bluuebunny/crossref_metadata_2025 huggingface dataset:
Age and education as factors associated with medication literacy: a community pharmacy perspective.
Authors: Plaza-Zamora Javier , Legaz Isabel , Osuna Eduardo , Pérez-Cárceles M. D.
Published: September 2020

Background: Aging implies a higher prevalence of chronic pathologies and a corresponding increase in medication. The correct adherence and use of the medication are prerequisites for reducing risks of disease progression, comorbidity, and mortality. Medication literacy (ML) is the specific ability to safely access and understand the information available concerning medication, and to act accordingly. Currently, there are few specific instruments that ascertain the extent of ML in the general population. The aim of this work was to analyse ML in a large cohort of pharmacy customers. Methods: A total of 400 community pharmacy clients were analyzed to assess the level of ML (documental and numeracy) through the validated MedLitRxSE tool. Results: The results showed that out of a total of 400 community pharmacy clients only 136 (34%) had an adequate degree of ML, while the rest of the clients (n=264; 66%) were adjudged not to have this ability. Statistically significant differences were found between the different age groups in terms of ML (P<0.001; OR=0.312; 95% CI: 0.195-0.499), the 51-65 and ˃65-year age groups having a lower frequency of adequate ML (23.5% and 7.1%, respectively) than the rest of the age groups. A statistically significant increase in adequate ML was observed as the academic level of the clients increased (P <0.001; OR=15.403; 95% CI: 8.109-29.257). Multivariate logistic regression confirmed the influence of both variables on ML. Conclusions: An inadequate ML level was found in community pharmacy clients over the age of 51, and also in those with primary or non-formal studies. Our data add to our knowledge about ML, and should pharmacists and other health professionals to adopt new strategies to prevent, or at least reduce, errors in taking medicines, thus avoiding the undesirable effects of any misuse.
Risk Factors Associated With Infection of Blood-Borne Virus among People Who Used Methamphetamine
Authors: Cai Yilin , Dai Zheng , Wen Sijin , Bhandari Ruchi
Published: September 2020

Background The surge of methamphetamine use has been a complicating factor compounding the steeply increasing number of drug overdose deaths in the U.S. Infection from blood-borne viruses including hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, related to methamphetamine use continue to grow. This study aims to examine the risk factors associated with HBV, HCV and HIV among people who used methamphetamine. Methods People who ever used methamphetamine were identified from five National Health and Nutrition Examination Survey (NHANES) cohorts, 2007 to 2016. The outcome was either positive or negative for blood-borne viruses as identified from laboratory tests. Weighted statistics for the combined ten years of data were calculated by multiplying the weighted variable for laboratory measurements by 0.2. We examined the association of sexual activities (sexual partners, sexual identity), drug use behaviors (poly-drug use, injection drug use, frequency of drug use, age started using methamphetamine), demographics, and socio-economic status with blood-borne viruses using bivariate and multivariable logistic regression models. Results There were 1132 participants representing approximately 11,996,319 persons who ever used methamphetamine in the U.S. Blood-borne viruses’ positive rate was 13.0 per 100,000. Multivariable logistic regression analyses showed significant associations of blood-borne infections with age 40-49 years (vs. age 20-29 years, adjusted odds ratio 4.77, 95% CI 1.11–20.55), age 50-59 years (vs. age 20-29 years, 10.25, 2.40-43.82), living within poverty index 1-1.9 (vs. poverty index >=2, 2.55; 1.19–5.49), living below the poverty threshold (vs. poverty index >=2, 2.55; 1.11 – 5.86), having lower than high school education (vs. equal or higher than high school education, 3.13; 1.51 – 6.46), sexual identity as other than heterosexual (vs. heterosexual, 5.60; 1.72 – 18.28), using methamphetamine and heroin and cocaine (vs. using methamphetamine alone, 4.24; 1.06 – 16.92), injection drug use (vs. no injection drug use, 3.15; 1.61 – 6.16), and started using methamphetamine at age above 25 (vs. started using methamphetamine at age between 10-17, 2.09; 1.01 – 4.35). Conclusions Among people who use methamphetamine, those who use polysubstance, or who inject substances, are in urgent need for vaccination and interventions to avoid further harm from blood-borne infections.
Cost-effective joint Optimisation of BBU Placement and Fronthaul Deployment in Brown-field Scenarios
Authors: Marotta Andrea , Correia Luis Manuel
Published: September 2020

In this work , one proposes a model to evaluate the optimal deployment of Centralised Radio Access Network (C- RAN ) architecture elements , i.e. Base Band processing Units ( BBUs ) and fronthaul links , in a brown- field scenario, in which traditional base stations are already deployed and a physical network is present. The proposed optimisation framework jointly optimises BBU placement and access network infrastructures deployment . It clusterises the Remote Radio Heads in the scenario through a Multicommodity Flow approach , and solves the minimum cost fronthaul network deployment through a Rooted Delay - Constrained Minimum Spanning Tree approach . Optical fibre and microwave links are considered as fronthaul infrastructures . The proposed optimisation framework is validated through a comparison with a theoretical output for a canonical scenario, being afterwards applied to a real scenario. A cost analysis for different scenario configurations is presented , and trade - offs and guidelines for a cost optimal deployment of C- RAN are provided . The analysis of results for the real scenario of the city of Lisbon and its surrounding areas shows that the delay budget in the fronthaul network highly impacts on capital expenditures as well as on operational ones . It is shown that a larger delay budget enables an annual cost reduction up to 72 % in urban areas and 54 % in rural ones .
Number of long-term inpatients in Japanese psychiatric care beds: trend analysis from the Patient Survey and the 630 Survey
Authors: Okayama Tatsushi , Usuda Kentaro , Okazaki Emi , Yamanouchi Yoshio
Published: September 2020

BackgroundThe number of psychiatric care beds and the mean length of stay in psychiatric care beds in Japan have decreased over the past 10 years. However, as has long been indicated here and elsewhere, Japan lags behind other countries in terms of deinstitutionalization. Furthermore, the population of inpatients in psychiatric care beds is aging dramatically. In addition to the diversification of mental illness, the question of what measures to implement going forward regarding current psychiatric bed resources has emerged as a new challenge.MethodsUsing data from the Patient Survey and the 630 Survey, we examined trends in the number of long-term inpatients in psychiatric care beds in Japan through 2040. Population estimation was used for estimating long-term hospital bed demand because of small fluctuations in the admission and discharge of long-term inpatients.ResultsIn 2017, nearly one-third of all long-term hospitalized patients were aged ≥75 years, and an estimated 47% of the total are expected to die by 2040. Thus, the overall demand for long-term hospitalization is forecast to decrease sharply due to aging of currently hospitalized long-term inpatients. The number of long-term inpatients in 2017 was 167,579, and this is projected to decrease to 103,141 in 2040.ConclusionsWe believe it is necessary to adopt a multifaceted approach to promote hospital discharge and transition to the community, and to address the diversification of mental illness and the issue of psychiatric care bed supply/availability, which are forecast to decrease due to the natural decrease in long-term inpatients.
Cessation of nucleos(t)ide analogues therapy in chronic hepatitis B: a systematic review and meta-analysis
Authors: Xie Yandi , Jin Rui , Song Guangjun , Ma Hui , Feng Bo
Published: September 2020

Background: To address the possibility of safe cessation of nucleos(t)ide analogues (NAs) therapy in chronic hepatitis B (CHB) and to identify factors associated with off-NAs virological relapse (VR). Methods: A published work search was performed to identify all published studies including patients who ceased NAs and were followed for ≥12 months. A meta-analysis was performed. Results: Twenty-six studies involving 2573 patients who discontinued NAs were included. The pooled rate of off-NAs VR was 0.64, being lower in initially hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients (0.62 versus 0.63, P = 0.731). The pooled rates of VR were 0.48, 0.56, 0.61, 0.53, 0.71 and 0.65 at 6, 12, 24, 36, 48 and 60 months after NAs cessation, respectively, being relatively lower in initially HBeAg-positive (0.36, 0.50, 0.58, 0.49, 0.50, 0.60) than HBeAg-negative patients (0.51, 0.56, 0.67, 0.59, 0.53, 0.65) (P = 0.400) . The pooled rate of biochemical relapse was 0.45, being lower in initially HBeAg-positive than HBeAg-negative patients (0.43 versus 0.51, P = 0.572). The pooled rates of hepatitis B surface antigen (HBsAg) loss and seroconversion was 0.09 and 0.06, respectively. The pooled rates of VR at 12 months after NAs cessation were significantly different between duration of on-NAs virological response ≤24 months and >24 months in all patients (0.55 versus 0.41, P = 0.011), initially HBeAg-positive patients (0.59 versus 0.41, P = 0.031), and initially HBeAg-negative patients (0.53 versus 0.37, P = 0.025). Conclusions: Cessation of NAs therapy seems to be safe in a small subset of CHB patients. On-NAs virological response >24 months reduces the risk of off-NAs VR.
Experience of Management of Anorexia Nervosa Patients With Extremely Severe Malnutrition In A Transdisciplinary Eating Disorders Inpatient Unit
Authors: Guinhut Marie , Melchior Jean-Claude , Godart Nathalie , Hanachi Mouna
Published: September 2020

Background: The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity.Method: First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients characteristics: demographic, nutritional status, history of ED, care pathway. Results: Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (± 11.5) years, mean BMI was 12.7 (± 2.2) kg/m². Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition.Conclusion: This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.
Evaluation of adhesion barrier types in a rat hepatectomy-induced adhesion model
Authors: Shimizu Atsushi , Kai Miho , Tasaki Masako , Chino Naotaka , Hasegawa Kiyoshi , Kokudo Norihiro
Published: September 2020

Background: Adhesion formation after hepatectomy creates problems for repeat hepatectomy. This study aimed to compare the effectiveness of a spray (AdSpray) and sheet adhesion barrier (Seprafilm) in a rat hepatectomy-induced adhesion model. Methods: Thirty male Sprague-Dawley rats underwent partial resection of the left lateral liver lobe. They were randomly assigned to control (n=10), AdSpray (n=10), and Seprafilm groups. Seven days after surgery, the animals were sacrificed, and adhesions at the hepatic resection surface were blindly evaluated. Results: In the control group, adhesions were formed in all 10 animals (100%), with a 69% adhesion extent (mean). In the AdSpray group, the incidence of adhesions (40%) and the adhesion extent (mean, 10%) were significantly lower than in the control group (incidence; p = 0.0147, adhesion extent; p = 0.0007). In the Seprafilm group, the incidence of adhesions was 70%. The adhesion extent of Seprafilm (mean, 30%) was significantly lower than in the control group (p = 0.0492). No significant differences were observed between the AdSpray and Seprafilm groups. As for histopathological examination, animals in the AdSpray group showed a similar healing profile to that of the control group without delayed healing and regeneration of mesothelial cells. In contrast, the Seprafilm group showed ongoing foreign body reaction to Seprafilm, and regeneration of mesothelial cells was immature at 7 days. Conclusions: Both the spray-type gel and sheet adhesion barriers significantly reduced adhesion formation after hepatectomy. The spray-type adhesion barrier caused no adverse events and induced favorable healing. These adhesion barriers may be effective in hepatectomy. Further animal studies and clinical trials are required to determine their benefits in clinical use.
Risk models and scores for metabolic syndrome: a systematic review
Authors: Ibrahim Musa Saulawa , Pang Dong , Pappas Yannis , Randhawa Gurch
Published: September 2020

Background:Metabolic syndrome - ‘a clustering of risk factors which includes hypertension, central obesity, impaired glucose metabolism with insulin resistance, and dyslipidaemia’ is linked with increased risk of CVD, T2DM and all-cause mortality. Despite the high number of models and scores for assessing the risk of developing MetS, there is hardly any used in research or practical setting. Hence, we conducted a systematic review to determine the performance of risk models and scores for predicting MetS.Methods:Following the methods proposed by EPPI-Centre, we systematically searched MEDLINE, CINAHL, PUBMED and Web of Science to identify studies that either derive or validate risk models or scores for predicting the risk of MetS. Search was originally done in September 2018 and updated in September 2020. Data concerning models’ statistical properties as well as details of internal or external validations were extracted. Tables were used to compare various components of models and statistical properties. Finally, PROBAST was used to assess the methodological quality (risk of bias) of included studies.Results:A total of 27 studies reporting about the development, validation or both of MetS risk models were included. There is significant heterogeneity between studies in terms of geography/demographics, data type and methodological approach. Majority of the models or risk scores were developed or validated using data from cross-sectional studies, or routine data. Various combinations of risk factors (predictors) were considered significant in the respective final model. Similarly, different criteria were used in the diagnosis of MetS, but, NCEP criteria including its modified versions were by far the most widely used (32.5%). There is generally poor reporting quality across the studies, especially concerning statistical data. Any form of internal validation is either not conducted, or not reported in nearly a fifth of the studies. Only two (2) risk models or scores were externally validatedConclusions:There is an abundance of MetS models in the literature. But, their usefulness is doubtful, due to limitations in methodology, poor reporting and lack of external validation and impact studies. Therefore, researchers in the future should focus more on externally validating/ applying such models in a different setting.
The Relationship between Quality of Life, Bone Pain, Skin Pruritus and Depression among Patients with Secondary Hyperparathyroidism undergoing Parathyroidectomy: A Cross-Sectional Study
Authors: Bi Ting , Feng Xiaodong , Zhang Wei , Cheng Guangming , Wang Chunhui , Tang Yufu , Bai Sijia , Guo Shuai
Published: September 2020

Background: Secondary hyperparathyroidism (SHPT), a manifestation of chronic kidney disease-mineral bone disorder (CKD-MBD), is common in CKD patients and has significant morbidity and mortality. Quality of life (QOL) in SHPT patients is seriously affected by symptoms such as bone pain and skin pruritus. However, studies have focused on operative effects and hypocalcemia rather than the relationships between QOL, bone pain, skin pruritus and depression symptoms.Methods: A cross-sectional survey was conducted from January 2017 to December 2019 in a third-class hospital in China. The brief table of the QOL measurement scale (QOL-BREF), a self-designed bone pain and skin pruritus scale and the Self-rating Depression Scale (SDS) were used to estimate QOL, bone pain and skin pruritus, and depression, respectively. Pearson’s correlation, multiple linear regression analysis and structural equation modeling (SEM) were used for analysis.Results: Overall, 320 questionnaires were considered valid (98.46% effective response rate). The prevalence of bone pain, skin pruritus and depression was 94.06%, 69.06%, and 77.81%, respectively. Bone pain, skin pruritus and depression were significantly associated with QOL. In SEM, QOL negatively correlated with bone pain (r=-0.509), skin pruritus (r=-0.517) and SDS (r=-0.465). Bone pain significantly (P<0.01) and positively correlated with skin pruritus (r=0.568) and SDS (r=0.450). Skin pruritus significantly (P<0.01) and positively correlated with SDS (r=0.426). In addition, QOL partially mediated the association between bone pain or skin pruritus and depression (mediation proportion of 48.62% or 45.08%).Conclusions: Patients with SHPT undergoing Parathyroidectomy(PTX) have high depression levels and poor QOL due to bone pain and skin pruritus. The effects on depression may be fully mediated by the impact of bone pain or skin pruritus on QOL. Thus, bone pain or skin pruritus could increase depression via the intermediary role of QOL.For clinical front-line medical staff,it can relieve bone pain and skin pruritus through timely operation and psychological intervention, so as to improve patients' quality of life and reduce anxiety.At the same time, we should also pay attention to the high-risk groups.
Evaluation of sensitivity and specificity of CanPatrolTM technology for detection of circulating tumor cells in patients with non-small cell lung cancer
Authors: Li Jingyao , Liao Yi , Ran Yaling , Wang Guiyu , Wu Wei , Qiu Yang , Liu Jie , Wen Ningyu , Jing Tao , Wang Haidong , Zhang Shixin
Published: September 2020

BackgroundThe early diagnosis of non-small cell lung cancer is of great significance to the prognosis of patients. However, traditional histopathology and imaging screening have certain limitations. Therefore, new diagnostical methods are urgently needed for the current clinical diagnosis. In this study we evaluated the sensitivity and specificity of CanPatrolTM technology for the detection of circulating tumor cells in patients with non-small cell lung cancer (NSCLC).MethodsCTCs in the peripheral blood of 98 patients with NSCLC and 38 patients with benign pulmonary diseases were collected by the latest typing of CanPatrolTM detection technology. A 3-year follow-up was performed to observe their recurrence and metastasis. Kruskal-Wallis test was used to compare multiple groups of data, Mann-Whitney U test was used to compare data between the two groups, and ROC curve analysis was used to obtain the critical value. The COX risk regression and Kaplan-Meier survival analysis were performed in the 63 NSCLC patients who were effectively followed up.ResultsThe epithelial, epithel﻿ial-mesenchymal, and total CTCs were significantly higher in NSCLC patients than that in patients with benign lung disease (P < 0.001). The mesenchymal CTCs of NSCLC patients was slightly higher than that of benign lung diseases (P = 0.013). The AUC of the ROC curve of the total CTCs was 0.837 (95% CI: 0.76-0.914), and the cut-off value corresponding to the most approximate index was 0.5 CTCs/5 ml, at which point the sensitivity was 81.6% and the specificity was 86.8%. COX regression analysis revealed that the clinical stage was correlated with patient survival (P = 0.006), while gender, age, and smoking were not (P > 0.05). After excluding the confounders of staging, surgery, and chemotherapy, Kaplan-Meier survival analysis showed that patients in stage IIIA with CTCs ≥ 0.5 had significantly lower DFS than those with CTCs < 0.5 (P = 0.022).ConclusionsCTC positive can well predict the recurrence of NSCLC patients. CanPatrolTM technology has good sensitivity and specificity in detecting CTCs in peripheral blood of NSCLC patients and has a certain value for clinical prognosis evaluation.
Conservative management of CIN2p16 positive lesions in women with multiple HPV infection
Authors: Bruno Maria Teresa , Scalia Guido , Cassaro Nazario , Costanzo Maria , Boemi Sara
Published: September 2020

BackgroundAccording to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. However, excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. In our study we sought to identify a clear management strategy, addressing the impact of routine use of p16 immunohistochemistry in this population and identify appropriate criteria for patient selection with the aim of reducing over-treatment.MethodWe studied the medical records of 130 patients who had undergone laser therapy for CIN2. Each patient underwent colposcopy, biopsy and HPV test and were tested for p16 protein,. Patients were divided based on HPV infection into: single infections, multiple infections. All patients underwent ZTA laser therapy with follow-up (2-year follow-up ). Statistical analysis Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p <0.05 were considered statistically significant.ResultsSingle infections had a histological regression of 61.8% (21/34) and a histological persistence rate of 35.3% (12/34), which was greater than the multiple infection rate. The common characteristic that the women with persistence and progression had was the dimension of the lesion and the genotype 16. Ten cases of histological persistence and the only case of progression had one lesion greater than three quarters of the cervix.ConclusionsWith the progress of our understanding of the natural history of infection from human papillomavirus and the increasing use of colposcopy, thanks to the addition of HPV genotyping and the technique of immunohistochemistry, conservative management of these lesions is now possible
Apolipoprotein C1 stimulates the malignant process of renal cell carcinoma via the Wnt3a signaling
Authors: jiang hao , Tang Jing-Yuan , Xue Dong , Chen Yi-Meng , Wu Ting-Chun , Zhuang Qian-Feng , He Xiao-Zhou
Published: September 2020

Background Renal cell carcinoma (RCC) is a clinically common tumor in the urinary system, showing an upward trend of both incidence and mortality. Apolipoprotein C1 (APOC1) has been identified as a vital regulator in tumor progression. This study aims to uncover the biological function of APOC1 in RCC process and the underlying mechanism. MethodsDifferential levels of APOC1 in RCC samples and normal tissues in a downloaded TCGA profile and clinical samples collected in our center were detected by quantitative reverse transcription PCR (qRT-PCR). The prognostic value of APOC1 in RCC was assessed by depicting Kaplan-Meier survival curves. After intervening APOC1 level by transfection of sh-APOC1 or oe-APOC1, changes in phenotypes of RCC cells were examined through CCK-8, colony formation, Transwell assay and flow cytometry. Subsequently, protein levels of EMT-related genes influenced by APOC1 were determined by Western blot. The involvement of the Wnt3a signaling in APOC1-regulated malignant process of RCC was then examined through a series of rescue experiments. Finally, a RCC xenograft model was generated in nude mice, aiming to further clarify the in vivo function of APOC1 in RCC process.ResultsAPOC1 was upregulated in RCC samples. Notably, its level was correlated to overall survival of RCC patients, displaying a certain prognostic value. APOC1 was able to stimulate proliferative and metastatic abilities in RCC cells. The Wnt3a signaling was identified to be involved in APOC1-mediated RCC process. Notably, Wnt3a was able to reverse the regulatory effects of APOC1 on RCC cell phenotypes. In vivo knockdown of APOC1 in xenografted nude mice slowed down the growth of RCC.ConclusionsAPOC1 stimulates the malignant process of RCC via targeting the Wnt3a signaling.
Smart@Home – Supporting safety and mobility of elderly and care dependent people in their own homes through the use of technical assistance systems and conventional mobility supporting tools: A cross-sectional survey
Authors: Jachan Deborah Elisabeth , Strube-Lahmann Sandra , Müller-Werdan Ursula , Lahmann Nils Axel
Published: September 2020

BACKGROUND: The use of technical solutions and conventional mobility supporting aids can support the independence of people into old age in their own homes. However, we found relatively few empirical investigations on the effects and costs of these systems.Methods: The aim of the study was to investigate usability, user satisfaction and the correlation between costs and benefits of different built-in smart home solutions and conventional mobility supporting tools in the home of elderly, partially care-dependent tenants (>65 years). A cross-sectional survey was conducted from February to March 2018 with tenants of a housing association in apartments equipped with smart home technology and conventional mobility supporting tools. The response rate in the intervention group was n=37 persons (out of 46 tenants with installed smart home and conventional solutions) and in the control group n=64 persons (out of 100 tenants without built-in smart home and conventional solutions). Data were collected by a written questionnaire regarding usability and satisfaction of the tenants with the built-in smart home solutions and conventional mobility supporting tools. In addition, both the intervention and the control group were asked general questions about communication, safety and how to deal with the need for long-term care in their own living environment.RESULTS: Results showed that with regard to usability, satisfaction and price performance ratio of the installed smart home solutions, the installation of the corresponding solutions with an overall score of 1.41 (on a scale of 1 (very good) to 6 (unsatisfactory)) was mostly positively evaluated by the tenants. Overall, users rated the installed smart home solutions better than the conventional mobility supporting tools (such as handholds and increased balcony floor level).CONCLUSIONS: Analysis of the price performance ratio showed that smart home solutions are generally more expensive than conventional tools, but also contribute significantly to an increased security of the tenants, and thus may enable longer living in a familiar environment. We recommend modularized offers consisting of various components of smart home solutions, since this significantly reduces installation costs and allows for an individual composition according to requirements. Moreover, smart home solutions should be considered to be listed as medical aids.
The Synergetic Effect of Imipenem-Clarithromycin Combination in the Mycobacteroides abscessus Complex
Authors: Takei Satomi , Ihara Hiroaki , Togo Shinsaku , Nakamura Ayako , Fujimoto Yuichi , Watanabe Junko , Kurokawa Kana , Kohei Shibayama , Sumiyoshi Issei , Ochi Yusuke , Iwai Moe , Okabe Takahiro , Chonan Masayoshi , Misawa Shigeki , Ohsaka Akimichi , Takahashi Kazuhisa
Published: September 2020

Background: Nontuberculous mycobacteria (NTM) are ubiquitous organisms and the incidence of NTM infections has been increasing in recent years. Mycobacteroides abscessus (M. abscessus) is one of the most antimicrobial-resistant NTM; however, no reliable antibiotic regimen can be officially advocated. We evaluated the efficacy of clarithromycin in combination with various antimicrobial agents against the M. abscessus complex. Results: Twenty-nine clinical strains of M. abscessus were isolated from various clinical samples. Of the isolates, 10 (34.5%) were of M. abscessus subsp. abscessus, 18 (62.1%) of M. abscessus subsp. massiliense, and 1 (3.4%) of M. abscessus subsp. bolletii. MICs of three antimicrobial agents (amikacin, imipenem, and moxifloxacin) were measured with or without clarithromycin. The imipenem-clarithromycin combination significantly reduced MICs compared to clarithromycin and imipenem monotherapies, including against resistant strains. The association between susceptibility of the M. abscessus complex and each combination of agents was significant (p = 0.001). Adjusted residuals indicated that the imipenem-clarithromycin combination had the synergistic effect (adjusted residual = 3.1) and suppressed the antagonistic effect (adjusted residual = -3.1). In subspecies of M. abscessus complex, the association with susceptibility of M. abscessus subsp. massiliense was similarly statistically significant (p = 0.036: adjusted residuals of synergistic and antagonistic effect respectively: 2.6 and -2.6). The association with susceptibility of M. abscessus subsp. abscessus also showed a similar trend but did not reach statistical significance. Conclusion: Our data suggest that the imipenem-clarithromycin combination could be the recommended therapeutic choice for the treatment of M. abscessus complex owing to its ability to restore antimicrobial susceptibility.
A GIS based approach to neighbourhood physical environment and walking among adults in Colombo Municipal Council Area, Sri Lanka
Authors: Weliange Shreenika De Silva , Fernando Dulitha , Withanage Shanthi , Gunatilake Jagath
Published: September 2020

Background Physical Activity (PA) promotes health and wellbeing and walking is one of the easiest and commonest way to incorporate activity into everyday life. This study examined the association between the objectively measured neighbourhood physical environment and walking among the adults in Colombo Municipal Council (CMC) area in Sri Lanka. Methods A cross sectional study was carried out and primary data collection carried out to assess walking, socio-demographic characteristics and geo location of residence. Secondary data was obtained to assess neighbourhood environment from existing spatially referenced data from the survey department of Sri Lanka. Geographic Information Systems (GIS) was used to calculate density measures (residential density, land use, connectivity and access) and distance measures, which were then correlated with walking. Results A sample consisted of 284 adults aged 29-59 years with a mean age of 40.6 (SD,10.9) years. The total mean minutes walked a week was 175.8 minutes with a standard deviation of 214.0. The mean and the standard deviations of walking per week for transportation and leisure were 158.4 (SD,196.6) and 17.5 (SD,70.1) respectively. Residential density measures, building foot print area, length of major roads, number of intersections, number of bus stops, and distance to nearest major roads showed significant moderate degree of correlations with total minutes of walked per week, (p < 0.001). These results were similar with walking for transportation. Conclusion There is indication that neighbourhood features are associated with walking among the adults in the CMC area using secondary data on physical environment. This paves way for further exploration to understand the relationship between neighbourhood physical environment and walking which could be used for effective interventions to promote walking.
A model based on CT radiomic features for predicting RT-PCR becoming negative in coronavirus disease 2019 (COVID-19) patients
Authors: Cai Quan , Du Siyao , Gao Si , Huang Guoliang , Zhang Zheng , Li Shu , Wang Xin , Li Peiling , Lv Peng , Hou Gang , Zhang Lina
Published: September 2020

Background: Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic. According to the diagnosis and treatment guidelines of China, negative reverse transcription-polymerase chain reaction (RT-PCR) is the key criterion for discharging COVID-19 patients. However, repeated RT-PCR tests lead to medical waste and prolonged hospital stays for COVID-19 patients during the recovery period. Our purpose is to assess a model based on chest computed tomography (CT) radiomic features and clinical characteristics to predict RT-PCR negativity during clinical treatment.Methods: From February 10 to March 10, 2020, 203 mild COVID-19 patients in Fangcang Shelter Hospital were retrospectively included (training: n=141; testing: n=62), and clinical characteristics were collected. Lung abnormalities on chest CT images were segmented with a deep learning algorithm. CT quantitative features and radiomic features were automatically extracted. Clinical characteristics and CT quantitative features were compared between RT-PCR-negative and RT-PCR-positive groups. Univariate logistic regression and Spearman correlation analyses identified the strongest features associated with RT-PCR negativity, and a multivariate logistic regression model was established. The diagnostic performance was evaluated for both cohorts.Results: The RT-PCR-negative group had a longer time interval from symptom onset to CT exams than the RT-PCR-positive group (median 23 vs. 16 days, p<0.001). There was no significant difference in the other clinical characteristics or CT quantitative features. In addition to the time interval from symptom onset to CT exams, nine CT radiomic features were selected for the model. ROC curve analysis revealed AUCs of 0.811 and 0.812 for differentiating the RT-PCR-negative group, with sensitivity/specificity of 0.765/0.625 and 0.784/0.600 in the training and testing datasets, respectively.Conclusion: The model combining CT radiomic features and clinical data helped predict RT-PCR negativity during clinical treatment, indicating the proper time for RT-PCR retesting.
Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart AngelTM app and an original web platform for patients following outpatient surgery: A prospective observational pilot study.
Authors: Chevallier Thierry , Buzancais Gautier , Occean Bob-valery , Rataboul Pierre , Boisson Christophe , simon natacha , Lannelongue Ariane , Chaniaud Noemie , Gricourt Yann , Lefrant Jean-Yves , cuvillon philippe
Published: September 2020

BackgroundRemote monitoring of mean arterial blood pressure (MAP), heart rate (HR) or oxygen saturation (SpO2) remains a challenge in outpatient surgery. This study evaluates a new digital technology (Smart AngelTM) for remotely monitoring hemodynamic data in real time: data transmitted from the patient's home to a central server, using a dedicated web-based software package.MethodsAdults scheduled for elective outpatient surgery were prospectively enrolled. In the first 5 postoperative days, patients completed a self-report questionnaire (pain, comfort, nausea, vomiting) and recorded SpO2, HR and MAP via two wireless Bluetooth monitors connected to a 4G tablet to transmit the data to a website, in real time, using Smart AngelTM software. Before transmission to the website, these data were also self-reported by the patient on a paper form. The primary outcome was the proportion of variables (self-monitored physiological data + questionnaire scores) correctly transmitted to the hospital via the system compared with the paper version.On Day 5, a system usability scale survey (SUS score 1-100) was also attributed.ResultsFrom May 2018 to September 2018, data were available for 29 out of 30 patients enrolled (1 patient was not discharged from hospital after surgery). The remote monitoring technology recorded 2038 data items (62%) compared with 2656 (82%) items recorded on the paper form (p=0.001). The most common errors with the remote technology were software malfunctioning when starting the MAP monitor and malfunctioning between the tablet and the Bluetooth monitor. No serious adverse events were noted. The SUS score for the system was 85 (68-93) for 26 patients.ConclusionThis work evaluates the ability of a pilot system for monitoring remote physiological data using digital technology after ambulatory surgery and highlights the digital limitations of this technology. Technological improvements are required to reduce malfunctioning (4G access, transmission between apps).Trial registration: ClinicalTrials.gov (NCT03464721) (March 8, 2018)
Prevalence and predictors of work related musculoskeletal disorders among workers of a Gold mine in the Democratic Republic of Congo
Authors: Okello Alfred , Wafula Solomon Tsebeni , Deogratias Deogratias K , Mugambe Richard K
Published: September 2020

Background: Work-related musculoskeletal disorders (WRMSDs) are a major constraint to worker performance and health. However, research on their prevalence and associated factors among workers at gold mines in the Democratic Republic of Congo (DRC) is insufficient. The present study aimed to determine the prevalence and predictors of WRMSDs among workers of a Gold Mine in South Kivu, DRC. Methods: Cross sectional data was collected using a modified Nordic questionnaire and upper limb Core QX checklist from 196 workers of a gold mine. A generalised linear model of the Poison family with link log and robust error variances was used to generate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the factors associated with WRMSDs. All analysis were performed in Stata 14 software.Results: Most workers were males 187 (95.4%) and their age ranged between 23 and 60 years with mean of 36.3 years. Of the 196 workers, 49 (25.0%) reported having WRMSDs during the previous 12 months. WRMSDs with highest occurrence rate were the lower back pain (24.6%), followed by thighs/hip pain (15.3%) and shoulder pain (13.6%). Prolonged heavy lifting/shovelling shovelling (PR = 2.26, 95% CI [1.32, 3.86] and longer work shifts (> 9hrs) (PR = 3.43, 95% CI [1.98, 12.03]) were predictive for WRMSDs while jobs with low demands were protective against WRMSDs (PR = 0.26, 95% CI [0.16, 0.42]).Conclusion: The prevalence of WRMSDs is high and associated with prolonged heavy lifting/shovelling, longer work shifts and job demands. We recommend lowering workload and job demands and improving work ergonomics to mitigate and prevent the WRMSDs among workers in goldmines.
Molecular detection of drug resistant polymorphisms in Plasmodium falciparum isolates from Southwest, Nigeria.
Authors: Tola Monday , Ajibola Olumide , Idowu Taiwo Emmanuel , Omidiji Olusesan , Awolola Samson Taiwo , Amambua-Ngwa Alfred
Published: September 2020

ObjectiveNigeria bears 25% of global malaria burden despite concerted efforts towards its control and elimination. The emergence of drug resistance to first line drugs, artemisinin combination therapies (ACTs), indicates an urgent need for continuous molecular surveillance of drug resistance especially in high burden countries where drug interventions are heavily relied on. This study describes mutations in Plasmodium falciparum genes associated with drug resistance in malaria; Pfk13, Pfmdr1, PfATPase6 and Pfcrt in isolates obtained from 83 symptomatic malaria patients collected in August 2014, aged 1-61 years old from South-west Nigeria. ResultsTwo Pfmdr1, N86 and Y184 variants were present at a prevalence of 56% and 13.25% of isolates respectively. There was one synonymous (S679S) and two non-synonymous (M699V, S769M) mutations in the PATPase6 gene, while Pfcrt genotype (CVIET), had a prevalence of 45%. The Pfk13 C580Y mutant allele was suspected by allelic discrimination in two samples with mixed genotypes although this could not be validated with independent isolation or additional methods. Our findings call for robust molecular surveillance of antimalarial drug resistance markers in west Africa especially with increased use of antimalarial drugs as prophylaxis for Covid-19.
Water hardness influenced reproductive potential in two freshwater fish species; Poecilia reticulata and Betta splendens
Authors: Krishnakumar Abarna , Patrick Anton , Jayawardena Uthpala
Published: September 2020

Objective: Hardness of water in the form of CaCO3 affect reproductive potential in various fish species, differently. The study evaluates the effect of water hardness on growth and reproduction of two aquarium fishes, Poecilia reticulata (Ovo-viviparous sp.) and Betta splendens (Oviparous sp.) by growing them under 150 (control), 320, 540 and 900 ppm CaCO3 levels in semi natural aquaria. Results: Growth increased with increasing water hardness, reporting a significant growth of P. reticulata (p=0.005) at 900ppm. Similarly, the reproductive potential of P. reticulata was improved significantly, recording the highest fecundity (16.22 ± 3.90) and Gonadosomatic Index (GSI-2.48 ± 0.597) at 900ppm. However, in B. splendens water hardness adversely affected the reproduction by reporting a significantly low hatchability and disturbed bubble nests at 900ppm, compared to the largest bubble nest formed at the control (108.58 ± 16.19 cm2). Thus, study revealed differential effects of water hardness on reproductive potential of the test species, by increasing the potential of P. reticulata while decreasing that of B. splendens. Though larval survival was affected in both species, larval growth was improved significantly in P. reticulata at 900ppm level. Understanding reproductive potential of aquarium fishes in natural waters is crucial for their propagation purposes. .
iTRAQ-based comparative proteomic analysis of differences in the protein profiles of stems and leaves from two alfalfa genotypes
Authors: Sun Hao , Yu Jie , Zhang Fan , Kang Junmei , Li Mingna , Wang Zhen , Liu Wenwen , Zhang Jiaju , Yang Qingchuan , Long Ruicai
Published: September 2020

Background: To explore the molecular regulatory mechanisms of early stem and leaf development, proteomic analysis was performed on leaves and stems of F genotype alfalfa, with thin stems and small leaves, and M genotype alfalfa, with thick stems and large leaves.Results: Based on fold-change thresholds of >1.20 or <0.83 (p<0.05), a large number of proteins were identified as being differentially enriched between the M and F genotypes: 249 downregulated and 139 upregulated in stems and 164 downregulated and 134 upregulated in leaves. The differentially enriched proteins in stems were mainly involved in amino acid biosynthesis, phenylpropanoid biosynthesis, carbon fixation, and phenylalanine metabolism. The differentially enriched proteins in leaves were mainly involved in porphyrin and chlorophyll metabolism, phenylpropanoid biosynthesis, starch and sucrose metabolism, and carbon fixation in photosynthetic organisms. Six differentially enriched proteins were mapped onto the porphyrin and chlorophyll metabolism pathway in leaves of the M genotype, including five upregulated proteins involved in chlorophyll biosynthesis and one downregulated protein involved in chlorophyll degradation. Eleven differentially enriched proteins were mapped onto the phenylpropanoid pathway in stems of the M genotype, including two upregulated proteins and nine downregulated proteins. Conclusion: Enhanced chlorophyll synthesis and decreased lignin synthesis provided a reasonable explanation for the larger leaves and lower levels of stem lignification in M genotype alfalfa. This proteomic study aimed to classify the functions of differentially enriched proteins and to provide information on the molecular regulatory networks involved in stem and leaf development.
The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial
Authors: Griffin Anne , O´Neill Aoife , O´Connor Margaret , Ryan Damien , Tierney Audrey , Galvin Rose
Published: September 2020

BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED.MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant.ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days.Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515