bluuebunny/crossref_metadata_2025 huggingface dataset:
Nuclear phylogeography of the temperate tree species Chiranthodendron pentadactylon (Malvaceae): Quaternary relicts in Mesoamerican cloud forests
Authors: Hernández-Langford Diana Gabriela , Siqueiros-Delgado María Elena , Ruíz-Sánchez Eduardo
Published: April 2020

Background

TheMexican hand treeorCanac(Chiranthodendron pentadactylon) is a temperate tree species of cloud and pine-oak forests of southern Mexico and Guatemala. Its characteristic hand-shaped flower is used in folk medicine and has constituted the iconic symbol of theSociedad Botánica de Méxicosince 1940. Here, the evolutionary history of this species was estimated through phylogeographic analyses of nuclear DNA sequences obtained through restriction site associated DNA sequencing and ecological niche modeling. Total genomic DNA was extracted from leaf samples obtained from a representative number (5 to 10 per sampling site) of individuals distributed along the species geographic range. In Mexico, population is comprised by spatially isolated individuals which may follow the trends of cloud forest fragmentation. By contrast, in GuatemalaChiranthodendronmay constitute a canopy dominant species near the Acatenango volcano. The distributional range of this species encompasses geographic provinces separated by the Isthmus of Tehuantepec.

The objectives of the study were to: (i) estimate its genetic structure to define whether the observed range disjunction exerted by the Isthmus of Tehuantepec translates into separate populations, (ii) link population divergence timing and demographic trends to historical climate change, and (iii) test hypotheses related to Pleistocene refugia.

Results

Patterns of genetic diversity indicated high levels of genetic differentiation between populations separated by the Isthmus. The western and eastern population diverged approximately 0.873 Million years ago (Ma). Demographic analyses supported a simultaneous split from an ancestral population and rapid expansion from a small stock approximately 0.2 Ma corresponding to a glacial period. The populations have remained stable since the LIG (130 Kilo years ago (Ka)). Species distribution modelling (SDM) predicted a decrease in potential distribution in the Last Interglacial (LIG) and an increase during the Last Glacial Maximum (LGM) (22 Ka), Mid-Holocene (6 Ka) and present times.

Conclusions

Divergence time estimations support the hypothesis that populations represent Quaternary relict elements of a species with broader and northernmost distribution. Pleistocene climatic shifts exerted major influence on the distribution of populations allowing dispersion during episodes of suitable climatic conditions and structuring during the first interglacial with a time period length of 100 Kilo years (Kyr) and the vicariant influence of the Isthmus. Limited demographic expansion and population connectivity during the LGM supports the moist forest hypothesis model.
Protein changes as robust signatures of fish chronic stress: a proteomics approach to fish welfare research
Authors: Raposo de Magalhães Cláudia , Schrama Denise , Farinha Ana Paula , Revets Dominique , Kuehn Annette , Planchon Sébastien , Rodrigues Pedro Miguel , Cerqueira Marco
Published: April 2020

Background

Aquaculture is a fast-growing industry and therefore welfare and environmental impact have become of utmost importance. Preventing stress associated to common aquaculture practices and optimizing the fish stress response by quantification of the stress level, are important steps towards the improvement of welfare standards. Stress is characterized by a cascade of physiological responses that, in-turn, induce further changes at the whole-animal level. These can either increase fitness or impair welfare. Nevertheless, monitorization of this dynamic process has, up until now, relied on indicators that are only a snapshot of the stress level experienced. Promising technological tools, such as proteomics, allow an unbiased approach for the discovery of potential biomarkers for stress monitoring. Within this scope, using Gilthead seabream (Sparus aurata) as a model, three chronic stress conditions, namely overcrowding, handling and hypoxia, were employed to evaluate the potential of the fish protein-based adaptations as reliable signatures of chronic stress, in contrast with the commonly used hormonal and metabolic indicators.

Results

A broad spectrum of biological variation regarding cortisol and glucose levels was observed, the values of which rose higher in net-handled fish. In this sense, a potential pattern of stressor-specificity was clear, as the level of response varied markedly between a persistent (crowding) and a repetitive stressor (handling). Gel-based proteomics analysis of the plasma proteome also revealed that net-handled fish had the highest number of differential proteins, compared to the other trials. Mass spectrometric analysis, followed by gene ontology enrichment and protein-protein interaction analyses, characterized those as humoral components of the innate immune system and key elements of the response to stimulus.

Conclusions

Overall, this study represents the first screening of more reliable signatures of physiological adaptation to chronic stress in fish, allowing the future development of novel biomarker models to monitor fish welfare.
Arabidopsis Chloroplast protein for Growth and Fertility1 (CGF1) and CGF2 are essential for chloroplast development and female gametogenesis
Authors: Zhu Rui-Min , Chai Sen , Zhang Zhuang-Zhuang , Ma Chang-Le , Zhang Yan , Li Sha
Published: April 2020

Background

Chloroplasts are essential organelles of plant cells for not only being the energy factory but also making plant cells adaptable to different environmental stimuli. The nuclear genome encodes most of the chloroplast proteins, among which a large percentage of membrane proteins have yet to be functionally characterized.

Results

We report here functional characterization of two nuclear-encoded chloroplast proteins, Chloroplast protein for Growth and Fertility (CGF1) and CGF2. CGF1 and CGF2 are expressed in diverse tissues and developmental stages. Proteins they encode are associated with chloroplasts through a N-terminal chloroplast-targeting signal in green tissues but also located at plastids in roots and seeds. Mutants of CGF1 and CGF2 generated by CRISPR/Cas9 exhibited vegetative defects, including reduced leaf size, dwarfism, and abnormal cell death. CGF1 and CGF2 redundantly mediate female gametogenesis, likely by securing local energy supply. Indeed, mutations of both genes impaired chloroplast integrity whereas exogenous sucrose rescued the growth defects of the CGF double mutant.

Conclusion

This study reports that two nuclear-encoded chloroplast proteins, Chloroplast protein for Growth and Fertility (CGF1) and CGF2, play important roles in vegetative growth, in female gametogenesis, and in embryogenesis likely by mediating chloroplast integrity and development.
Epicardial adipose tissue thickness as a potential predictor of gestational diabetes mellitus: a prospective cohort study
Authors: Liu Jing , Song Guang , Meng Tao , Zhao Ge
Published: April 2020

Background

Gestational diabetes mellitus (GDM) is the most common metabolic disorder that can occur during pregnancy and is associated with a long-term risk of both maternal and neonatal comorbidities. This study aimed to investigate the association between echocardiographic epicardial adipose tissue (EAT) and the risk for GDM during the early second trimester of pregnancy.

Method

We recruited all singleton pregnancies between January 2014 and December 2018 at 16 weeks + 0 days to 19 weeks + 6 days. We then used generalized linear models to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for EAT as a potential predictor for GDM. Receiver-operating-characteristic (ROC) analysis was then conducted to investigate the discriminative capacity of any individual maternal factor for the prediction of GDM.

Results

In total, our study involved 314 pregnant women with GDM and 1832 pregnant women without GDM. Multivariate regression analysis revealed that EAT thickness (OR = 2.87; 95% CI: 2.49–3.31) was significantly associated with the presence of GDM (P < 0.001). Furthermore, EAT thickness was also significantly associated with a range of adverse outcomes in the GDM group, including large size for gestational age, neonatal hypoglycemia, admission to the neonatal intensive care unit, preterm delivery, and hyperbilirubinemia (P < 0.001). ROC analysis revealed that the area under the curve was 0.790 (95% CI: 0.768–0.812). When the cutoff value for EAT thickness was set to 5.49 mm, the sensitivity was 95.2% and the specificity was 50.5%.

Conclusions

Echocardiographic EAT thickness is positively and significantly associated with both the risk of GDM and adverse outcomes related to GDM. Echocardiographic EAT has the potential to predict GDM prior to actual clinical diagnosis.
Identifying and understanding the health and social care needs of Indigenous older adults with multiple chronic conditions and their caregivers: a scoping review
Authors: Webkamigad Sharlene , Rowe Robyn , Peltier Shanna , Froehlich Chow Amanda , McGilton Katherine S. , Walker Jennifer D.
Published: April 2020

Background

Indigenous people continue to experience high rates of multiple chronic conditions (MCC) at younger ages than other populations, resulting in an increase in health and social care needs. Those who provide services designed to address MCC for Indigenous communities require synthesized information to develop interventions that meet the needs of their older adult population. This review seeks to answer the research question: What are the health and social care needs, priorities and preferences of Indigenous older adults (living outside of long-term care settings) with MCC and their caregivers?

Methods

A scoping review, guided by a refinement of the Arksey & O’Malley framework, was conducted. Articles were included if the authors reported on health and social care needs and priorities of older Indigenous adults. We also included articles that focused on Indigenous conceptions of wellness, resilience, well-being, and/or balance within the context of aging, and articles where authors drew from Indigenous specific worldviews, ways of knowing, cultural safety, cultural competence, cultural appropriateness, cultural relevance and community needs.

Results

This scoping review included 9 articles that were examined using an Indigenous determinants of health (IDH) theoretical framework to analyze the needs of older adults and CGs. Five areas of needs were identified: accessible health services; building community capacity; improved social support networks; preservation of cultural values in health care; and wellness-based approaches.

Conclusion

The review highlights key determinants of health that influenced older adults’ needs: education and literacy, ethnicity, and social support/network (proximal); health promotion and health care (intermediate); and a combination of historical and contemporary structures (distal). The findings highlight the importance of local Indigenous knowledge and perspectives to improve accessibility of culturally relevant health and social services.
Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study
Authors: Özger Hasan Selçuk , Fakıoğlu Dolunay Merve , Erbay Kübra , Albayrak Aslınur , Hızel Kenan
Published: April 2020

Background

Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use.

Methods

This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment.

SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation.

Results

It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use.

Conclusions

In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses.
Modulation of SIRT3 expression through CDK4/6 enhances the anti-cancer effect of sorafenib in hepatocellular carcinoma cells
Authors: Jo Hanhee , Park Yusun , Kim Taehun , Kim Jisu , Lee Jong Sook , Kim Seon Yoo , Chung Jee-in , Ko Hae yong , Pyun Jae-Chul , Kim Kyung Sik , Lee Misu , Yun Mijin
Published: April 2020

Background

Hepatocellular carcinoma (HCC) is the leading cause of cancer-related deaths worldwide. The only drug currently approved for clinical use in the treatment of advanced HCC is sorafenib. However, many patients with HCC show reduced sensitivity to sorafenib during treatment. SIRT3, a member of the mammalian sirtuin family, is a tumor suppressor in certain tumor types. However, only few studies have investigated the effects of SIRT3 on tumor prognosis and sorafenib sensitivity in patients with HCC. Here, we aimed to investigate the correlation between SIRT3 expression and glucose metabolism and proliferation in HCC and discover effective compounds that increase endogenous SIRT3 modulation effect of sorafenib.

Methods

To determine the correlation between SIRT3 and glucose related proteins, immunostaining was performed with liver cancer tissue using various antibodies. To investigate whether the expression of SIRT3 in HCC is related to the resistance to sorafenib, we treated sorafenib after the modulation of SIRT3 levels in HCC cell lines (overexpression in Huh7, knockdown in HepG2). We also employed PD0332991 to modulate the SIRT3 expression in HCC cell and conducted functional assays.

Results

SIRT3 expression was downregulated in high glycolytic and proliferative HCC cells of human patients, xenograft model and HCC cell lines. Moreover, SIRT3 expression was downregulated after sorafenib treatment, resulting in reduced drug sensitivity in HCC cell lines. To enhance the anti-tumor effect of sorafenib, we employed PD0332991 (CDK4/6-Rb inhibitor) based on the correlation between SIRT3 and phosphorylated retinoblastoma protein in HCC. Notably, combined treatment with sorafenib and PD0332991 showed an enhancement of the anti-tumor effect in HCC cells.

Conclusions

Our data suggest that the modulation of SIRT3 by CDK4/6 inhibition might be useful for HCC therapy together with sorafenib, which, unfortunately, has limited efficacy and whose use is often associated with drug resistance.
Demographic profile, clinical features, and outcome of peripapillary subretinal hemorrhage: an observational study
Authors: Zou Ming , Zhang Yi , Huang Xi , Gao Sheng , Zhang Junjun
Published: April 2020

Background

To evaluate the etiology, demographic profile, clinical features, and outcomes in patients with peripapillary subretinal hemorrhage (PSH).

Methods

Thirty-eight eyes of 37 consecutive patients with PSH were enrolled in this prospective observational study over 4 years; all were followed for 2 years. The main outcome measures were demographic profile, possible etiology, clinical features, outcome, and prognosis.

Results

Sixty-eight percent (26/38) of eyes were in female patients; the mean patient age was 20 years. Only 1 patient (1/37) showed bilateral involvement. All patients experienced acute onset of PSH. All eyes were myopic and their best-corrected visual acuities ranged from 20/1000 to 20/12.5. The fundus features of affected eyes were classified into 3 groups: (1) PSH alone (4/38 eyes, 10.5%); (2) PSH with intrapapillary hemorrhage (17/38 eyes, 44.7%); (3) PSH with intrapapillary and vitreous hemorrhage (17/38 eyes, 44.7%). PSH occurred in nasal edges of optic discs with a crescent shape and dull-red color. All affected optic discs were small and crowded, exhibiting variable degrees of tilting. The cup of affected optic discs was narrower and deeper than that of normal control discs. Other ancillary tests provided no additional value. After a mean follow-up of 2.85 months, the hemorrhages resolved spontaneously without sequelae. Recurrence of disease was not observed in any patients.

Conclusions

PSH is common in myopic eyes with tilted optic discs. We suspect that these hemorrhages occurred as a result of abrupt movement acting on a morphologically vulnerable optic disc.
Return-to-work-experts for inpatient treatment of patients with mental illnesses– a proof-of-concept-study (RETURN): the study protocol
Authors: Riedl Lina , Blank Daniela , Kohl Monika , Lang Anne , Kehl Victoria , Brieger Peter , Hamann Johannes
Published: April 2020

Background

Patients with mental illnesses often have massive difficulties returning to work after inpatient treatment at a psychiatric clinic and are often at risk of losing their jobs. The psychosocial support for this patient group at the interface of clinic/outpatient care is often insufficient.

Methods/design

The RETURN-study prospectively assesses and surveys 200 patients with mental disorders in a cluster randomized intervention study, i.e. treatment teams and patients from intervention wards receive a return-to-work (RTW) intervention. Patients in control wards obtain treatment as usual (TAU). Pairs of comparable wards (similar patient population, similar staff density) have been identified and then randomized for control and intervention (n = 14 for each condition). On intervention wards return-to-work experts (RTW experts) who focus treatment on the workplace-related needs of patients with mental illnesses have been established. These RTW experts ensure the use of available resources within the framework of work-related discharge management and should lead to a more successful return to the workplace.

The days at work in the year after release will be evaluated in a mixed methods approach as well as the return rate in the year after release, disability days in the year after return, relapse rate after 12 months, cost-benefit ratio of the intervention, analysis of the predictors / barriers for a successful return to the workplace (e.g. psychopathology, cognition, stigma, social-psychiatric support, company support, etc.), possibilities to implement the concept of RTW experts in standard psychiatric care (TAU - treatment as usual), the impact of the RTW experts’ approach on the treatment process in standard psychiatric care.

Discussion

This approach is already internationally established in the field of somatic rehabilitation and supported employment [Am J Psychiatry 171:1183–90, 2014; Lancet 370:1146–52, 2007; Cochrane Database Syst Rev, doi:10.1002/14651858.CD006237.pub3, 2014]; the innovative aspect of this project is to implement and evaluate it in standard psychiatric care in Germany. This project requires no new interventions to be developed and tested, as the techniques of the case manager/job coach is applied to the field of return to work.

Trial registration

The study was registered in Deutsches Register Klinische Studien searchable via its Meta-registry (http://apps.who.int/trialsearch/), Trial registration number: DRKS00016037, Date of registration: 21/12/2018, URL of trial registry record.
The impact of global budget on expenditure, service volume, and quality of care among patients with pneumonia in a secondary hospital in China: a retrospective study
Authors: Guan Xiaodong , Zhang Chi , Hu Huajie , Shi Luwen
Published: April 2020

Background

The Chinese government has begun to dampen the growth of health expenditure by implementing Global Budgets (GB). Concerns were raised about whether reductions in expenditure would lead to a deterioration of quality of care. This paper aims to evaluate the impact of GB on health expenditure, service volume and quality of care among Chinese pneumonia patients.

Methods

A secondary hospital that replaced Fee-For-Service (FFS) with GB in China in 2016 was sampled. We used daily expenditure to assess health expenditure; monthly admission, length of stay (LOS), number of drugs per record and record containing antibiotics to evaluate service volume; record with multiple antibiotics and readmission to assess quality of care. Descriptive analyses were adopted to evaluate changes after the reform, logistic regression and multivariable linear regressions were used to analyze changes associated with the reform.

Results

In 2015 and 2016, 3400 admissions from 3173 inpatients and 2342 admissions from 2246 inpatients were admitted, respectively. According to regression analyses, daily expenditure, LOS, readmission, and records with multiple antibiotic usages significantly declined after the reform. However, no significant relation was observed between GB and the number of drugs per record or record containing antibiotics.

Conclusions

When compared with FFS, GB can curtail health expenditure and improve quality of care. As far as service volume was concerned, LOS and monthly admission declined, while number of drugs per record and record containing antibiotics were not affected.
Individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia; a multi-level analysis of 2016 Ethiopia Demographic and Health Survey
Authors: Yalew Melaku , Adane Bezawit , Kefale Bereket , Damtie Yitayish
Published: April 2020

Background

There is limited evidence on the unmet need for contraceptives among married reproductive-age women especially in developing countries like Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia.

Method

A secondary analysis was done on the 2016 Ethiopian Demographic and Health Survey (EDHS) dataset which were collected cross-sectional. A total of 9056 women who were fecund, married and/or sexually active were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA version 14.0 to identify individual and community-level factors. Adjusted odds ratio with 95% confidence interval was used to show the strength and direction of the association and statistical significance was declared at P value less than 0.05.

Result

Factors significantly associated with unmet need were; ages of women between 45 and 49 years [AOR = 2.25, 95% CI: (1.34, 3.79)], greater than or equal to three living children [AOR = 1.87, 95% CI: (1.40, 2.49)], belong to richer household [AOR = 0.73, 95% CI: (0.54, 0.97)], Muslim followers [AOR = 1.37, 95% CI: (1.02, 1.83)], married more than once [AOR = 1.31, 95% CI: (1.06, 1.62)]. From community level variables: belong to the Somali region [AOR = 0.34, 95% CI: (0.19, 0.61)] were significantly associated with unmet need.

Conclusion

Both individual and community-level factors were significant determinants of unmet need. From individual-level factors: advanced ages of women, many total numbers of living children, live in the richer wealth quintile, being Muslim follower and married more than once and from community-level variables: belong to the Somali region were significantly associated with unmet need for contraception. The findings suggested that health care providers should mainly focus on women nearly on menopauses, who live in the poorest household and who had many numbers of living children and married more than once to decrease the unmet need for contraceptives.
Armed conflict as a determinant of children malnourishment: a cross-sectional study in The Sudan
Authors: Dahab Rihab , Bécares Laia , Brown Mark
Published: April 2020

Background

Children’s nutritional status influences their physical, socioemotional and cognitive development throughout the life course. We aimed to determine the role of armed conflict on the prevalence of childhood malnourishment in The Sudan, and understand the underlying mechanisms using a framework based on the social determinants of health.

Methods

We analysed cross-sectional data from the 2014-Sudan Multiple Indicator Cluster Survey (n = 14,081) to compare the prevalence of malnourishment in states undergoing armed conflict and states free of conflict. Four-level multilevel multivariate modelling was conducted to identify the contribution of the social determinants of malnourishment in explaining the role of armed conflict in child health, with conflict status as the central predictor and progressive adjustments for child-, household- and cluster- and state-level predictors.

Results

Armed conflict is strongly associated with greater risk of severe and moderate underweight among children under-5. Adjusting for key social determinants of health reduced the strength of the association between armed conflict and risk of underweight, but there is statistical evidence of association between armed conflict and risk of severe underweight (OR: 1.60, 95%CI: 1.03–2.49 for the low intensity group).

Conclusion

Conflict-exposed children are particularly vulnerable to malnourishment, and this association is mostly explained by key socio-demographic factors. With the prolonged political instability in The Sudan, sustainable nutritional interventions are necessary to ease hard conditions in conflict-exposed states, and also among disadvantaged families in conflict-free regions.
Interprofessional team-based learning (TBL): how do students engage?
Authors: Burgess Annette , Kalman Eszter , Haq Inam , Leaver Andrew , Roberts Chris , Bleasel Jane
Published: April 2020

Background

Although challenging to integrate within university curricula, evidence suggests that interprofessional education (IPE) positively impacts communication and teamwork skills in the workplace. The nature of Team-based learning (TBL) lends itself to interprofessional education, with the capacity to foster a culture of collaboration among health professional students. Our study was designed to pilot an interprofessional ‘back pain’ TBL module for physiotherapy and medical students, and to explore their experience of the TBL process, using the conceptual framework of ‘knowledge reconsolidation’ to discuss our finding.

Methods

Three hundred and eleven students participated in the TBL session: 222/277 (80%) of Year 1 medical students and 89/89 (100%) of Year 2 physiotherapy students. Students completed one interprofessional Musculoskeletal Sciences TBL session on the topic of ‘back pain’. A questionnaire including closed and open-ended items, was distributed to students immediately following completion of the TBL session. Descriptive statistics were used to analyse the quantitative data. Thematic analysis was used to code and categorise qualitative data into themes. Pre-class quiz scores were compared between the groups using a one-way between groups Analysis of Variance (ANOVA) test with Tukeys Post Hoc test.

Results

In total, 117/311 (38%) of participants completed the questionnaire. Both medicine and physiotherapy students appreciated the opportunity to learn about the curriculum of another healthcare discipline, and their scope of practice; gain multiple perspectives on a patient case from different disciplines; and recognised the importance of multidisciplinary teams in patient care. Students felt having an interprofessional team of facilitators who provided immediate feedback helped to consolidate student learning and promoted clinical reasoning. An analysis of variance revealed no difference between Physiotherapy and Medical students’ pre-class quiz scores.

Conclusion

Our study demonstrated that the small group and task-focused characteristics of TBL provided a student-centred teaching strategy to support the achievement of interprofessional learning goals. Students valued their interactions with other students from a different professional degree, the opportunity to problem solve together, and learn different perspectives on a patient case. The pre-class quiz results demonstrate that both groups of students had a comparative level of prior knowledge to be able to work together on the in-class activities.
Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes
Authors: Zechmeister-Koss Ingrid , Goodyear Melinda , Tüchler Heinz , Paul Jean Lillian
Published: April 2020

Background

A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context.

Methods

We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate.

Results

We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children’s needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs.

Conclusions

The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.
Experiences of shared decision-making in community rehabilitation: a focused ethnography
Authors: Manhas Kiran Pohar , Olson Karin , Churchill Katie , Vohra Sunita , Wasylak Tracy
Published: April 2020

Background

Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM.

Methods

We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers).

Results

We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient’s perceived assertiveness, lack of capacity, and level of deference.

Conclusions

We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.
Bacillus subtilis and Bacillus licheniformis reduce faecal protein catabolites concentration and odour in dogs
Authors: Bastos Tais Silvino , de Lima Daniele Cristina , Souza Camilla Mariane Menezes , Maiorka Alex , de Oliveira Simone Gisele , Bittencourt Letícia Cardoso , Félix Ananda Portella
Published: April 2020

Background

Direct-fed microbials (DFM), such as Bacillus subtilis and Bacillus licheniformis, may improve gut functionality of the host by favouring non-pathogenic bacteria and reducing the formation of putrefactive compounds. The aim of this study was to assess the nutrient digestibility, faecal characteristics and intestinal-fermentation products in dogs fed diets with Bacillus subtilis and Bacillus licheniformis. Sixteen dogs were randomly divided into two groups. Every eight dogs were fed with the control diet or the diet with the addition of 62.5 g of DFM (B. subtilis and B. licheniformis)/ton. Diets were provided throughout a 20-day adaptation period, followed by 5 days of total faecal collection. Nutrient digestibility and the metabolisable energy of the diets, plus the dogs’ faecal characteristics and intestinal fermentation products were assessed.

Results

There were no differences in nutrient digestibility (P > 0.05). However, DFM supplementation improved faecal score and resulted in less fetid faeces (P < 0.001). DFM inclusion reduced (P < 0.05) the biogenic amines concentration: putrescine, spermidine and cadaverine, besides the concentration of phenols and quinoline.

Conclusions

The use of B. subtillis and B. licheniformis as DFM reduce the concentration of nitrogen fermentation products in faeces and faecal odour, but the digestibility of nutrients is not altered in dogs.
Prohibitin 1/2 mediates Dengue-3 entry into human neuroblastoma (SH-SY5Y) and microglia (CHME-3) cells
Authors: Sharma Amita , Vasanthapuram Ravi , M Venkataswamy Manjunatha , Desai Anita
Published: April 2020

Background

Very few studies have identified receptor molecules for dengue virus (DENV) on neural cells. This study was designed to identify putative receptor/(s) involved in entry of DENV-3 in human neural cells of various lineages; neuronal-SH-SY5Y, astroglial-U-87 MG and microglial-CHME-3 cells.

Result

Virus overlay protein binding assay, LC-MS/MS and SEQUEST identified prohibitin1/2 (PHB1/2) as interacting proteins on SH-SY5Y, CHME-3, and U-87 MG cells. Infection inhibition and siRNA assays confirmed the role of PHB1/2 in the entry of DENV-3 into SH-SY5Y and CHME-3 cells but not in U-87 MG cells. Indirect immunofluorescence and flow-cytometry demonstrated the presence of PHB1/2 on the surface of SH-SY5Y and CHME-3 cells. Co-immunoprecipitation and Western blot, as well as double labelling, reconfirmed the interaction between PHB1/2 and DENV-3 EDIII protein.

Conclusion

These observations together for the first time indicate that PHB1/2 may serve as a putative receptor for DENV-3 in SH-SY5Y and CHME-3 cells. The study provided insights into DENV-3 and neural cell interactions.
Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania
Authors: Mikomangwa Wigilya P. , Minzi Omary , Mutagonda Ritah , Baraka Vito , Mlugu Eulambius M. , Aklillu Eleni , Kamuhabwa Appolinary A. R.
Published: April 2020

Background

Malaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥ 3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings.

Methods

A cross-sectional study that involved consecutively selected 1161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR).

Results

In total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤ 2) while 764 (65.8%) used optimal doses (≥ 3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI 1.10–30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76 ± 2.51 μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤ 2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36-fold compared to ≥ 3 doses (aOR, 1.36; 95% CI 1.04–1.79; p = 0.02).

Conclusion

The use of < 2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤ 2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥ 3 doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.
Does women’s age matter in the SDGs era: coverage of demand for family planning satisfied with modern methods and institutional delivery in 91 low- and middle-income countries
Authors: da Silva Inacio Crochemore M. , Everling Fernanda , Hellwig Franciele , Ronsmans Carine , Benova Lenka , Requejo Jennifer , Raj Anita , Barros Aluisio J. D. , Victora Cesar G.
Published: April 2020

Background

The Sustainable Development Goals (SDGs) include specific targets for family planning (SDG 3.7) and birth attendance (SDG 3.1.2), and require analyses disaggregated by age and other dimensions of inequality (SDG 17.18). We aimed to describe coverage with demand for family planning satisfied with modern methods (DFPSm) and institutional delivery in low- and middle-income countries across the reproductive age spectrum. We attempted to identify a typology of patterns of coverage by age and compare their distribution according to geographic regions, World Bank income groups and intervention coverage levels.

Methods

We used Demographic and Health Survey and Multiple Indicator Cluster Surveys. For DFPSm, we considered the woman’s age at the time of the survey, whereas for institutional delivery we considered the woman’s age at birth of the child. Both age variables were categorized into seven groups of 5 year-intervals, 15–19 up to 45–49. Five distinct patterns were identified: (a) increasing coverage with age; (b) similar coverage in all age groups; (c) U-shaped; (d) inverse U-shaped; and (e) declining coverage with age. The frequency of the five patterns was examined according to UNICEF regions, World Bank income groups, and coverage at national level of the given indicator.

Results

We analyzed 91 countries. For DFPSm, the most frequent age patterns were inverse U-shaped (53%, 47 countries) and increasing coverage with age (41%, 36 countries). Inverse-U shaped patterns for DFPSm was the commonest pattern among lower-middle income countries, while low- and upper middle-income countries showed a more balanced distribution between increasing with age and U-shaped patterns. In the first and second tertiles of national coverage of DFPSm, inverse U-shaped was observed in more than half of countries. For institutional delivery, declining coverage with age was the prevailing pattern (44%, 39 countries), followed by similar coverage across age groups (39%, 35 countries). Most (79%) upper-middle income countries showed no variation by age group while most low-income countries showed declining coverage with age (71%).

Conclusion

Large inequalities in DFPSm and institutional delivery were identified by age, varying from one intervention to the other. Policy and programmatic approaches must be tailored to national patterns, and in most cases older women and adolescents will require special attention due to lower coverage and because they are at higher risk for maternal mortality and other poor obstetrical outcomes.
Promoter activity of Merkel cell Polyomavirus variants in human dermal fibroblasts and a Merkel cell carcinoma cell line
Authors: Abdulsalam Ibrahim , Rasheed Kashif , Sveinbjørnsson Baldur , Ehlers Bernhard , Moens Ugo
Published: April 2020

Background

Merkel cell polyomavirus (MCPyV) is a human polyomavirus that establishes a life-long harmless infection in most individuals, with dermal fibroblasts believed to be the natural host cell. However, this virus is the major cause of Merkel cell carcinoma (MCC), an aggressive skin cancer. Several MCPyV variants with polymorphism in their promoter region have been isolated, but it is not known whether these differences affect the biological properties of the virus.

Methods

Using transient transfection studies in human dermal fibroblasts and the MCC cell line MCC13, we compared the transcription activity of the early and late promoters of the most commonly described non-coding control region MCPyV variant and six other isolates containing specific mutation patterns.

Results

Both the early and late promoters were significantly stronger in human dermal fibroblasts compared with MCC13 cells, and a different promoter strength between the MCPyV variants was observed. The expression of full-length large T-antigen, a viral protein that regulates early and late promoter activity, inhibited early and late promoter activities in both cell lines. Nonetheless, a truncated large T-antigen, which is expressed in virus-positive MCCs, stimulated the activity of its cognate promoter.

Conclusion

The promoter activities of all MCPyV variants tested was stronger in human dermal fibroblasts, a cell line that supports viral replication, than in MCC13 cells, which are not permissive for MCPyV. Truncated large T-antigen, but not full-length large T-antigen stimulated viral promoter activity. Whether, the difference in promoter strength and regulation by large T-antigen may affect the replication and tumorigenic properties of the virus remains to be determined.
Characterization of dimensional, morphological and morphometric features of retrieved 3D-printed acetabular cups for hip arthroplasty
Authors: Dall’Ava Lorenzo , Hothi Harry , Henckel Johann , Di Laura Anna , Shearing Paul , Hart Alister
Published: April 2020

Background

Three-dimensional (3D) printing of porous titanium implants is increasing in orthopaedics, promising enhanced bony fixation whilst maintaining design similarities with conventionally manufactured components. Our study is one of the first to non-destructively characterize 3D-printed implants, using conventionally manufactured components as a reference.

Methods

We analysed 16 acetabular cups retrieved from patients, divided into two groups: ‘3D-printed’ (n= 6) and ‘conventional’ (n= 10). Coordinate-measuring machine (CMM), electron microscopy (SEM) and microcomputed tomography (micro-CT) were used to investigate the roundness of the internal cup surface, the morphology of the backside surface and the morphometric features of the porous structures of the cups, respectively. The amount of bony attachment was also evaluated.

Results

CMM analysis showed a median roundness of 19.45 and 14.52 μm for 3D-printed and conventional cups, respectively (p= 0.1114). SEM images revealed partially molten particles on the struts of 3D-printed implants; these are a by-product of the manufacturing technique, unlike the beads shown by conventional cups. As expected, porosity, pore size, strut thickness and thickness of the porous structure were significantly higher for 3D-printed components (p= 0.0002), with median values of 72.3%, 915 μm, 498 μm and 1.287 mm (p= 0.0002). The median values of bony attachment were 84.9% and 69.3% for 3D-printed and conventional cups, respectively (p= 0.2635).

Conclusion

3D-printed implants are designed to be significantly more porous than some conventional components, as shown in this study, whilst still exhibiting the same shape and size. We found differences in the surface morphologies of the groups, related to the different manufacturing methods; a key finding was the presence of partially molten particles on the 3D-printed cups.