criteria met by a participant fell from 2.2±1.4 to 1.4±1.0.Conclusions: The number of MetS criteria that the participants met in 2016 was lower than in 2007, probably due to the high number of steps taken daily. Therefore, their risk of developing cardiovascular diseases was lower too.