bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardized definitions and concepts of radicality during minimally invasive thymoma resection
Authors: De Iaco Giulia , Brascia Debora , Geronimo Alessandro , Sampietro Doroty , Fiorella Angela , Schiavone Marcella , Panza Teodora , Signore Francesca , Marulli Giuseppe
Published: September 2020

Radical thymectomy is the gold standard treatment for thymoma; in particular, completeness of surgical resection of a well-encapsulated thymoma and adequate margins are considered the most important prognostic factors. According to the International Thymic Malignancy Interest Group instructions, in fact, the thymus should be resected en bloc with its upper cervical poles and the surrounding mediastinal fat and through a no-touch surgical technique. For years, the open approaches have been considered the gold standard treatment for thymic masses, because of technical advantages and proved good oncological results. When applied to properly chosen patients on the basis of the tumor stage, dimension, and histology, minimally invasive approaches could be as effective as open ones in terms of long-term outcomes. To accomplish a minimally invasive thymoma resection, several minimally invasive techniques (transcervical, subxiphoid, thoracoscopic, and robotic) have been described, each presenting advantages and drawbacks. Moreover, when dealing with early stage neoplasms, many authors have proposed to perform the thymomectomy alone, not involving the rest of the thymic gland, but evidence is still imprecise and vague, and some studies have described a higher rate of local recurrence when using this technique. Finally, many studies suggest that surgeons with expertise in minimally invasive lymphadenectomy for lung cancer may easily endorse the idea of nodal dissection, to be performed at least in advanced thymomas involving neighboring structures, large masses, and thymic carcinomas.
Traditional geraizeiros communities in brazil territory: formation, identity and culture
Authors: Campos Alexandre de Castro , Campos Raquel Teixeira , Melo Valdemir Garcia Neto , Pires Bruno Ricardo Carvalho , Moraes Nelson Russo de
Published: September 2020

In the Brazilian territory, as well as in the territories of Latin American countries (although it has greater ethnic and cultural diversity than other countries), it has in its history a trajectory in the formation of the Brazilian people who carry the presence of diversity in their company. In Brazil, indigenous people reach more than 300 ethnic groups, as native peoples and other groups of individuals generally limited as traditional communities, among them quilombolas, fishermen, riverside dwellers, caiçaras, babassu coconut breakers, communities grazing land, rubber tapper communities and the farmers. The identification of the breeding community has been sculpted over the course of centuries, passing from generation to generation, being the object of research of some scientific research works by universities and research groups in graduate programs. This work brings results of academic works concluded and that understand as a problem: “having its specific tradition and culture, but being in different regions, how can a traditional community of farmers be established?”. The work describes the identity of traditional breeder communities and mentions the existence of these communities in territories in other regions of Brazil.
P versus NP
Authors: Vega Frank
Published: September 2020

$P$ versus $NP$ is considered as one of the most important open problems in computer science. This consists in knowing the answer of the following question: Is $P$ equal to $NP$? The precise statement of the $P$ versus $NP$ problem was introduced independently by Stephen Cook and Leonid Levin. Since that date, all efforts to find a proof for this problem have failed. Another major complexity class is $\textit{P-Sel}$. $\textit{P-Sel}$ is the class of decision problems for which there is a polynomial time algorithm (called a selector) with the following property: Whenever it's given two instances, a $``yes"$ and a $``no"$ instance, the algorithm can always decide which is the $``yes"$ instance. It is known that if $NP$ is contained in $\textit{P-Sel}$, then $P = NP$. We consider the problem of computing the sum of the weighted densities of states of a Boolean formula in $3CNF$. Given a Boolean formula $\phi$ with $m$ clauses, the density of states $n(E)$ for some integer $0 \leq E \leq m$ counts the number of truth assignments that leave exactly $E$ clauses unsatisfied in $\phi$. The weighted density of states $m(E)$ is equal to $E \times n(E)$. The sum of the weighted densities of states of a Boolean formula in $3CNF$ with $m$ clauses is equal to $\sum_{E = 0}^{m} m(E)$. We prove that we can calculate the sum of the weighted densities of states in polynomial time. Given two Boolean formulas $\phi_{1}$ and $\phi_{2}$ in $3CNF$ with $n$ variables and $m$ clauses, the combinatorial optimization problem $\textit{SELECTOR-3SAT}$ consists in selecting the formula which is satisfiable, where every clause from $\phi_{1}$ and $\phi_{2}$ can be unsatisfied for some truth assignment. We assume that the formula that is satisfiable has the minimum sum of the weighted densities of states. In this way, we solve $\textit{SELECTOR-3SAT}$ with an exact polynomial time algorithm. We claim this problem is a selector of $3SAT$ and thus, $P = NP$.
EEG Power Spectrum Correlates of Working Memory in Children with Learning Disorders
Authors: Martínez Briones Benito Javier , Fernandez Harmony Thalia , Garófalo Gómez Nicolás , Biscay Lirio Rolando Jose , Bosch-Bayard Jorge
Published: September 2020

Learning disorders (LD) are diagnosed in children whose academic skills of reading, writing or mathematics are impaired and lagged according to their age, schooling and intelligence. Children with LD experience substantial working memory (WM) deficits, even more pronounced if more than one of the academic skills is affected. We compared the task-related EEG power spectral density of children with LD (n= 23), with a control group of children with good academic achievement (n= 22), during the performance of a WM task. sLoreta was used to estimate the current distribution at the sources, and 18 brain regions of interests (ROIs) were chosen with an extended version of the eigenvector centrality mapping technique. In this way, we lessen some drawbacks of the traditional EEG at the sensor space by an analysis at the brain sources level over data-driven selected ROIs. Results: The LD group showed fewer correct responses at the WM task, an overall slower EEG with more theta activity in all ROIs, less upper-alpha power at posterior areas, and less high-frequency beta activity in frontal areas. We explain these EEG patterns in LD children as indices of an inefficient neural resource management related with a delay in the neural development.
One Health Landscape in Sub-Saharan African Countries
Authors: Fasina Folorunso Oludayo , Fasanmi Olubunmi G. , Makonnen Yilma J. , Bebay Charles , Bett Bernard , Roesel Kristina
Published: September 2020

An evaluation of emerging issues in One Health (OH) in Sub-Saharan Africa was undertaken to map the existing OH initiatives in Sub-Saharan African (SSA) countries. Desk review, expert opinions survey, limited interviews and wider consultations with selected OH stakeholders were conducted. The strengths, weaknesses, opportunities and threats to OH initiatives were identified. OH influence, interest and impacts were evaluated. One Health is transiting from multidisciplinary to transdisciplinary concepts and OH viewpoint should move from ‘proxy for zoonoses’, to include issues of climate change, nutrition and food safety, social sciences, geography, policy and planning, economics, welfare and well-being, antimicrobial resistance (AMR), vector-borne diseases, toxicosis and pesticides issues. While the identified major strengths should be boosted, the weaknesses should be addressed.OH Networks in SSA were spatially and temporally spread across SSA and stakeholders were classified as key, latent, marginal and OH defenders. Imbalance in stakeholders’ representation led to hesitation in buying-in from stakeholders who are outside the main networks. Theory of change, monitoring and evaluation frameworks, and tools to standardized evaluation of OH policies is needed for sustained future of OH and the future OH engagement should be outputs and outcomes-driven and not activity-driven.National roadmap for OH implementation and institutionalization is necessary and proofs of concepts in OH should be verified and scaled-up. Dependence on external funding is unsustainable and must be addressed. Necessary policy and legal instrument to support OH nationally and sub-nationally should be implemented taking cognizance of contemporary issues like urbanization, endemic poverty and other emerging issues. Utilizing current technologies and OH approach to address ongoing pandemic of COVID-19 and other emerging diseases is desirable. Finally, OH implementation should be anticipatory and not reactive to significantly benefit budgeting and contain disease outbreaks in animal sources before the risk of spillover to human can be envisaged.
SARS-CoV-2 Infections - Gene Expression Omnibus (GEO) Data Mining, Pathway Enrichment Analysis, and Prediction of Repurposable Drugs/Compounds
Authors: Chaparala Srilakshmi , Iwema Carrie L , Chattopadhyay Ansuman
Published: September 2020

The COVID-19 global pandemic has created dire consequences with an alarming rate of morbidity and mortality. There are not yet vaccine or efficacious treatment options to combat the causative SARS-CoV-2 infection. This paper describes the identification of potentially repurposable drugs for COVID-19 treatment by conducting pathway enrichment analysis on publicly available Gene Expression Omnibus datasets. We first determined SARS-CoV-2 infection-induced alterations of host gene expressions and pathways. We then identified drugs or compounds that target and counter virus-triggered cellular perturbations, suggesting their potential repurposing for COVID-19 treatment. The key findings are that SARS-CoV-2 infection in host cells induces mitochondrial dysfunction, inhibits oxidative phosphorylation, and activates several immune response and pro-inflammatory pathways. Triptolide, the major bioactive component of a traditional Chinese medicine herb, may rescue mitochondrial dysfunction by activating oxidative phosphorylation. Further in vitro and in vivo studies are necessary to verify these results prior to clinical application.
Comparative Life Cycle Assessment of Five Greek Yogurt Production Systems: A Perspective beyond the Plant Boundaries
Authors: Houssard Catherine , Maxime Dominique , Benoit Scott , Pouliot Yves , Margni Manuele
Published: September 2020

Greek yogurt (GY), a high-protein-low-fat dairy product, particularly prized for its sensory and nutritional benefits, revolutionized the North American yogurt market in less than a decade, bringing with it new sustainability challenges. The standard production of GY generates large volumes of acid whey, a co-product that is a potential source of environmental pollution if not recovered. This study aims to assess the environmental performance of different technologies and identify the main factors for improving GY production. A complete life cycle assessment (LCA) was performed to compare the standard technology (centrifugation) with two new technologies (fortification and ultrafiltration) to reduce acid whey volumes. Three milk protein concentrate alternatives were also assessed. Results show that the technology choice is not a clear discriminant factor. However, minimizing losses and wastage (accounting for 23 to 25% of the environmental impacts for all indicators) beyond the processing plant and selecting milk ingredients (accounting for 63 to 67% of the impacts) with low environmental impacts are key factors in improving the environmental performance of GY systems. From a methodological perspective, the results also highlight a shortcoming in the current International Dairy Federation LCA guidelines (2015) for treating the multifunctionality of GY systems.
Learning beyond the Brick and Mortar: A Review of Prospects and Challenges of E-learning Innovation
Authors: Ceesay Lamin B.
Published: September 2020

Increased proliferation of IT services in all sectors has reinforced the adoption and diffusion across all levels of education and training institutions. However, lack of awareness of and knowledge about the key challenges and opportunities of elearning, seem to allude policymakers, resulting in low adoption or increased failure rate of many e-learning projects. Our study tries to address this problem through a review of relevant literature in e-learning. Our goal was to draw from the existing literature, insights into the opportunities and challenges of e-learning diffusion, and the current state-of-research in the field. To do this, we employed a systematic review of literature on some of the salient opportunities and challenges of e-learning innovation for educational institutions. These results aimed to inform policymakers and suggest some interesting issues to advance the research and adoption and diffusion of e-learning. Moreover, the bibliometric analysis shows that the field is experiencing high research attraction among scholars. However, several research areas in the field witnessed relatively low research paucity. Based on these findings, we discussed topics for possible future research.
Stabilization and Synchronization of Hyper-Chaotic Financial System Involved in Positive Interest Rate
Authors: Rao Ruofeng
Published: September 2020

In real financial market, the delayed market feedback and the delayed effect of government macro-control are inevitable. And both the delay of market feedback and the delay of macro-control effect bring about the mathematical difficulties in studying stabilization and synchronization of the hyper-chaotic financial system. However, employing Lyapunov function method, differential mean value theorem, suitable bounded hypotheses and pulse control technology results in the globally asymptotical stabilization and synchronization criteria. It is the first paper to drive the stabilization and synchronization criteria under the assumptions of the double delays. Finally, numerical examples illuminate the effectiveness of the proposed methods.
Mechanistic Research for the Student or Educator (Part II of II)
Authors: Leak Rehana
Published: September 2020

This two-part series describes how to test hypotheses on molecular mechanisms that underlie biological phenomena, using preclinical drug testing as a simplified example. While pursuing drug testing in preclinical research, it is important for students to understand the limitations of descriptive as well as mechanistic studies. The former does not identify any causal links between two or more variables; it identifies the presence or absence of correlations. The latter has caveats presented in Parts I and II of this series. Part II also describes how to test for a causal link between drug-induced activation of biological targets and therapeutic outcomes. Here, the mechanism of action of the drug is identified with pharmacological or genetic approaches that modify the expression/activity of the drug targets. Without interference with the proposed mechanism of action, a causal link between activation (or inhibition) of the target P and the therapeutic outcomes of drug D cannot be established. Using pharmacological agonists and antagonists, gene knockout and overexpression, or protein knockdown tools, designing a full-factorial three-way ANOVA forces the investigator to include the appropriate control groups, mitigating the risk of false positive or false negative conclusions. Upon completion of this series, the educator and student will have some of the tools in hand to design mechanistic studies and interpret various experimental outcomes, with knowledge of strengths and limitations of preclinical research.
Is the Past Determined?
Authors: ZWIRN Hervé
Published: September 2020

In a recent paper [1], I argued against backward in time effects used by several authors to explain delayed choice experiments. I gave an explanation showing that there is no physical influence propagating from the present to the past and modifying the state of the system at a time previous to the measurement. However, though the solution is straightforward in the case of delayed choice experiments involving only one particle, it is subtler in the case of experiments involving two entangled particles because they give rise to EPR-like situations. Considering that a measurement is not an actual change of the physical state of a system and is relative to the observer allows to understand that there is neither backward in time effects nor instantaneous collapse of the second system when the first one is measured, as is often postulated. This allows also to get rid of any non-locality [2]. In this paper, I want to go further into the consequences of this way of considering the measurement, that I have called Convivial Solipsism, and show that even if, in the usual sense, there is no physical effect of the present or of the future on the past, we must nevertheless consider that the observer’s past is sometimes not entirely determined and that it becomes determined only when certain measurements are done latter. This apparent contradiction disappears if one understand that each observer builds, through her own measurements, her own world (that I call the phenomenal world in Convivial Solipsism) which is different from what we are used to consider as the common world shared by everybody.
Long-Term Survival of Metastatic Bladder Cancer Treated With Chemotherapy, Radiation, and Arthroplasty
Authors: Defant John , Huff Scott , Henningsen Joseph , Krishnamurthy Anil
Published: September 2020

Case:

A 64-year-old man suffered a pathologic left femoral neck fracture. Biopsy demonstrated metastatic urothelial cancer with a nonmuscle invasive bladder cancer primary confirmed by cystoscopy. The patient underwent hemiarthroplasty, chemotherapy, radiation, and eventually, a conversion to total hip arthroplasty. Today, over a decade from the initial surgery, the patient remains alive and highly functional. To our knowledge, this is the only report of bone metastatic bladder cancer with over 10-year survival.

Conclusion:

Combined chemotherapy, radiation, and surgical resection of metastasis with reconstruction may confer a survival benefit in bony oligometastatic bladder cancer.
Fast-Growing Cervical Juxtafacet Cyst Mimicking Epidural Hematoma
Authors: Tanishima Shinji , Mihara Tokumitsu , Takeda Chikako , Ogawa Shinya , Nagashima Hideki
Published: September 2020

Case:

A 75-year-old man, who was a carpenter, experienced neck pain and numbness in the upper and lower extremities while hammering a nail and later developed a gait disturbance. Initial magnetic resonance imaging (MRI) revealed a tumor-like mass at the C5 epidural space compressing the spinal cord. The first diagnosis was cervical epidural hematoma. The following day, the patient’s symptom deteriorated. A second MRI revealed an increase in the size of the mass, and surgery was performed. Operative findings included a juxtafacet cyst.

Conclusion:

Repeated job-related load on the facet joint in this patient caused rapid progression of facet cysts, causing myelopathy similar to an epidural hematoma.
Late Renaissance Garden Art in the Carpathian Basin
Authors: Fekete Albert
Published: September 2020

The aim of the article was to find, scientifically define and locate the most frequent occurrences of the Late Renaissance garden units of the Carpathian Basin. This article - as partial result of a research work entitled "Castle Garden Inventory in the Carpathian Basin" and conducted by teachers and students of the Faculty of Landscape Architecture and Urbanism of Szent István University, Budapest - aims to identify through historical research, on-site visits and assessments the current status of 148 Late Renaissance residency gardens located in seven different countries of the Carpathian Basin (Austria, Hungary, Slovakia, Ukraine, Romania, Croatia and Slovenia). Based on the archival and literary sources as well as the field studies carried out, we defined the spatial distribution of Late Renaissance residential gardens, we delineated six very characteristic Late Renaissance garden units and we defined the most typical Late Renaissance garden features for the region. At the same time, we explored and documented still existing values of garden history at some locations from the Renaissance era.
Assessing longitudinal and cross-sectional effects of age on adult obesity in an Iranian population: results from a large population-based cohort study
Authors: Alhossaini Mahsa Rafiee , Kazemnejad Anoshirvan , Zayeri Farid , Sadeghi Masoumeh
Published: September 2020

BackgroundObesity is a significant risk factor for noncommunicable diseases, and it is related to many adverse health consequences. The risk of obesity commonly changes with age, which is called a longitudinal (aging) effect. Also, individuals enter the study of the same age have similar living conditions that may influence their obesity risk in a particular way; this is a cross-sectional effect.ObjectiveTo assess the cross-sectional and longitudinal effects of age, using a Marginal Logistic Regression (MLR) model.MethodsIn the current study, we used the information of individuals who had participated in the Isfahan Cohort Study (ICS). Participants were a large group of Iranian adults over 35 years of age in 2001, who lived in the central region of Iran. They were followed up for 12 years. Repeated measurements of obesity were obtained in 2001, 2007, and 2013. The Marginal Logistic Regression model including the effects of the age at baseline and its difference with current age, is used.ResultsFrom 2001 to 2013, the percentage of obesity in men and women has raised from 13% to 18% and from 31% to 44%, respectively. Both cross-sectional and longitudinal effects of age were significantly associated with the odds ratio of obesity. There was a rise in the probability of obesity for individuals with baseline age 35 to 60 and a decline for the older ones. Furthermore, the odds of obesity had about 2% increase (on average) by each year of aging, regardless of the baseline age.ConclusionThe high frequency of obese individuals and its fast growth has been a serious public health issue among Iranians adults aged 35-60 years, especially in women. To better understand the effect of age on obesity and identify the related factors, both cross-sectional and longitudinal effects of age should be considered.
Burnout Profiles Among French Workers in Health Units for Inmates: Results of the EHCAU Study
Authors: Boulier Stéphanie , Baumann Cédric , Rousseau Hélène , Horrach Pierre , Bourion-Bedes stephanie
Published: September 2020

Background: Professionals who work in penitentiary environments are at a risk of burnout due to a variety of factors. Recent literature has proposed a classification system involving five burnout profiles in a continuum between engagement and burnout. The objective of this study is to measure the prevalence of these profiles among professionals working in all care levels in French health units providing health services for inmates and to investigate their characteristics to propose appropriate prevention and management strategies.Methods: This study involved a cross-sectional analysis of data from the Evaluation of Health CAre in Units for inmates (EHCAU) study, a multicentric cohort study of professionals working in health units for inmates in the East area of France. Occupational burnout was measured by the Maslach Burnout Inventory (MBI) at the emotional exhaustion, depersonalization and personal accomplishment levels. Job conditions and characteristics were assessed using the Karasek Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire. Data on sociodemographic characteristics and self-reported health status were also collected. Differences between MBI profiles were identified using Fisher’s exact test and Wilcoxon test.Results: Of 350 professionals surveyed, 150 responded (42.9%). The most frequent profiles were ineffective (36.9%) and engagement (34.8%). Burnout (7.8%), overextended (15.6%), and disengaged (5.0%) profiles made up the remaining quarter. Significant differences were seen in the burnout profiles in regard to professional occupation (p=0.01), irregular eating hours (p=0.04), history of complaint procedures (p=0.05), anxiety (p<0.0001), depression (p<0.0001) and the mental component of self-reported quality of life (p<0.0001).Conclusions: These results confirm that special attention should be given to professionals working in these challenging settings. The results have important implications for theory and research and for more customized approach interventions.Trial registration: ID RCB : 2018-A03029-46
Analysis of Urine Test Results of Han and Tibetan 0-6 Years Old Children in Gansu Province, Western China: A Cross-Sectional Study
Authors: Li Yanfen , Pei Hongbo , Qiu Hao , Cui Jinqiao , Ma Liang , Fu Ping , Zhen Xiaoyan
Published: September 2020

Background Urine examination can reflect concealed kidney diseases in children. However, few surveys described the difference in urine routine indicators between children belonging to different ethnic groups. This study aimed to compare urine components between Han and Tibetan preschool children in western China and explore influencing factors for early kidney disease prevention.MethodsThe urine routine data were obtained by cluster sampling of children (N = 1645: NHan = 1019, NTibetan = 626, age range: 0–6 years) in 10 child care institutions of Lanzhou City and Gannan Tibetan Autonomous Prefecture through the medical examination center affiliated to a top three hospital in Gansu Province in western China. The correlation of the urine routine indicators with the factors, including living environment, diet, family income, and kidney disease in parents, were explored through multiple logistic regression analysis.ResultsThe lower age group (1–3 years old) was a protective factor for urinary vitamin C in Han children [odds ratio (OR) Han = 0.13, 95% confidence interval (CI) = 0.05–0.32], while it was a risk factor among Tibetan children (OR Tibetan = 3.01, 95% CI = 1.28–7.10), compared with the higher age group (4–6 years old). Among Han children, male sex was the risk factor for urinary ketone body (OR Han = 2.28, 95% CI = 1.20–4.33). Among Tibetan children, living in newly decorated houses was a risk factor for urinary ketone body and urinary occult blood (OR ketone body = 2.35, 95% CI = 1.12–4.93; ORoccult blood = 18.20, 95% CI = 4.30–76.92). Male sex is the protective factor for urinary leukocyte detection in both Han and Tibetan children (OR Han = 0.10, 95% CI = 0.04–0.20; ORTibetan = 0.25, 95% CI = 0.10–0.63). The intake of lead-containing foods is a risk factor for urinary leukocyte detection in Tibetan children (ORTibetan = 4.34, 95% CI=1.19–15.91). Parental kidney disease history is a risk factor for urinary occult blood in Han children (ORHan = 2.56, 95% CI=1.21–5.41).ConclusionThe differences in physiology, diet, and living environment in children belonging to different ethnic groups were influencing factors for different urine abnormalities.
The Association Between the Perceived Unjust Treatment in Healthcare Settings and the Unmet Need for General Practitioner Services Among People With Foreign Background in Finland
Authors: Somersalo Laura , Kankkunen Päivi , Lilja Eero , Koponen Päivikki , Kuusio Hannamaria
Published: September 2020

Background: Unjust experiences are relatively common among people with foreign background (PFB) in Finland. Despite universal access to public health care, previous studies have shown inequities in the unmet need for medical care between immigrants and the general population. This study examines the association between unjust treatment in healthcare settings and unmet need for general practitioner (GP) services among PFB. Method: The data for this study were drawn from Survey on work and well-being among people of foreign origin (UTH) (n = 4977, response rate 66%). The respondent characteristics were weighted and summarized, and multivariate logistic regression analyses were performed to assess the adjusted odds ratios (OR) of association between perceived unjust treatment and unmet need for GP services. The analyses were conducted in a four-step process where the first model tested the association between unjust treatment in health care settings and unmet need for GP services, second model adjusted this association by sociodemographic factors, third model was further adjusted by migration related factors, and the fourth model adjusted the previous models even further by health related factors.Results: The results of multivariate regression showed that PFB reporting unjust treatment were also significantly more likely to report an unmet need for GP services. The difference remained significant even after controlling for other tested factors (OR=8.68, 95% CI 6.09-12.36, p<.001). In addition to perceived unjust treatment, only younger age, lower self-rated health and existing long-term illness were significantly associated with unmet need for medical care in the final, fully adjusted model.Conclusions: Thus, perceived unjust treatment in health care settings is significantly associated with unmet need for general practitioner services. Ensuring cultural competence throughout the entire organizational structures creates an environment to promote equal treatment for all clients. The overall costs can be reduced effectively by giving the best possible treatment for all health care users.
Inequalities in socioeconomic status, behaviors, healthcare services and vulnerability to HIV/STIs between brothel-based and street-based female sex workers in Yunnan, China
Authors: Cai Guoxi , Liu Yufen , Lu Yixiao , Wu Jiwen , Zhuang Jinman , Hu Zhijian , Zhang Jianping , He Fei
Published: September 2020

BackgroundCommercial sex plays a critical role in the transmission of HIV/STI infections in mainland China because female sex workers (FSWs), who tend to be either street-based (SSWs) or brothel-based (BSWs), are extremely prevalent. These two groups had different behaviors and treatment. Few studies investigated due to SSWs group is difficult to reach. MethodsA cross-sectional survey was conducted in Yunnan Province of China with 129 street-based and 185 brothel-based participants. Peer educators conducted anonymous, face-to-face interviews to collect data on socio-demographic characteristics, HIV/STIs-related knowledge, sex work history, sex behaviours, experience of receiving healthcare service, and experience of abuse from clients. Blood samples were taken for HIV and syphilis testing. Urine samples were taken for gonorrhoea and chlamydia testing. ResultsSignificant differences on socio-economic characters and HIV/STIs prevalence are found between the two types of FSWs. SSWs are older than BSWs; have less education, more dependents, and more clients in one week; receive less healthcare services; and have a higher prevalence of HIV/STIs. Binary logistic regression model results showed that venue for sex trade and experience of HIV testing were significantly associated with the prevalence of HIV/STIs ConclusionsThe SSWs are at lower socio-economic status and have high HIV/STIs mobility, who are more marginalized, receive less healthcare and are, thus, more vulnerable. China’s next step in healthcare intervention should focus on the most hard-to-reach-marginalised groups. HIV/STIs testing and socio-psychological support programmes are urgent needed for these neglected people.
Whole Health System Change in Ireland: A Collaborative Inquiry Into the Enablers and Challenges of Implementation
Authors: Carroll Aine , Twomey Valerie
Published: September 2020

BackgroundAcross the world, health and care systems are struggling to contain costs and improve quality of services by improving prevention, developing wellness programmes, and providing person-centred coordinated health and care. The development of the National Clinical Programmes (NCPs) in Ireland in 2009 coincided with a profoundly challenging period for the Irish economy and consequently for publicly funded health services. These programmes are focused on implementing clinical and operational models of care that have access, quality and value at their core. By 2012, there was a clear recognition among senior health leaders that the desired outcome of nationalising best practice and achieving whole system change had not been achieved through the NCPs and a series of world café events were then planned to assess the challenges that had been experienced by the programmes in order to inform the next phase.MethodsA Multi-Stakeholder Engagement Process using the World Café method of collaborative participatory inquiry, was conducted to obtain a rich, in-depth understanding of the development and implementation of health service reform in Ireland. Three keys questions were explored through an inductive approach to analysis of themes that emerged from conversations with key stakeholders.ResultsThere were 59 participants. A total of 408 responses were received. Using an inductive approach to analysis of themes 5 key themes emerged; Integrated care; Patient Centred Care; Clinical Governance; Funding models and e-Health.ConclusionHaving a clear vision, a prescribed methodology and clinician buy and involvement in the design of new models of care is not sufficient to ensure implementation. A whole system approach to the design and implementation of new models of care must be supported by essential enablers such as policy, financial and human resource models and knowledge management systems. This research informed the planning and design for the second phase of the programmes and sought to overcome the barriers and work with operations and policy makers to improve outcomes for patients by implementing person centered evidence-based models of integrated care.
Simulation Analysis and Verification of Temperature and Stress of Wheel-Mounted Brake Disc of a High-Speed Train
Authors: Qu Junsheng , Wang Wenjing , Dong Ziyu
Published: September 2020

During the braking process, a large amount of heat energy is generated at the friction surfaces between the brake disc and pads and rapidly dissipates into the disc volume. In this paper, a three-dimensional thermo-mechanical coupling model of high-speed wheel-mounted brake discs containing bolted joints and contact relationships is established. The direct coupling method is used to analyse the temperature and stress of the brake discs during an emergency braking event with an initial speed of 300 km/h. A full-scale bench test is also conducted to monitor the temperatures of the friction ring and bolted joints. The simulation result shows that the surface temperature of the friction ring reaches its peak value of 413.7°C after 102 s of braking, which agrees well with the bench test result. The maximum alternating thermal stress occurs in the bolt hole where the maximum circumferential compressive stress is -658 MPa and the maximum circumferential tensile stress is 134 MPa. During the braking process, the out-of-plane deformation of the middle part of the friction ring is larger than that of the edge, which increases the axial tensile load of the connecting bolt. This work provides support for the design of brake discs and connecting bolts.
Identification of Missense Mutation Pro77Arg As A Founder Mutation in Morquio-A Syndrome in Indian Gujarati Patel Ethnicity
Authors: Sheth Jayesh J , Bhavsar Riddhi , Nair Aadhira , Patel Chandni , Naik Premal , Shah Maulin , Chaudhary Mayank , Sheth Frenny , Pandey Nishtha , Deshpande Prajakta , Dubey Shweta , Nair Sreeja , Tamraparni Vandana , Sriniva Sudha
Published: September 2020

Background: Morquio A syndrome (MPS IVA) is a mucopolysaccharide group storage disorder caused due to the deficient activity of the lysosomal enzyme N-acetylgalactoseamine-6-sulfatase encoded by GALNS. The present study represents the mutation spectrum of GALNS in 25 Gujarati Patel patients of India clinically and biochemically confirmed with Morquio-A disorder.Methods: Urinary GAG quantitation and leucocyte enzyme assay was carried out in all 25 patients. This was followed by molecular characterization by amplification and sequencing of the exons and adjacent intronic regions of GALNS gene. Haplotype analysis was performed in patients showing p.P77R variant, using microsatellite markers D16S3121, D16S3026 and D16S3023 and SNPs.Results: We identified 11 mutations that include eight missense mutations: (p.L36R, p.D39G, p.P77R, p.C79R, pP125L, p.P151L, p.G255A and p.L350P), one splice site mutation: (c.121-7C>G), one small insertion: (c.1241_1242insA, p.I416HfsTer2) and one small deletion: (c.839_41delACA). Of these, three missense mutations (p.D39G, p.G255A and p.L350P), one splice site and the two indels mentioned above are novel. In the present study, we found maximum number of mutant alleles in exon 2, and of note, the variant p.P77R was seen in fourteen patients. Conclusion: p.P77R variant was predominantly found in Gujarati Patel community and the results of haplotype analysis indicated it to be the founder mutation in this community. Further, a study of 200 unrelated healthy control participants from Gujarat has identified this mutation in the heterozygous status in two individuals. Overall, our study suggests that p.P77R is likely to be a founder mutation for Morquio-A syndrome in Gujarati Patel ethnicity.
Age is Associated With Increased Expression of Pattern Recognition Receptor Genes and ACE2, the Receptor for SARs-Cov-2: Implications for the Epidemiology of COVID-19 Disease
Authors: Bickler Stephen W. , Cauvi David M. , Fisch Kathleen M. , Prieto James M. , Gaidry Alicia D. , Thangarajah Hariharan , Lazar David , Ignacio Romeo , Gerstmann Dale R. , Ryan Allen F. , Bickler Philip E. , Maio Antonio De
Published: September 2020

Background: Older aged adults and those with pre-existing conditions are at highest risk for severe COVID-19 associated outcomes. Methods: Using a large dataset of genome-wide RNA-seq profiles derived from human dermal fibroblasts (GSE113957) we investigated whether age affects the expression of pattern recognition receptor (PRR) genes and ACE2, the receptor for SARS-CoV-2. Results: Older age was associated with increased expression of PRR genes, ACE2 and four genes that encode proteins that have been shown to interact with SAR2-CoV-2 proteins. Conclusions: Assessment of PRR expression might provide a strategy for stratifying the risk of severe COVID-19 disease at both the individual and population levels.
Effect of Bleomycin on Oral Leukoplakia Cell line- an in Vitro Study
Authors: Khair Al Moutassem B. , Luke Alexander , Shetty Shishir R. , Mathew Simy , Patnaik Rajashree
Published: September 2020

Background Leukoplakia generally refers to a firmly attached white patch on a mucous membrane which is associated with an increased risk of cancer. So it is important to diagnose leukoplakia in early stage. In this study we are trying to treat leukoplakia as a marker for prediagnosis of cancer. Since, bleomycin as a chemotherapeutic agent, is mainly used in the treatment of multiple tumors, and several cancers. Hence in this study effect of bleomycin was studied in D38, a leukoplakia cell line.Methods Percent lethality values of leukoplakia cells after treated with several concentations of bleomycin was studied by acridine orange/ethidium bromide staining (AO/EB), propidium iodide (PI) staining, 3-(4, 5-dimethythiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay and comet assay. Minimum inhibitory concentration (MIC), lethal concentration25 (LC25), lethal concentration50 (LC50), lethal concentration75 (LC75) and highest permissive concentration (HPC) was calculated from probit computational method.Results From AO/EB staining, PI staining, MTT assay and comet assay the MIC value was 15 mg/L concentration of bleomycin, where as the HPC was found at 100 mg/L of bleomycin. The comet tail length gradually increased from 15 mg/L to 100 mg/L of bleomycin. Percent lethality values were also increased from 15 to 100 mg/L concentration of bleomycin in all the staining protocols as well as in comet assay technique.Conclusion It is important to diagnose leukoplakia in early stage. Since, bleomycin as a chemotherapeutic agent, it is mainly used in the treatment of multiple tumors, testicular carcinomas, lymphomas, and head, neck cancers. From the results, it was found that bleomycin can be used for treatment of oral leukoplakia to prevent its development to SCC.
Young Male With Recurrent Headache: A Case Report
Authors: Chien Yu-Ta , Feng Shang-Yu
Published: September 2020

Background Headache, one of the most common symptoms presenting to the emergency department, is usually benign but sometimes fatal. Identifying high-risk headache syndromes and providing appropriate headache therapy remain the first priority for emergency physicians. Common “Red flags” includes sudden onset, focal neurological deficit, fever, neck stiffness and so on. We categorize headache into primary (such as tension, cluster headache and migraine) and secondary (subarachnoid hemorrhage, acute meningitis, intracranial hemorrhage, etc) while ruling out secondary headache is the first step in management. Case presentation We report a case of nasopharyngeal carcinoma(NPC) with defect at left side of nasopharynx and sphenoid sinus causing diffuse pneumocephalus. The 35-year-old male presented to the emergency department for sudden-onset headache with unusual associated symptom: rhinorrhea. Computed tomographic (CT) examination revealed a diffuse pneumocephalus, which did not present in magnetic resonance imaging of brain one month ago. The treatment was mainly conservative and the recovery was smooth.Conclusions Unusual symptoms like rhinorrhea and otorrhea should not be ignored, they might be the only clues to the diagnosis of pneumocephalus. Most of the pneumocephalus related to NPC occurred after recent radiotherapy. However, this patient finished radiotherapy on 2012/5. Thus, metastatic skull bony erosion with associated pneumocephalus might be taken into consideration.
Quality Assessment of Fungal Synthesized Bio-Surfactants From Agro-Wastes(Cassava, Yam and Sweet Potato Peels)
Authors: Ezeonu Chukwuma Stephen , Otiwa Simon Ofana
Published: September 2020

Background: Biosurfactants are produced extracellularly by microorganism on cell surface or extracellularly on media environments. They are known for their role in surface and interfacial tension reduction between molecules at the surface and interface, respectively. Thus, this study was conducted to determine and compare the capability of biosurfactant production from immediate agrochemical wastes (yam, cassava and sweet potato peels) using fungal isolates. Materials and Method: The test fungi (Aspergillus niger and Fusarium oxysporum) were isolated from yam, potato and cassava peels showing advanced rottenness. Standardized production of biosurfactants using well researched protocol involving media and inclusion of agrochemical wastes in a fermentation broth containing the isolated fungi was carried out. Results and Discussion: The highest biosurfactant activity value obtained was with F. oxsporum on yam peels with emulsification index (EI) of 94.2±0.20% on kerosene after 72 hours (EI72). While the lowest activity of biosurfactant was observed in A. niger grown on cassava peels broth with EI72 activity of 36.36±0.53% on diesel. The trend showed that emulsification index on diesel after 24 hours (E24) with biosurfactant from A. niger grown in yam peel broth gave the highest EI concentration (48.42±0.14%) followed by biosurfactant from F. oxysporum cultured in yam peels (48.27±0.99%). In comparison with kerosene emulsion formed: biosurfactant from F. oxysporum grown in yam peels showed highest EI (94±0.10%) followed by A. niger cultured in yam peels (78.72±1.08). The EI results showed that yam peel served as a better substrate for biosurfactant production while F. oxysporum is the better biosurfactant producing fungi. The EI values were slightly maintained for 48hrs (EI48) and 72hrs (EI72). The result of the oil spreading assay using engine oil revealed that biosurfactants produced by F. oxysporum grown on sweet potato peels broth displaced more area of expired engine oil in water by forming miscelles with oil displacement area (ODA) of 9.08±0.02cm2 followed by biosurfactant from A. niger grown in sweet potato broth with ODA of 8.04±0.38 cm2. In terms of substrate specificity the sequence of increment in EI was: Yam>Cassava>Sweet potato. However, considering the critical micellar level or the oil displacement ability of the product, the sequential increment was: Sweet potato>Cassava>Yam peels. Conclusion: The biosurfactant produced shows more cleansing ability towards kerosene than it does for diesel. Conversely, it could be channelled toward clean-up of kerosene viz a-viz crude oil contaminated surfaces and environment.
A Survey to Oral Health Status and Oral Hygiene Behaviour of Orphan Children Located in Support Centres
Authors: Abedassar Saeedeh , Mohammadi Tayebeh Malek , Dehesh Tania , Dehesh Sajad , Hajizamani Hamid Reza
Published: September 2020

The authors have requested that this preprint be removed from Research Square.
Comparison of The Risk Factors For Falls Among Older Adults Between Urban and Rural Areas of Shantou City, China
Authors: Chen Xiaodong , Lin Zeting , Gao Ran , Yang Yijian , Li Liping
Published: September 2020

Background: To investigate the prevalence of falls and risk factors among older adults in urban and rural areas and to facilitate the design of fall prevention interventions.Methods: We used cluster random sampling to investigate the sociodemographic information, living habits, medical history, and falls among 649 older adult participants. Univariable and multivariable logistic regression was used to examine fall risk factors in urban and rural areas.Results: The fall rate and rate of injury from falls among older adults in urban areas were 27.3% and 18.6%, respectively, which were higher than those in rural areas (17.0% and 12.2%; P<0.05). Multivariable analysis showed that the risk factors for falls among urban older adults included a high school or below education level (OR=3.737, 95% CI: 1.503~9.291); diabetes medicine use (OR=4.518, 95% CI: 1.228~16.626); incontinence (OR=8.792, 95% CI: 1.894~40.824); lack of fall prevention education (OR = 11.907, 95% CI: 1.321～107.354); and reduced balance function (OR = 3.901, 95% CI: 1.894~7.815). The risk factors among rural older adults included a previous nonfarming occupation (OR=2.496, 95% CI: 1.416~4.398); incontinence (OR =11.396, 95% CI: 1.901~68.327); poor living environment (OR=3.457, 95% CI: 1.488~8.033); and reduced balance function (OR =4.260, 95% CI: 2.361~7.688).Discussion: The rate of falls among older adults in urban areas is higher than that in rural areas of Shantou City. Fall prevention in urban areas should target older adults with low education and modify the diabetes medication use. Interventions should focus on improving the home environment of older adults in rural areas.