bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovative Use of Google Cardboard in Clinical Examination of Patients of Vertigo
Authors: Yeolekar Aditya M , Shinde Kiran J , Qadri Haris
Published: October 2019

Background:

Vertigo is 1 of the most prominent and frequent neurological symptom. It is estimated that about 30% of all people need medical care once in their life due to this index symptom. The neurological expertise required is usually scarce in underprivileged areas. One has to look for spontaneous nystagmus, and perform Dix–Hallpike maneuver and Head Impulse test specifically to differentiate central from peripheral vertigo. The nystagmus, that is spontaneous, involuntary to-and-fro movement of the eyeball which aids in the diagnosis, can be better elicited by Frenzel glasses, Munich glasses. These devices consist of the combination of magnifying glasses and a lighting system to detect eye movements better than routine examination.

Objective:

To test usefulness of modified Google cardboard as Frenzel glasses in poor resource setting.

Study design:

A modified Google cardboard was used in 52 consecutive cases of vertigo and compared with examination with naked eye. The device consists of 2 magnifying lenses, 1 for each eye with power of +24 dioptres.

Observation:

The tool was found to be better for identifying spontaneous nystagmus, in Dix–Hallpike maneuver and during head impulse test as compared with the naked eye owing to the property of magnification and inhibition of fixation. Being a cheaper alternative and handy, it could be carried by every doctor in any setting.
The importance of external clinical facilitation for a perinatal and infant telemental health service
Authors: Taylor Monica , Kikkawa Naomi , Hoehn Elisabeth , Haydon Helen , Neuhaus Maike , Smith Anthony C , Caffery Liam J
Published: October 2019

Introduction

Clinical facilitation is an established strategy for introducing innovation into clinical practice. The Queensland Centre for Perinatal and Infant Mental Health has used clinical facilitation to establish a telehealth service to support perinatal and infant mental health in regional, rural and remote areas of the Australian state of Queensland. The aim of this study is to explore the role of clinical facilitation in implementing and sustaining the telehealth service.

Methods

Semi-structured interviews were conducted with 14 remote-site users of the telehealth service. Interviews were analysed using thematic analysis.

Results

Two dominant themes emerged: unmet need and service visibility. The study confirms the usefulness of telehealth as a way to address unmet need for specialist mental health services in regional, rural and remote areas. The study also provides evidence that a telehealth service with intermittent demand requires a consistent clinical facilitator, to keep the service visible to remote-site clinicians and maintain awareness of the service as a referral option.

Conclusion

Previous research has identified the importance of clinical facilitation in initial service implementation. This study demonstrates the necessity of clinical facilitation for ongoing service provision. Facilitation is likely to be more important where the telehealth service responds to intermittent or infrequent clinical need, compared with high-volume services where clinics are conducted routinely.
Impact and observations of cylinder deactivation and reactivation in a downsized gasoline turbocharged direct injection engine
Authors: Parker Matthew C , Jiang Changzhao , Butcher Daniel , Spencer Adrian , Garner Colin P , Witt Dennis
Published: October 2019

Cylinder deactivation, sometimes referred to as variable displacement engine technology, is a method being employed in state-of-the-art reciprocating engines to improve fuel economy. The approach involves disabling the valve actuation of one or more cylinders to deactivate them, thus forcing the engine to operate at a higher specific load across the remaining cylinders to produce the torque demanded. Operating at such a point with an increased throttle opening reduces the engine’s pumping losses and hence reduces fuel consumption. In this work, the spray morphology, combustion and emissions of a three-cylinder downsized gasoline turbocharged direct injection engine with variable displacement engine capability on one cylinder were studied. This investigation allowed the interaction between the fuel spray, engine performance and emissions immediately following the reactivation of the deactivated cylinder to be better understood. Three operation modes were examined which included running the engine at full displacement, at the reduced displacement and at full displacement with increased indicated mean effective pressure, matching that of the reduced displacement mode. The study showed that cylinder deactivation significantly reduced specific fuel consumption at the conditions tested in comparison to full displacement operation. It was also found that when running the engine at full displacement but with the reduced displacement–level indicated mean effective pressure, the specific fuel consumption was greater than for reduced displacement operation. In addition, it was observed that particulate number emissions increase transiently during the deactivation period due to the disturbances to the fuelling control caused by displacement transitions. Improved fuelling control, refinement of the engine calibration during reduced displacement operation or a gasoline particulate filter could be used to manage this particulate number level.
Case of a Malignant Carotid Body Tumor With Systemic Metastases: The Utility of Multimodal Imaging
Authors: Amorosi Natasha M. , Dann Ayla , White Alison
Published: October 2019

Carotid body tumors (CBTs) are rare neoplastic paragangliomas that are typically benign; however, 10% to 15% are malignant with local invasion and, in rare cases, metastases systemically. A 45-year-old woman with a familial history of CBT presented following a syncopal episode. Multimodal imaging confirmed the presence of bilateral CBTs. 68Gallium-DOTATATE Positron Emission Tomography (DOTATATE-PET) scans revealed distant systemic metastases in the liver and vertebra. Surgical intervention was undertaken to excise the less complex right CBT. This report presents a case of malignant CBT with systemic metastases, describing the postintervention multimodal imaging findings with a focus on the duplex ultrasound features.
In-Home Passive Sensor Data Collection and Its Implications for Social Media Research: Perspectives of Community Women in Rural South Africa
Authors: van Heerden Alastair , Wassenaar Doug , Essack Zaynab , Vilakazi Khanya , Kohrt Brandon A.
Published: October 2019

There has been a recent increase in debates on the ethics of social media research, passive sensor data collection, and big data analytics. However, little evidence exists to describe how people experience and understand these applications of technology. This study aimed to passively collect data from mobile phone sensors, lapel cameras, and Bluetooth beacons to assess people’s understanding and acceptance of these technologies. Seven households were purposefully sampled and data collected for 10 days. The study generated 48 hr of audio data and 30,000 images. After participant review, the data were destroyed and in-depth interviews conducted. Participants found the data collected acceptable and reported willingness to participate in similar studies. Key risks included that the camera could capture nudity and sex acts, but family review of footage before sharing helped reduce concerns. The Emanuel et al. ethics framework was found to accommodate the concerns and perspectives of study participants.
Physician and patient’s insights towards generic prescribing: The scenario in the United Arab Emirates
Authors: Abduelkarem Abduelmula R , Othman Amna M , Elgendy Sara M , Moustafa Raneem E , Al-Areqi Noor M
Published: October 2019

Objective

To assess the perspectives and perceptions of physicians and patients towards generic prescribing in the United Arab Emirates. Founding those views can help in improving medicines prescription to provide the best cost-effective healthcare services in the country.

Methods

A cross-sectional study targeted physicians and patients across the United Arab Emirates. Two different questionnaires were conducted in 25 clinics, government healthcare centres and private hospitals. Collected data were analysed by descriptive analysis and Chi-square test. Key findings: Around half of 225 patients, agreed that generic medications have the same efficacy as branded medications. However, 54.7% believes that medications have been on the market longer are safer than newer ones. Majority of patients agreed that physicians’ advice would influence their choice when choosing between a generic and brand medication, though only a third of the participants agreed that the pharmacist’s advice would influence their choice. Of the 100 physicians, a preponderance reported that they actively prescribe generic medications. Moreover, they reported that the patient’s financial status would affect their decision when prescribing medications. Additionally, they identify medical representatives (64%) as their main sources of information regarding generic medications in the UAE.

Conclusions

The results showed somewhat negative views of physicians and patients towards generics prescriptions. Hence, measures should be taken by the Health Regulatory Authorities to clear up the misconceptions. This could be done by providing valid sources of information and assurance to the public about generic medications.
Quantification and Simplified Detoxification Investigation on Fuzi, Root of Aconitum carmichaelii
Authors: Lai Yun-Chien , Tai Chi-Jung , El-Shazly Mohamed , Chuang Yu-Che , Chiang Shu-Tuan , Tsai Yi-Hong , Csupor Dezső , Hohmann Judith , Wu Yang-Chang , Chang Fang-Rong
Published: October 2019

Fuzi (lateral root of Aconitum carmichaelii) has been used for millennia in Traditional Chinese Medicine (TCM) and Ayurveda to treat cancer and cardiovascular diseases. Fuzi must be processed before use to decrease the concentration of its toxic alkaloids. Detoxification during processing occurs through the transformation of diester-diterpenoid alkaloids (DDAs) to monoester-diterpenoid alkaloids (MDAs). However, traditional detoxification methods are time-consuming and expensive on large-scale production. To develop efficient detoxification protocols to reduce unnecessary processing procedure and keep the maximum functional contents from raw Fuzi, we replicated the traditional procedure and quantified the DDAs and MDAs by UPLC-MS/MS and UPLC-PDA during different steps and conditions of processing. With due consideration of obtained data, we concluded that soaking in Danba solution and the washing steps were inefficient traditional processing methods. The detoxification effect of steaming (56.3 ± 0.27 μg/g DDAs, lowest after steaming) was weaker and slower than boiling (5.8 ± 0.33 μg/g DDAs, lowest after boiling). Moreover, roasting at 105℃ showed better effect in lowering the DDAs (5.8 ± 0.33 μg/g DDAs) and increasing the MDAs (729.1 ± 1.22 μg/g MDAs, highest) than roasting at 60℃ (17.3 ± 0.65 μg/g DDAs; 504.0 ± 0.99 μg/g MDAs). With these highly reliable analytic data, we established an efficient and referenceable detoxification protocol for Fuzi TCM products, in which DDAs and MDAs should legitimately follow the safe and specific ranges stipulated in pharmacopeias.
Stroke Patients’ Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit
Authors: Arbel Ifah , Ye Bing , Mihailidis Alex
Published: October 2019

Objectives:

This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs).

Background:

Healing environments in healthcare settings can promote patients’ healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context—a stroke rehabilitation unit.

Methods:

The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods.

Results:

The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs.

Conclusion:

The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.
Customer Service Evaluations of Employees With Disabilities: The Roles of Perceived Competence and Service Failure
Authors: Madera Juan M. , Taylor D. Christopher , Barber Nelson A.
Published: October 2019

Although employees with disabilities represent a significant percentage of the American hospitality labor force, they often face workplace discrimination. Despite this reality, no research has examined whether customer service evaluations are affected by employees with visible disabilities and the mechanisms behind why and when customer service evaluations can be negatively impacted by employee disability status. This is a significant gap in the literature focusing on disability discrimination because customers—through their customer service evaluations—play a significant role in the evaluation of hospitality employees. Therefore, the current article examined if employee disability status (i.e., does or does not have a disability) influences customer service evaluations using experimental methods in which a hotel service experience is performed by an employee who does or does not have a disability. The current research found that (a) customers do evaluate hospitality employees with disabilities lower than employees without disabilities, (b) customer service evaluations are negatively impacted by employee disability status because they are perceived as less competent than employees without disabilities, and (c) customers are more likely to do so in the presence of a service failure.
People with intellectual disabilities and labour market inclusion: What role for EU labour law?
Authors: Bell Mark
Published: October 2019

People with intellectual disabilities occupy a peripheral position in the labour market. They have low rates of participation in employment and this often takes the form of sheltered employment in settings segregated from persons without disabilities. Although their working lives have received limited attention in legal scholarship, this article argues that law can play a positive role in fostering greater inclusion. Taking into account the UN Convention on the Rights of Persons with Disabilities, this article analyses EU legislation and case law in order to identify how these apply to those working in sheltered employment and how they may assist in tackling barriers to participating in the open labour market. While EU labour law already contains measures that have the potential to improve the position of people with intellectual disabilities, the article identifies scope for enhancing the effectiveness of these instruments.
The Timed Up and Go test and the ageing heart: Findings from a national health screening of 1,084,875 community-dwelling older adults
Authors: Chun Sohyun , Shin Dong Wook , Han Kyungdo , Jung Jin Hyung , Kim Bongseong , Jung Hee-Won , Son Ki Young , Lee Seung-Pyo , Lee Sang Chol
Published: October 2019

Aim

This study aimed to evaluate the relationship between Timed Up and Go test performance and the incidence of older adult heart diseases and mortality.

Methods

This was a retrospective cohort study of 1,084,875 older adults who participated in a national health screening program between 2009–2014 (all aged 66 years old). Participants free of myocardial infarction, congestive heart failure, and atrial fibrillation at baseline were included and were divided into Group 1 (<10 s), Group 2 (10−20 s) and Group 3 (≥20 s) using the Timed Up and Go test scores. The endpoints were incident myocardial infarction, congestive heart failure, atrial fibrillation, and all-cause mortality.

Results

During mean follow-up of 3.6 years (maximum 8.0 years), 8885 myocardial infarctions, 10,617 congestive heart failures, 15,322 atrial fibrillations, and 22,189 deaths occurred. Compared with participants in Group 1, Group 2 and Group 3 participants had higher incidences of myocardial infarction (Group 3: adjusted hazard ratio = 1.40, 95% confidence interval = 1.11–1.77), congestive heart failure (Group 3: adjusted hazard ratio = 1.59, 95% confidence interval = 1.31–1.94) and total mortality (Group 3: adjusted hazard ratio=1.93, 95% confidence interval = 1.69–2.20). The additional risks remained after adjusting for multiple conventional risk factors. For atrial fibrillation, a linear trend of increased risk was observed with slower Timed Up and Go test speed, but was statistically marginal (Group 3: adjusted hazard ratio=1.17, 95% confidence interval=0.96–1.44).

Conclusion

Slower Timed Up and Go test speed is associated with increased risk of developing myocardial infarction, congestive heart failure, and mortality in older adults.
Long-term management of high-grade atrioventricular block using cilostazol in a cat
Authors: Iwasa Naoki , Nishii Naohito , Takashima Satoshi , Kobatake Yui , Nomura Saki , Iwasa Kazuko , Iwasa Tatsuo , Suzuki Tomomi , Machida Noboru , Kitagawa Hitoshi
Published: October 2019

Case summary

A 12-year-old neutered female domestic shorthair cat was admitted for syncope. Clinical signs and electrocardiography revealed high-grade atrioventricular (AV) block. Treatment with cilostazol ameliorated the clinical signs and arrhythmia. However, the high-grade AV block recurred on several occasions. After 640 days, the cat presented again with clinical deterioration owing to reoccurrence of the arrhythmia and it died 11 days later. Histopathological examination revealed a loss of conduction cells within the His bundle.

Relevance and novel information

To our knowledge, this is the first report of high-grade AV block treated with cilostazol in a cat. Treatment with cilostazol prolonged survival for 650 days without pacemaker implantation. Histological findings suggested that the AV block was related to fibrosis of the impulse conduction system.
A cross-sectional study of physical activity participation among adults with chronic conditions participating in a digital health program
Authors: Smith-Ray Renae L , Nikzad Nima , Singh Tanya , Jiang Jenny Z , Taitel Michael S , Quer Giorgio , Cherry Jean , Steinhubl Steven R
Published: October 2019

Objective

Many American adults are insufficiently active. Digital health programs are designed to motivate this population to engage in regular physical activity and often rely on wearable devices and apps to objectively measure physical activity for a large number of participants. The purpose of this epidemiological study was to analyze the rates of physical activity among participants in a digital health program.

Method

We conducted a cross-sectional study of participants enrolled in a digital health program between January 2014 and December 2016. All activity data were objectively collected through wearable devices.

Results

Participants ( n =  241,013) were on average 39.7 years old and 65.7% were female. Participants walked on average 3.72 miles per day. Overall, 5.3% and 21.8% of participants were being treated with diabetes and cardiovascular medications respectively, but these rates varied across young, middle and older adults. Participants of all ages being treated with cardiovascular and/or diabetes medications walked significantly less than those not being treated for these conditions.

Conclusion

The feasibility of using a large database containing data from consumer-grade activity trackers was demonstrated through this epidemiological study of physical activity rates across age and condition status of participants. The approach and findings described may inform future research as the information age brings about new opportunities to manage and study massive amounts of data generated by connected devices.
The Impact of CEO Ethnicity and Language Choice on Crisis Communication in Japan
Authors: Barkley Katharina
Published: October 2019

Spokesperson ethnicity research has shown that organizations can benefit from matching spokespersons to their target audiences. However, one facet of Japanese crisis communication can make this approach difficult for foreign organizations facing crises in Japan. The Japanese tendency to focus on collective-level causality and place blame with leaders through proxy logic, frequently forces CEOs into the role of crisis spokesperson. The current study utilized an experimental design to examine the effect of CEO ethnicity and language choice on how culturally matched and unmatched crisis responses were evaluated by a Japanese audience. Specifically, participants’ perceptions of ideological similarity, spokesperson credibility, and organizational reputation were compared between the Japanese CEO baseline and a Caucasian CEO speaking either in English or Japanese. The study found that the foreign CEO condition was evaluated more favorably across all measures independent of response match but found variations in the impact of choosing to forgo a translator in favor of delivering the response in Japanese.
A Point-Based Model to Predict Absolute Risk of Revision in Anatomic Shoulder Arthroplasty
Authors: Lapner Peter LC , Rollins Meaghan D , Tuna Meltem G , Netting Caleb , Bader Eddeen Anan , van Walraven Carl
Published: October 2019

Background

Total shoulder arthroplasty (TSA) has demonstrated good long-term survivorship but early implant failure can occur. This study identified factors associated with shoulder arthroplasty revision and constructed a risk score for revision surgery following shoulder arthroplasty.

Methods

A validated algorithm was used to identify all patients who underwent anatomic TSA between 2002 and 2012 using population-based data. Demographic variables included shoulder implant type, age and sex, Charlson comorbidity score, income quintile, diagnosis, and surgeon arthroplasty volume. The associations of covariates with time to revision were measured while treating death as a competing risk and were expressed in the Shoulder Arthroplasty Revision Risk Score (SARRS).

Results

During the study period, 4079 patients underwent TSA. Revision risk decreased in a nonlinear fashion as patients aged and in the absence of osteoarthritis with no influence from surgery type or other covariables. The SARRS ranged from −21 points (5-year revision risk 0.75%) to 30 points (risk 11.4%). Score discrimination was relatively weak 0.55 (95% confidence interval: 0.530.61) but calibration was very good with a test statistic of 5.77 ( df = 8, P = .762).

Discussion

The SARRS model accurately predicted the 5-year revision risk in patients undergoing TSA. Validation studies are required before this score can be used clinically to predict revision risk. Further study is needed to determine if the addition of detailed clinical data including functional outcome measures and the severity of glenohumeral arthrosis increases the model’s discrimination.
Leveraging Emotions for Successful Organisational Transformation
Authors: Shankar Krishnamurthy
Published: October 2019

Organisations are going through significant change and strategic transformation in these dynamic times. However, emotions have often been under-leveraged in the process of strategic change management. This article explores how leaders and organisational routines can create appropriate collective emotions to achieve relevant objectives in their strategic transformation. Using a case study approach, this study identified that collective emotions formed are dependent on the type of affective events and the current emotion state of the team, including their ‘identity’ strength, and is mediated by the organisational processes of listening and addressing concerns and the historical learning of the team from similar experiences, and moderated by leader emotion management actions. This article outlines the key emotions of excitement, optimism, gratitude, interest, happiness, pride and dissatisfaction, which are necessary at different stages in the strategic transformation process, and the organisational routines and leader actions needed to build them.
Differential Chemokine Expression in Tissues Involved by Hodgkin’s Disease: Direct Correlation of Eotaxin Expression and Tissue Eosinophilia
Authors: Teruya-Feldstein Julie , Jaffe Elaine S. , Burd Parris R. , Kingma Douglas W. , Setsuda Joyce E. , Tosato Giovanna
Published: October 2019

Hodgkin’s disease (HD) is a lymphoid malignancy characterized by infrequent malignant cells surrounded by abundant inflammatory cells. In this study, we examined the potential contribution of chemokines to inflammatory cell recruitment in different subtypes of HD. Chemokines are small proteins that are active as chemoattractants and regulators of cell activation. We found that HD tissues generally express higher levels of interferon-γ–inducible protein-10 (IP-10), Mig, RANTES, macrophage inflammatory protein-1 (MIP-1), and eotaxin, but not macrophage-derived chemotactic factor (MDC), than tissues from lymphoid hyperplasia (LH). Within HD subtypes, expression of IP-10 and Mig was highest in the mixed cellularity (MC) subtype, whereas expression of eotaxin and MDC was highest in the nodular sclerosis (NS) subtype. A significant direct correlation was detected between evidence of Epstein-Barr virus (EBV) infection in the neoplastic cells and levels of expression of IP-10, RANTES, and MIP-1. Levels of eotaxin expression correlated directly with the extent of tissue eosinophilia. By immunohistochemistry, IP-10, Mig, and eotaxin proteins localized in the malignant Reed-Sternberg (RS) cells and their variants, and to some surrounding inflammatory cells. Eotaxin was also detected in fibroblasts and smooth muscle cells of vessels. These results provide evidence of high level chemokine expression in HD tissues and suggest that chemokines may play an important role in the recruitment of inflammatory cell infiltrates into tissues involved by HD.
Acute myeloid leukemia–induced T-cell suppression can be reversed by inhibition of the MAPK pathway
Authors: Moshofsky Kaycee B. , Cho Hyun J. , Wu Guanming , Romine Kyle A. , Newman Matthew T. , Kosaka Yoko , McWeeney Shannon K. , Lind Evan F.
Published: October 2019

Key Points

MEK inhibition rescues T cells from activation-induced cell death in an AML model. MEK inhibitor sensitivity is associated with inflammation pathways and PD-L1 expression.
Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions
Authors: Kho Sze Shyang , Chan Swee Kim , Yong Mei Ching , Tie Siew Teck
Published: October 2019

Background

Radial endobronchial ultrasound (R-EBUS) is an effective technique in the diagnosis of peripheral pulmonary lesions (PPL). However, lesion orientation with regards to the radial probe remains an important factor for effective biopsy. “Within” orientation was associated with significantly higher diagnostic yield. Cryobiopsy is a novel technique in obtaining larger tissue samples with the frozen tip allowing biopsy in a 360° direction, thus potentially achieving more effective biopsy in eccentrically and adjacently orientated lesions. We aimed to evaluate the performance and safety of transbronchial cryobiopsyversusforceps biopsy in eccentrically and adjacently orientated R-EBUS lesions.

Methods

Retrospective review of R-EBUS transbronchial biopsy for PPL over 17 months.

Results

114 R-EBUS scans were included for analysis during the study period. Forceps biopsy was performed in 76 (66.7%) cases and cryobiopsy in 38 (33.3%) cases. Baseline demographics and lesion characteristics did not differ between the two groups. Median (interquartile range) lesion size was 3.48 (2.63–4.51) cm. Overall, 41.2% of lesions were of eccentric orientation and 15.8% adjacent orientation; only 43% were concentric in orientation. Overall diagnostic yield was 67.5% (77 out of 114). Orientation remained an important factor affecting diagnostic yield. Transbronchial cryobiopsy significantly increased the diagnostic yield in eccentrically and adjacently orientated lesions to 75.0% (18 out of 24), compared to 48.8% (20 out of 41) obtainedviaforceps biopsy (p<0.05); but not in concentric lesions. Cryobiopsy was associated with more mild and moderate bleeding complications compared to the forceps biopsy group.

Conclusions

Transbronchial cryobiopsy under R-EBUS guidance is a safe procedure which potentially increases diagnostic yield in eccentrically and adjacently orientated PPLs.
Genetic diversity and population structure of the sweet leaf herb, Stevia rebaudiana B., cultivated and landraces germplasm assessed by EST-SSRs genotyping and steviol glycosides phenotyping
Authors: Cosson Patrick , Hastoy Cécile , Errazzu Luis Ernesto , Budeguer Carlos Jorge , Boutié Philippe , Rolin Dominique , Schurdi-Levraud Valérie
Published: October 2019

Background

Stevia rebaudiana(Asteraceae),native from Paraguay, accumulates steviol glycosides (SGs) into its leaves. These compounds exhibit acaloric intense sweet taste which answers to consumer demands for reducing daily sugar intake. Despite the developpement ofS. rebaudianacultivation all over the world, the development of new cultivars is very recent, in particular due to a colossal lack of (1) germplasm collection and breeding, (2) studies on genetic diversity and its structuring, (3) genomic tools.

Results

In this study, we developped 18 EST-SSR from 150,258 EST from The Compositae Genome Project of UC Davis (http://compgenomics.ucdavis.edu/data/). We genotyped 145 S. rebaudianaindividuals, issued from thirty-one cultivars and thirty-one landraces of various origins worldwide. Markers polymorphic information content (PIC) ranged between 0.60 and 0.84. An average of 12 alleles per locus and a high observed heterozygoty of 0.69 could be observed. The landraces revealed twice as many private alleles as cultivars. The genotypes could be clustered into 3 genetic populations. The landraces were grouped in the same cluster in which the oldest cultivars “Eirete” and “MoritaIII” type are also found. The other two clusters only include cultivated genotypes. One of them revealed an original genetic variability. SG phenotypes could not discriminate the three genetic clusters but phenotyping showed a wide range of composition in terms of bitter to sweet SGs.

Conclusion

This is the first study of genetic diversity inStevia rebaudianainvolving 145 genotypes, including known cultivars as well as landrace populations of different origin. This study pointed out the structuration ofS. rebaudianagermplasm and the resource of the landrace populations for genetic improvement, even on the trait of SG’s composition.
Patient, clinician and logistic barriers to blood pressure control among adult hypertensives in rural district hospitals in Rwanda: a cross-sectional study
Authors: Sibomana J. P. , McNamara R. L. , Walker T. D.
Published: October 2019

Background

Hypertension management in rural, resource-poor settings is difficult. Detailed understanding of patient, clinician and logistic factors which pose barriers to effective blood pressure control could enable strategies to improve control to be implemented.

Methods

This cross-sectional, multifactorial, observational study was conducted at four rural Rwandan district hospitals, examining patient, clinician and logistic factors. Questionnaires were administered to consenting adult outpatient hypertensive patients, obtaining information on sociodemographic factors, past management for hypertension, and adherence (by Morisky Medication Adherence 8-item Scale (MMAS-8). Treating clinicians identified local difficulties in providing hypertension management from a standard World Health Organisation list and nominated their preferred treatment regimens. Blood pressure measurements and other clinical data were collected during the study visit and used to determine blood pressure control, according to goals from JNC-8 guidelines. Medication availability and cost at each hospital’s pharmacy were reviewed as logistic barriers to treatment.

Results

The 112 participating patients were 80% female, with only 41% having completed primary education. Self-reported adherence by the MMAS-8 was high in 77% (86/112) and significantly associated) with literacy, lack of medication side effects and the particular hospital and pharmacy attended (all p < 0.05). However, of 89 patients with blood pressure data, only 26 (29%) had achieved goal blood pressure. No patient factor were statistically associated with poor blood pressure control. Among 30 participating clinicians, deficiencies in knowledge were evident; 43% (13/30) and 37% (11/30) chose a loop diuretic as their prescribed medication and as an ideal medication, respectively, for a newly diagnosed hypertensive patient without comorbidities, counter to JNC 8 recommendations, and 50% (15/30) identified clinician non-adherence to hypertension guidelines as a barrier. In the pharmacies, common anti-hypertensive medications were affordably available (> 6 out of 8 examined medications available in all pharmacies, cost <US$0.50 per month); however, clinicians perceived medication cost and availability to be barriers to care.

Conclusions

Clinician-based factors are a major barrier to blood pressure control in rural district hospitals in Rwanda, and blood pressure control overall was poor. Patient and logistic barriers to blood pressure were not evident in this study.
Culturally adapted depression education and engagement in treatment among Hispanics in primary care: outcomes from a pilot feasibility study
Authors: Sanchez Katherine , Killian Michael O. , Eghaneyan Brittany H. , Cabassa Leopoldo J. , Trivedi Madhukar H.
Published: October 2019

Background

Low use of anti-depressant medication, poor doctor-patient communication, and persistent stigma are key barriers to the treatment of depression in Hispanics. Common concerns include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications and seeking mental health treatments. In 2014, the Center for Medicare and Medicaid Services (CMS) funded theDepression Screening and Education: Options to Reduce Barriers to Treatment (DESEO)project to implement an education intervention designed to increase disease literacy and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement.

Methods

TheDESEOstudy utilized a one-group pretest-posttest design to assess the effects a culturally-adapted Depression Education Intervention’s (DEI) on depression knowledge, stigma, and engagement in treatment in a sample of 350 Hispanic primary care patients with depression. The DEI utilized afotonovela, a health education tool available in English and Spanish that uses posed photographs, captions, and soap opera narratives to raise awareness about depression and depression treatments.

Results

Participants reported significant decreases in depression symptoms and reported stigma about mental health care. Additionally, participants reported increased knowledge of depression yet greater negative perceptions about antidepressant medication. Finally, 89.5% of participants reported entering some form of treatment at follow-up.

Conclusions

Culturally adapted depression education shows promise in increasing understanding of depression, decreasing stigma, and increasing treatment engagement among Hispanic patients in a community-based health center. Results have implications for practice in addressing common concerns about depression treatments which include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications.

Trial registration

The study was retrospectively registered withwww.clinicaltrials.gov: NCT02491034 July 2, 2015.
Physio4FMD: protocol for a multicentre randomised controlled trial of specialist physiotherapy for functional motor disorder
Authors:   on behalf of the Physio4FMD Collaborative Group, Nielsen Glenn , Stone Jon , Buszewicz Marta , Carson Alan , Goldstein Laura H. , Holt Kate , Hunter Rachael , Marsden Jonathan , Marston Louise , Noble Hayley , Reuber Markus , Edwards Mark J.
Published: October 2019

Background

Patients with functional motor disorder (FMD) experience persistent and disabling neurological symptoms such as weakness, tremor, dystonia and disordered gait. Physiotherapy is usually considered an important part of treatment; however, sufficiently-powered controlled studies are lacking. Here we present the protocol of a randomised controlled trial (RCT) that aims to evaluate the clinical and cost effectiveness of a specialist physiotherapy programme for FMD.

Methods/design

The trial is a pragmatic, multicentre, single blind parallel arm randomised controlled trial (RCT). 264 Adults with a clinically definite diagnosis of FMD will be recruited from neurology clinics and randomised to receive either the trial intervention (a specialist physiotherapy protocol) or treatment as usual control (referral to a community physiotherapy service suitable for people with neurological symptoms). Participants will be followed up at 6 and 12 months. The primary outcome is the Physical Function domain of the Short Form 36 questionnaire at 12 months. Secondary domains of measurement will include participant perception of change, mobility, health-related quality of life, health service utilisation, anxiety and depression. Health economic analysis will evaluate the cost impact of trial and control interventions from a health and social care perspective as well as societal perspective.

Discussion

This trial will be the first adequately-powered RCT of physical-based rehabilitation for FMD.

Trial registration

International Standard Randomised Controlled Trials NumberISRCTN56136713. Registered 27 March 2018.
Prevalence and factors associated with depressive, anxiety and stress symptoms among women with gestational diabetes mellitus in tertiary care centres in Malaysia: a cross-sectional study
Authors: Lee Kai Wei , Ching Siew Mooi , Hoo Fan Kee , Ramachandran Vasudevan , Chong Seng Choi , Tusimin Maiza , Mohd Nordin Noraihan
Published: October 2019

Background

Research on antenatal depressive, anxiety and stress symptoms among women with gestational diabetes mellitus (GDM) is lacking in Malaysia. This study aimed to determine the prevalence and factors associated with antenatal depressive, anxiety and stress symptoms among Malaysian women with GDM.

Methods

This was a descriptive, cross-sectional study of 526 women with GDM. Depressive, anxiety and stress symptoms are defined as the final score in mild to extremely severe risk in the severity rating scale. Data analysis was performed using SPSS v.21, while multiple logistic regression was used to identify predictors of depressive, anxiety and stress symptoms.

Results

Prevalence of anxiety symptoms was highest (39.9%), followed by depressive symptoms (12.5%) and stress symptoms (10.6%) among women with GDM. According to multiple logistic regression analyses, younger age (OR = 0.955, 95% CI = 0.919–0.993), comorbidity with asthma (OR = 2.436, 95% CI = 1.219–4.870) and a family history of depression and anxiety (OR = 4.782, 95% CI = 1.281–17.853) had significant associations with antenatal anxiety symptoms. Being non-Muslim (OR = 2.937, 95% CI = 1.434–6.018) and having a family history of depression and anxiety (OR = 4.706, 95% CI = 1.362–16.254) had significant associations with antenatal depressive symptoms. Furthermore, being non-Muslim (OR = 2.451, 95% CI = 1.273–4.718) had a significant association with antenatal stress symptoms.

Conclusions

Within a population of women with GDM in Malaysia, those at higher risk of having depressive, anxiety and stress symptoms can be identified from several baseline clinical characteristics. Clinicians should be more alert so that the high-risk patients can be referred earlier for further intervention.
Ectopic expression of BIRC5-targeting miR-101-3p overcomes bone marrow stroma-mediated drug resistance in multiple myeloma cells
Authors: Abdi Jahangir , Rastgoo Nasrin , Chen Yan , Chen Guo An , Chang Hong
Published: October 2019

Background

Multiple myeloma (MM) cells gain protection against drugs through interaction with bone marrow stromal cells (BMSCs). This form of resistance largely accounts for resistance to therapy in MM patients which warrants further exploration to identify more potential therapeutic targets.

Methods

We performed miRNA/mRNA qPCR arrays and western blotting to analyze transcriptional and translational changes in MM cells co-cultured with BMSCs. Drug cytotoxicity and apoptosis in MMGFP-BMSC co-cultures were measured using fluorescence plate reader and flowcytometry, respectively. miRNA was overexpressed in MM cell lines using Lentiviral transduction, miRNA-3’UTR binding was examined using luciferase assay.

Results

We found that BMSCs downregulated miR-101-3p and upregulated survivin (BIRC5) in MM cells. Survivin was downregulated by miR-101-3p overexpression and found to be a direct target of miR-101-3p using 3’UTR luciferase assay. Overexpression of survivin increased viability of MM cells in the presence of anti-myeloma drugs, and miR-101-3p inhibition by anti-miR against miR-101-3p upregulated survivin. Furthermore, overexpression of miR-101-3p or silencing of survivin triggered apoptosis in MM cells and sensitized them to anti-myeloma drugs in the presence of BMSCs overcoming the stroma-induced drug resistance.

Conclusions

Our study demonstrates that BMSC-induced resistance to drugs is associated with survivin upregulation which is a direct target of miR-101-3p. This study also identifies miR-101-3p-survivin interaction as a druggable target involved in stroma-mediated drug resistance in MM and suggests it for developing more efficient therapeutic strategies.
Validation of computational determination of microsatellite status using whole exome sequencing data from colorectal cancer patients
Authors: Johansen Amanda Frydendahl Boll , Kassentoft Christine Gaasdal , Knudsen Michael , Laursen Maria Bach , Madsen Anders Husted , Iversen Lene Hjerrild , Sunesen Kåre Gotschalck , Rasmussen Mads Heilskov , Andersen Claus Lindbjerg
Published: October 2019

Background

Microsatellite instability (MSI), resulting from a defective mismatch repair system, occurs in approximately 15% of sporadic colorectal cancers (CRC). Since MSI is associated with a poor response to 5-fluorouracile based chemotherapy and is a positive predictive marker of immunotherapy, it is routine practice to evaluate the MSI status of resected tumors in CRC patients. MSIsensor is a novel computational tool for determining MSI status using Next Generation Sequencing. However, it is not widely used in the clinic and has not been independently validated in exome data from CRC. To facilitate clinical implementation of computational determination of MSI status, we compared MSIsensor to current gold standard methods for MSI testing.

Methods

MSI status was determined for 130 CRC patients (UICC stage I-IV) using immunohistochemistry, PCR based microsatellite stability testing and by applying MSIsensor to exome sequenced tumors and paired germline DNA. Furthermore, we investigated correlation between MSI status, mutational load and mutational signatures.

Results

Eighteen out of 130 (13.8%) patients were microsatellite instable. We found a 100% agreement between MSIsensor and gold standard methods for MSI testing. All MSI tumors were hypermutated. In addition, two microsatellite stable (MSS) tumors were hypermutated, which was explained by a dominant POLE signature and pathogenic POLE mutations (p.Pro286Arg and p.Ser459Phe).

Conclusion

MSIsensor is a robust tool, which can be used to determine MSI status of tumor samples from exome sequenced CRC patients.
Effects of closed-loop automatic control of the inspiratory fraction of oxygen (FiO2-C) on outcome of extremely preterm infants – study protocol of a randomized controlled parallel group multicenter trial for safety and efficacy
Authors:   FiO2-C Study Group, Maiwald Christian A. , Niemarkt Hendrik J. , Poets Christian F. , Urschitz Michael S. , König Jochem , Hummler Helmut , Bassler Dirk , Engel Corinna , Franz Axel R.
Published: October 2019

Background

Most extremely low gestational age neonates (ELGANS, postmenstrual age at birth (PMA) < 28 completed weeks) require supplemental oxygen and experience frequent intermittent hypoxemic and hyperoxemic episodes. Hypoxemic episodes and exposure to inadequately high concentrations of oxygen are associated with an increased risk of retinopathy of prematurity (ROP), chronic lung disease of prematurity (BPD), necrotizing enterocolitis (NEC), neurodevelopmental impairment (NDI), and death beyond 36 weeks PMA.

Closed-loop automated control of the inspiratory fraction of oxygen (FiO2-C) reduces time outside the hemoglobin oxygen saturation (SpO2) target range, number and duration of hypo- and hyperoxemic episodes and caregivers’ workload. Effects on clinically important outcomes in ELGANs such as ROP, BPD, NEC, NDI and mortality have not yet been studied.

Methods

An outcome-assessor-blinded, randomized controlled, parallel-group trial was designed and powered to study the effect of FiO2-C (in addition to routine manual control (RMC) of FiO2), compared to RMC only, on death and severe complications related to hypoxemia and/or hyperoxemia. 2340 ELGANS with a GA of 23 + 0/7 to 27 + 6/7 weeks will be recruited in approximately 75 European tertiary care neonatal centers. Study participants are randomly assigned to RMC (control-group) or FiO2-C in addition to RMC (intervention-group). Central randomization is stratified for center, gender and PMA at birth (< 26 weeks and ≥ 26 weeks).

FiO2-C is provided by commercially available and CE-marked ventilators with an FiO2-C algorithm intended for use in newborn infants. The primary outcome variable (composite of death, severe ROP, BPD or NEC) is assessed at 36 weeks PMA (or, in case of ROP, until complete vascularization of the retina, respectively). The co-primary outcome variable (composite outcome of death, language/cognitive delay, motor impairment, severe visual impairment or hearing impairment) is assessed at 24 months corrected age.

Discussion

Short-term studies on FiO2-C showed improved time ELGANs spent within their assigned SpO2target range, but effects of FiO2-C on clinical outcomes are yet unknown and will be addressed in the FiO2-C trial. This will ensure an appropriate assessment of safety and efficacy before FiO2-C may be implemented as standard therapy.

Trial registration

The study is registered at www.ClinicalTrials.gov:NCT03168516, May 30, 2017.