bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture for poststroke hemiplegia focusing on cerebral bilateral connections: study protocol for a randomised controlled neuroimaging trial
Authors: Jiang Lan , Geng Hualei , Lu Mengxin , Du Zhongming , Chen Pei , Han Xiao , Wang Yue , Tang Lixin , Tan Zhongjian , Zhang Hua , Zou Yihuai
Published: April 2020

Introduction

Acupuncture is safe and effective for improving the motor function of poststroke hemiplegic patients, but there still exists a certain gap between clinical practice and understanding its neural mechanisms. The cerebral functional reconstruction after unilateral motor pathway injury exhibits a bilateral tendency, however current studies seldom pay attention to it. Hence, based on cerebral bilateral connections, the underlying mechanism of acupuncture in stroke rehabilitation remains an area for further research. The results of this study will increase our understanding of acupuncture-induced motor recovery in patients who had suffered a stroke and demonstrate the differences in brain response and clinical assessments.

Methods and analysis

This is a single-centre, randomised controlled, paralleled neuroimaging trial, with patients and outcome assessors blinded. Thirty patients who had a stroke with motor dysfunction meeting the inclusion criteria will be randomly assigned (2:1) to receive either 10 sessions true or sham acupoints treatments (five sessions per week for 2 weeks). All the participants will receive conventional standard medical care and rehabilitation. Motor function assessments and neuroimaging scanning will be conducted before and after the entire acupuncture treatment. The clinical and neuroimaging data will be analysed, respectively. The voxel-mirrored homotopic connectivity will be the primary outcome and the primary effect indicator. The secondary outcomes comprise clinical evaluations and neuroimaging assessments, which include Fugl-Meyer Assessment, the National Institutes of Health Stroke Scale, fractional anisotropy and gray matter volume. The Needle Sensation Assessment Scale is an additional outcome. The correlation analysis will be explored between the neuroimaging indicators, clinical motor assessments and needle sensation.

Ethics and dissemination

The protocol has been approved by the ethics committee of Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine (DZMEC-KY-2018-04). The results of the neuroimaging trial will be disseminated through peer-reviewed publications and conferences.

Trial registration number

Chinese Clinical Trials Registry (ChiCTR 1800016263).
Novel team-based approach to quality improvement effectively engages staff and reduces adverse events in healthcare settings
Authors: Curtin Annie Gabrielle , Anderson Vitas , Brockhus Fran , Cohen Donna Ruth
Published: April 2020

Background

Despite significant attention to safety and quality in healthcare over two decades, patient harm in hospitals remains a challenge. There is now growing emphasis on continuous quality improvement, with approaches that engage front-line staff. Our objective was to determine whether a novel approach to reviewing routine clinical practice through structured conversations—map-enabled experiential review—could improve engagement of front-line staff in quality improvement activities and drive improvements in indicators of patient harm.

Methods

Once a week over a 10-month period, front-line staff were engaged in 35 min team-based conversations about routine practices relating to five national safety standards. Structure for the conversations was provided by interactive graphical logic maps representing each standard. Staff awareness of—and attitudes to—quality improvement, as well as their perceptions of the intervention and its impact, were canvassed through surveys. The impact of the intervention on measures of patient safety was determined through analysis of selected incident data reported in the hospital’s risk management system.

Results

Themap-enabled experiential reviewapproach was well received by staff, who reported increased awareness and understanding of national standards and related hospital policies and protocols, as well as increased interest in quality issues and improvement. The data also indicate an improvement in quality and safety in the two participating units, with a 34% statistically significant decrease in the recorded incident rates of the participating units relative to the rest of the hospital for a set of independently recorded incidents relating to patient identification.

Discussion

This exploratory study provided promising initial results on the feasibility and effectiveness ofmap-enabled experiential reviewas a quality improvement approach in an acute clinical setting.
Partnering with patients to improve access to primary care
Authors: Davie Sam , Kiran Tara
Published: April 2020

Continuity and timely access are hallmarks of high-quality primary care and are important considerations for urgent concerns that present both during the day and after-hours. It can be especially difficult to ensure continuity of primary care after-hours in urban settings where walk-in clinics offer patients easy and convenient access. Patients of our large, multisite primary care practice in inner-city Toronto, Canada were reporting that they were not easily able to access after-hours care from their team without having to use outside services. In partnership with patients, we combined the Model for Improvement with Experience-Based Design methodology to address the issue of poor access to after-hours care. We did a root cause analysis to isolate the causes of the local problem, using a variety of capture tools designed to incorporate the patient voice. Then, patients and providers codesigned two Plan-Do-Study-Act (PDSA) cycles aimed to increase the ease of accessing after-hours care. Key actions included a redesign of our after-hours advertisement and communication of the material in multiple formats. Following these PDSA cycles, the team saw a 26%, 23% and 17% increase in awareness of weekday evening clinics, weekend clinics and after-hours phone services, respectively, and a 16% increase in the proportion of patients reporting that it was very or somewhat easy to get care during the evening, on the weekend or on a holiday from their care team. Measures continued to improve and improvements have been sustained 3 years later. Our success highlights the effectiveness of partnering with patients to improve access to primary care.
Establishment of consensus on content and learning objectives for an interprofessional education in childhood cancer: a Delphi survey
Authors: Topperzer Martha Krogh , Thellesen Line , Hoffmann Marianne , Larsen Hanne Baekgaard , Weibel Mette , Lausen Birgitte , Schmiegelow Kjeld , Sørensen Jette Led
Published: April 2020

Background

Complex treatment, care and rehabilitation require continuous healthcare professional development and maintenance of competencies in collaboration with other professionals. Interprofessional education in childhood cancer involves several groups of healthcare professionals with both general and specific knowledge and skills.

Objective

To establish consensus on content and interprofessional learning objectives for an interprofessional education in childhood cancer.

Design

A three-round Delphi survey in Scandinavian childhood cancer departments.

Participants

Healthcare professionals appointed by their head of departments and head nurses based on their profession and their involvement in continuing professional development.

Main outcome measures

A prioritised list of interprofessional learning objectives with a mean score of ≥3 on a five-point scale (1=not relevant, 5=extremely relevant).

Results

12 childhood cancer departments participated with 30 healthcare professionals: 11 nurses, 10 medical doctors, 5 social workers, 2 physiotherapists and 2 pedagogues. In total, 28 (93%), 25 (83%) and 22 (73%) completed the first, second and third round, respectively. In the first round, we asked open-ended questions and used directed content analysis to analyse 386 statements. We formulated 170 interprofessional learning objectives in six categories: (1) acute life-threatening situations, (2) gastrointestinal toxicities and side effects, (3) pain, (4) palliation, (5) play and activity, and (6) prescription and administration of medicine. The second round resulted in 168 interprofessional learning objectives receiving a mean score of ≥3 on a five-point scale. Final agreement in the third round resulted in a prioritised list of 168 learning objectives.

Conclusions

Consensus on content and interprofessional learning objectives for an interprofessional education in childhood cancer was established across five groups of healthcare professionals in three countries. Some learning objectives are generic and can be applied in settings other than childhood cancer, where healthcare professionals collaborate to provide patients and families optimal treatment and care.
Young adults with life-limiting or life-threatening conditions: sexuality and relationships support
Authors: Earle Sarah , Blackburn Madeleine
Published: April 2020

Objective

The research project addressed the need to support young adults with issues relating to sexuality and relationships though the development of guidance and standards for practice.

Methods

An action research project underpinned by an interpretivist qualitative framework. Participants were recruited to the project via three hospices in the UK. Data from four focus groups were analysed thematically using a process of constant comparison.

Results

Sixteen young adults with life-limiting or life-threatening conditions aged 21–33 years participated in the study. Three significant themes were identified: sexuality and the transition to adulthood, recognising the significance of sex and relationships, and realising sexual rights.

Conclusion

Sexuality and relationships play an important role in the transition to adulthood for people with life-limiting or life-threatening conditions living in the UK. While young adults with these conditions may have considerable support needs, it is important to balance this with the freedom to exercise choice and to make independent decisions. Sex negativity can have an adverse impact on the experiences of young adults and creates barriers. Improved ongoing access to sex education and the provision of enabling environments that afford privacy and safety are important to support young adults with sexuality and relationships.
Advance care plans and hospitalized frail older adults: a systematic review
Authors: Hopkins Sarah A , Bentley Allison , Phillips Veronica , Barclay Stephen
Published: April 2020

Introduction

Frail older people are known to have low rates of advance care planning (ACP). Many frail patients prefer less aggressive treatment, but these preferences are often not known or respected. Frail patients often have multiple hospital admissions, potentially providing opportunities for ACP.

Objective

To systematically review the literature concerning ACP with frail older people in the acute hospital, with particular reference to: (1) Does ACP improve outcomes? (2) What are the views of patients, relatives and healthcare professionals regarding ACP? (3) Does ACP currently occur? (4) What are the facilitators and barriers to ACP?

Design

Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO and Embase databases from January 1990 to May 2019 inclusive. Studies in the acute setting of populations with a mean age>75 years, not focused on a disease-specific terminal condition were included.

Results

16 133 articles were retrieved, 14 met inclusion criteria. No studies used an objective measure of frailty. One randomised controlled trial (RCT) found that ACP improves outcomes for older patients. Although 74%–84% of capacitous older inpatients are receptive to ACP, rates of ACP are 0%–5%; the reasons for this discrepancy have been little studied. The nature of ACP in clinical practice is unknown thus the extent to which it reflects the RCT intervention cannot be assessed. The outcomes that are important to patients are poorly understood and family and physician experiences have not been explored.

Conclusions

A better understanding of this area could help to improve end-of-life care for frail older people.

PROSPERO registration number

CRD42017080246.
NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus
Authors: Gómez-Batiste Xavier , Turrillas Pamela , Tebé Cristian , Calsina-Berna Agnès , Amblàs-Novellas Jordi
Published: April 2020

Objective

To develop a proposal for a 2-year mortality prognostic approach for patients with advanced chronic conditions based on the palliative care need (PCN) items of theNECesidades PALiativas(NECPAL) CCOMS-ICO V.3.1 2017 tool.

Methods

A phase 1 study using three components based on the NECPAL items: (1) a rapid review of systematic reviews (SRs) on prognostic factors of mortality in patients with advanced chronic diseases and PCNs; (2) a clinician and statistician experts' consensus based on the Delphi technique on the selection of mortality prognostic factors; and (3) a panel meeting to discuss the findings of components (1) and (2).

Results

Twenty SRs were included in a rapid review, and 50% were considered of moderate quality. Despite methodological issues, nutritional and functional decline, severe and refractory dyspnoea, multimorbidity, use of resources and specific disease indicators were found to be potentially prognostic variables for mortality across four clinical groups and end-of-life (EoL) trajectories: cancer, dementia and neurologic diseases, chronic organ failure and frailty. Experts’ consensus added ‘needs’ identified by health professionals. However, clinicians were less able to discriminate which NECPAL items were more reliable for a ‘general’ model. A retrospective cohort study was designed to evaluate this proposal in phase 2.

Conclusions

We identified several parameters with prognostic value and linked them to the tool’s utility to timely identify PCNs of patients with advanced chronic conditions in all settings of care. Initial results show this is a clinical and feasible tool, that will help with clinical pragmatic decision-making and to define services.
Steroid use and misuse: a key performance indicator in the management of IBD
Authors: Blackwell Jonathan , Selinger Christian , Raine Tim , Parkes Gareth , Smith Melissa A , Pollok Richard
Published: April 2020

Corticosteroids remain an important tool for inducing remission in inflammatory bowel disease (IBD) but they have no role in maintenance of remission. The significant adverse side effect profile of these drugs means their use should be avoided where possible or measures taken to reduce their risk. Despite an expanding array of alternative therapies, corticosteroid dependency and excess remain common. Appropriate steroid use is now regarded a key performance indicator in the management of IBD. This article aims to outline indications for corticosteroid use in IBD, their risks and strategies to reduce their use and misuse.
Feasibility and safety of transradial access for pediatric neurointerventions
Authors: Srinivasan Visish M , Hadley Caroline C , Prablek Marc , LoPresti Melissa , Chen Stephanie H , Peterson Eric C , Sweid Ahmad , Jabbour Pascal , Young Christopher , Levitt Michael , Osbun Joshua W , Burkhardt Jan-Karl , Johnson Jeremiah , Kan Peter
Published: April 2020

Background

Diagnostic cerebral angiograms are increasingly being performed by transradial access (TRA) in adults, following data from the coronary literature supporting fewer access-site complications. Despite this ongoing trend in neuroangiography, there has been no discussion of its use in the pediatric population. Pediatric TRA has scarcely been described even for coronary or other applications. This is the first dedicated large study of transradial access for neuroangiography in pediatric patients.

Methods

A multi-institutional series of consecutively performed pediatric transradial angiograms and interventions was collected. This included demographic, procedural, outcomes, and safety data. Data was prospectively recorded and retrospectively analyzed.

Results

Thirty-seven diagnostic angiograms and 24 interventions were performed in 47 pediatric patients. Mean age, height, and weight was 14.1 years, 158.6 cm, and 57.1 kg, respectively. The radial artery measured 2.09+/-0.54 mm distally, and 2.09+/-0.44 mm proximally. Proximal and distal angiography were performed for both diagnostic and interventional application (17 distal angiograms, two distal interventions). Clinically significant vasospasm occurred in eight patients (13.1%). Re-access was successfully performed 11 times in seven patients. Conversion to femoral access occurred in five cases (8.2%). The only access-related complication was a small asymptomatic wrist hematoma after TR band removal.

Conclusions

Transradial access in pediatric patients is safe and feasible. It can be performed successfully in many cases but carries some unique challenges compared with the adult population. Despite the challenge of higher rates of vasospasm and conversion to femoral access, it is worth exploring further, given the potential benefits.
Thyroid haemangiosarcoma in a seven‐year‐old female Shih Tzu
Authors: Moreira Luis Pedro Rocha , Scurrell Emma , Mahoney Paul , Baines Stephen
Published: April 2020

Canine thyroid tumours are uncommon and the majority of tumours are carcinomas or adenomas, with only very few mixed tumours or metastases from distant sites described to date. A primary thyroid haemangiosarcoma has never been reported in veterinary medicine. In this case report, we describe a dog with a history of a large, non‐painful, mobile ventral neck mass in the right paralaryngeal region. CT and ultrasound‐guided fine needle aspirates were used for clinical staging. The mass was surgically excised and histopathological examination indicated a haemangiosarcoma. Abdominal ultrasound revealed the presence of splenic nodules and splenectomy indicated the presence of haemangiosarcoma. Chemotherapy with doxorubicin was started, but the dog was euthanased after three rounds of therapy, 97 days after the mass was discovered.
Experimental study on the coefficient of restitution of grain against block interfaces for natural and engineered materials
Authors: Sandeep C.S. , Senetakis K. , Cheung D. , Choi C.E. , Wang Y. , Coop M.R. , Ng C.W.W.
Published: April 2020

The coefficient of restitution (COR) is an important input parameter in the numerical simulation of granular flows, as it governs the travel distance, the lateral spreading, and the design of barriers. In this study, a new custom-built micromechanical impact loading apparatus is presented along with impact experiments on engineered and natural materials. The COR and energy loss of various grains and base block combinations are studied, including fairly regular-shaped Leighton Buzzard sand (LBS) grains as a natural soil and granite or rubber as base blocks, apart from the use of engineered materials for the grains (chrome steel balls, glass balls) and blocks (stainless steel, brass). The repeatability of the new micromechanical impact loading apparatus was checked by impacting chrome steel balls on stainless steel block. In all the test combinations, the higher and lower values of the COR are found for granite block (ranging between 0.75 and 0.95) and rubber block (ranging between 0.37 and 0.44) combinations, respectively. For the tested grain–block combinations, lower values of COR were observed for impacts between materials of low values of composite Young’s modulus. However, within the narrow range of composite surface roughness of the tested grain–block interfaces no particular trend was observed in the COR values. Compared to glass balls and chrome steel balls, greater scatter in the COR values is observed for natural sand grains. This is due to the variation of the elastic and morphological characteristics among individual LBS grains.
Distinguishing Impatiens capensis from Impatiens pallida (Balsaminaceae) using leaf traits
Authors: Whitfield Heather L. , Toczydlowski Rachel H.
Published: April 2020

Impatiens capensis (Meerb.) (orange jewelweed) and Impatiens pallida (Nutt.) (yellow jewelweed) are annual species with similar phenotypes that grow in similar environments throughout the eastern United States. This makes them extremely difficult to distinguish when (chasmogamous) flowers are absent. We use morphometric analyses to identify leaf characters that distinguish these species. After collecting and scanning 342 leaves from plants of each species growing in co-occurring populations in Madison, Wisconson, USA, we quantified: leaf size, shape (using elliptical Fourier analysis), serratedness, and color. Using leaf size and shape traits, a linear discriminate analysis assigned up to 100% of leaves to the correct species. The uppermost fully expanded leaf yielded the most accurate species assignments based on size and shape traits. This leaf was, on average, smaller, less deeply serrated, with a more acute base, apex, and elliptical shape in I. capensis compared with I. pallida. Leaves of I. pallida had more color contrast (lighter veins and margins) than I. capensis, which were solid green throughout. Morphometric analysis is a promising technique to identify species-distinguishing characters in the absence of binary traits or molecular genetic analyses. Leaves from across these species’ ranges should be analyzed to test the robustness of the species-distinguishing characters we present.
Incorporating stand density effects in modeling the taper of red pine plantations
Authors: Sharma Mahadev
Published: April 2020

Taper models are used to estimate the diameter at any height along the bole of a tree. Individual tree volume can then be calculated based on these diameters and corresponding heights. As tree diameters are affected by stand density, inside- and outside-bark taper models that incorporate stand density information were developed for trees in red pine (Pinus resinosa Aiton) plantations. Data used in this study came from stem analysis on 150 red pine trees sampled from 30 even-aged, monospecific plantations across Ontario, Canada. A nonlinear mixed-effects approach was applied in fitting these taper models. Several forms of stand density were evaluated for both inside- and outside-bark diameters. A combination of stand densities expressed as [Formula: see text] (BA, basal area; TPH, trees per hectare) explained the most variation in stem taper of trees grown in red pine plantations in Ontario. This variable was highly significant in the regression and improved the predictive accuracies of both inside- and outside-bark taper models. The taper models presented here are dimensionally compatible. Therefore, these models are applicable for data using any system of units without adjusting parameter values.
The Health of Undocumented Latinx Immigrants: What We Know and Future Directions
Authors: Ornelas India J. , Yamanis Thespina J. , Ruiz Raymond A.
Published: April 2020

Undocumented Latinx immigrants experience unique factors prior to migration, during migration, and after migration that shape their health. Our review summarizes the limited but growing literature highlighting how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect the mental and physical health of undocumented Latinx immigrants. We also discuss how policies and social ties can promote their health. We focus on areas of particular concern, including health care, mental health, and HIV. Future research should use interdisciplinary approaches and intersectional frameworks to understand and address health inequities. Conducting research with undocumented Latinx immigrant communities requires community engagement, assurance of confidentiality, and creative recruitment and retention strategies. Recommendations for public health practice include investing in community health centers and organizations to ensure access to health and social services; presenting results with sufficient contextualization to interpret their generalizability; and advocating for federal-, state-, and local-level policy changes that reduce the negative health consequences associated with being undocumented.
Built Environment, Physical Activity, and Obesity: Findings from the International Physical Activity and Environment Network (IPEN) Adult Study
Authors: Sallis James F. , Cerin Ester , Kerr Jacqueline , Adams Marc A. , Sugiyama Takemi , Christiansen Lars B. , Schipperijn Jasper , Davey Rachel , Salvo Deborah , Frank Lawrence D. , De Bourdeaudhuij Ilse , Owen Neville
Published: April 2020

Creating more physical activity–supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weight status in 12 countries on 5 continents ( n > 14,000). This article presents reanalyzed data from eight primary papers to identify patterns of findings across studies. Neighborhood environment attributes, whether measured objectively or by self-report, were strongly related to all physical activity outcomes (accelerometer-assessed total physical activity, reported walking for transport and leisure) and meaningfully related to overweight/obesity. Multivariable indexes of built environment variables were more strongly related to most outcomes than were single-environment variables. Designing activity-supportive built environments should be a higher international health priority. Results provide evidence in support of global initiatives to increase physical activity and control noncommunicable diseases while achieving sustainable development goals.
Improved Electrochemical Performance of Na3V2−xZrx(PO4)3/C Through Electronic and Ionic Conductivities Regulation
Authors: Ma Hongyang , Zhao Bangchuan , Bai Jin , Li Kunzhen , Fang Zhitang , Wang Peiyao , Li Wanyun , Zhu Xuebin , Sun Yuping
Published: April 2020

Electronic and ionic conductivities are two key parameters in determining the electrochemical performance of lithium/sodium ion batteries, and element-doping is an effective way to regulate the conductivity of an active material. In this work, we attempt to modify the electronic and ionic conductivities of Na3V2(PO4)3/C cathode through a proper content of Zr-doping and the two kinds of conductivities are distinguished by an ion-blocking measurement method. All Zr-doped samples display significant increase of the electronic conductivity and the x = 0.1 sample possesses the highest value of the electronic conductivity. The ionic conductivity shows a similar variation trend, but the variation value is far smaller than that of the electronic conductivity. The increase of the electronic conductivity is about one order larger than that of the ionic conductivity as x increases from 0 to 0.1. The enhanced electronic and ionic conductivities can considerably improve the cycling and rate performance of the sodium ion batteries using Na3V2(PO4)3/C cathode, especially the rate performance. The x = 0.1 electrode exhibits a much higher capacity in the whole cycling process after 1000 cycles at 10 C rate and its capacity at 50 C is about 5 times larger than that of the pristine sample.
Exercise and physical activity in cirrhosis: opportunities or perils
Authors: Bellar Annette , Welch Nicole , Dasarathy Srinivasan
Published: April 2020

Reduced exercise capacity and impaired physical performance are observed in nearly all patients with liver cirrhosis. Physical activity and exercise are physiological anabolic stimuli that can reverse dysregulated protein homeostasis or proteostasis and potentially increase muscle mass and contractile function in healthy subjects. Cirrhosis is a state of anabolic resistance, and unlike the beneficial responses to exercise reported in physiological states, there are few systematic studies evaluating the response to exercise in cirrhosis. Hyperammonemia is a mediator of the liver-muscle axis with net skeletal muscle ammonia uptake in cirrhosis causing signaling perturbations, mitochondrial dysfunction with decreased ATP content, modifications of contractile proteins, and impaired ribosomal function, all of which contribute to anabolic resistance in cirrhosis and have the potential to impair the beneficial responses to exercise. English language-publications in peer-reviewed journals that specifically evaluated the impact of exercise in cirrhosis were reviewed. Most studies evaluated responses to endurance exercise, and readouts included peak or maximum oxygen utilization, grip strength, and functional capacity. Endurance exercise for up to 12 wk is clinically tolerated in well-compensated cirrhosis. Data on the safety of resistance exercise are conflicting. Nutritional supplements enhance the benefits of exercise in healthy subjects but have not been evaluated in cirrhosis. Whether the beneficial physiological responses with endurance exercise and increase in muscle mass with resistance exercise that occur in healthy subjects also occur in cirrhotics is not known. Specific organ-system responses, changes in body composition, or improved long-term clinical outcomes with exercise in cirrhosis need evaluation.
Effect of inorganic nitrate on exercise capacity, mitochondria respiration, and vascular function in heart failure with reduced ejection fraction
Authors: Woessner Mary N. , Neil Christopher , Saner Nicholas J. , Goodman Craig A. , McIlvenna Luke C. , Ortiz de Zevallos Joaquin , Garnham Andrew , Levinger Itamar , Allen Jason D.
Published: April 2020

This is the largest study to date to examine the effects of inorganic nitrate supplementation in patients with heart failure with reduced ejection fraction (HFrEF) and the first to include measures of vascular function and mitochondrial respiration. Although daily supplementation increased plasma nitrite, our data indicate that supplementation with inorganic nitrate as a standalone treatment is ineffective at improving exercise capacity, vascular function, or mitochondrial respiration in patients with HFrEF.
Two Cases of Persistent Complex Bereavement Disorder Diagnosed in the Acute Inpatient Unit
Authors: Olaolu Olalekan , Tumenta Terrence , Adeyemo Samuel , Popoola Olusegun , Oladeji Oluwatoyin , Olupona Tolu
Published: April 2020

Pathological grief has been noted to have considerable adverse effects on affected individuals. In the DSM-5, the diagnosis of complicated grief is included under conditions for further study as Persistent Complex Bereavement Disorder (PCBD). PCBD can be easily missed because it is a relatively new and developing diagnosis. It can also be overlooked when it is comorbid with more common psychiatric disorders. We present 2 patients with PCBD diagnosed in the inpatient unit, while the patients were admitted for comorbid disorders. PCBD contributed immensely to both patients’ suffering and decline in functioning. This report highlights the presentation, diagnoses, and management of these patients. We theorize that paying attention to separation distress, reactive distress to loss, and identity disruption in individuals who have been bereaved for over 12 months will enhance treatment specificity and lead to better patient outcomes.
Characterization of a Complex Mixture of Immunomodulator Peptides Obtained from Autologous Urine
Authors: Fragoso Alberto , Pedraza-Jiménez Mérida , Espinoza-González Laura , Ceja-Mendoza María Luisa , Sánchez-Mercado Hugo , Robles-Pérez Gloria , Granados Julio , Medina-Rivero Emilio
Published: April 2020

A complex mixture of peptides plays a key role in the regulation of the immune system; different sources as raw materials mainly from animals and vegetables have been reported to provide these extracts. The batch-to-batch product consistency depends on in-process controls established. However, when an immunomodulator is a customized product obtained from the same volunteer who will receive the product to personalize the treatment, the criteria to establish the consistency between volunteers are different. In this sense, it is expected to have the same molecular weight range although the profile of peptide abundance is different. Here, we characterized the peptide profile of three extracts of an immunomodulator obtained from the urine of different volunteers suffering from three different diseases (i.e., allergic rhinitis, rheumatoid arthritis, and chronic rhinopharyngitis), using size exclusion chromatography (SEC) and mass spectrometry (MS). The peptides contained in the immunomodulators were stable after six months, stored in a refrigerator. Our results showed a chromatographic profile with the same range of low molecular weight (less than 17 kDa) in all analyzed samples by SEC; these results were also confirmed by MS showing an exact mass spectrum from 3 to 13 kDa. The fact that the peptide profiles were conserved during a six-month period at refrigeration conditions (2 to 8°C) maintaining the quality and stability of the immunomodulator supports the notion that it might be an alternative in the treatment of chronic hypersensibility disorders.
Integrated Data Mining and TOPSIS Entropy Weight Method to Evaluate Logistics Supply and Demand Efficiency of a 3PL Company
Authors: Yan Xintong , Gong Jian , He Jie , Zhang Hao , Zhang Changjian , Liu Ziyang
Published: April 2020

In the past decades, despite considerable attention having been paid to third-party logistics (3PL) owing to its specialized service, sophisticated operation, and reduced cost, research on quantitative methods for estimating the efficiency of 3PL companies is still lacking, especially for those with small or medium scale. Therefore, the purpose of this study was to establish a quantitative evaluation method to measure the efficiency of the individual nongovernmental 3PL firms and explore the valuable information for the management of 3PL business with Apriori and K-means. Taking TopChains (an emerging nongovernmental 3PL company) as an example, the monthly supply and demand (S&D) level and matching degree were evaluated via the integrating data mining algorithm (i.e., Apriori and K-means) and TOPSIS entropy weight method based on historical data. The findings demonstrate that the S&D level varied with time and space, and the customer demand in February tended to reduce substantially. Besides, the outcome of S&D matching degree in June is undesirable, indicating the unsatisfactory efficiency in resource management. The evaluation maneuver stated in this study can serve as a valuable tool to measure individual nongovernmental 3PL enterprises’ efficiency in terms of S&D, and for reference, the results can aid in rational enterprise investment plan. Besides, this attempt broadened the direction of ARM and K-means being applied in the logistics field.
Pkh1p-Ypk1p and Pkh1p-Sch9p Pathways Are Activated by Acetic Acid to Induce a Mitochondrial-Dependent Regulated Cell Death
Authors: Rego António , Mendes Filipa , Costa Vítor , Chaves Susana Rodrigues , Côrte-Real Manuela
Published: April 2020

The yeast Saccharomyces cerevisiae undergoes a mitochondrial-dependent regulated cell death (RCD) exhibiting typical markers of mammalian apoptosis. We have previously shown that ceramide production contributes to RCD induced by acetic acid and is involved in mitochondrial outer membrane permeabilization and cytochrome c release, especially through hydrolysis of complex sphingolipids catalyzed by Isc1p. Recently, we also showed that Sch9p regulates the translocation of Isc1p from the endoplasmic reticulum into mitochondria, perturbing sphingolipid balance and determining cell fate. In this study, we addressed the role of other signaling proteins in acetic acid-induced RCD. We found that single deletion of PKH1 or YPK1, as shown for SCH9 and ISC1, leads to an increase in cell survival in response to acetic acid and that Pkh1/2p-dependent phosphorylation of Ypk1p and Sch9p increases under these conditions. These results indicate that Pkh1p regulates acetic acid-induced RCD through Ypk1p and Sch9p. In addition, our results suggest that Pkh1p-Ypk1p is necessary for isc1Δ resistance to acetic acid-induced RCD. Moreover, double deletion of ISC1 and PKH1 has a drastic effect on cell survival associated with increased ROS accumulation and release of cytochrome c, which is counteracted by overexpression of the PKA pathway negative regulator PDE2. Overall, our results suggest that Pkh1p-Ypk1p and Pkh1p-Sch9p pathways contribute to RCD induced by acetic acid.
Analysis of Similarities and Differences between Acoustic Emission and Charge Signal Based on Fractal Characteristics of Coal Fracture
Authors: Ding Xin , Xiao Xiao-Chun , Lv Xiang-Feng , Wu Di , Pan Yishan
Published: April 2020

Rock burst is a catastrophic dynamic disaster caused by sudden failure and instability of coal, which brings threats to deep coal mining; the AE‐charge signals and the fragment distribution are related to both mechanical properties of coal and disaster early warning directly. Hence, the variation of AE and charge induction during coal failure, fractal feature of coal fragments, and their relationship should be studied in depth. In this paper, uniaxial loading test was carried out for coal with bursting tendency samples produced by blocks cored from 800 m depth in Xiaoqing coal mine of the Tiefa Coal Group in northeast China; the fractal characteristics of specimens are obtained by using the statistical fractal method. The mechanics of similarities and differences between acoustic emission and charge signal is investigated by using loading experiments and theoretical analysis. It is found that the fragments of coal have good self‐similarity properties; the fractal dimension of the specimens is in the range 2.085–2.521, the maximum range being 2.300–2.468, which is slightly higher than that of rock. The high‐amplitude pulses of the acoustic emission and charge are concentrated in the macroscopic fissure development and expansion stage but they have asynchronous characteristics between them. The charge generation process is accompanied by the inhomogeneous deformation and sliding friction; the friction slip is the major one and is analysed theoretically. A theoretical model for the force‐electric coupling relationship is established. The statistical results show that both the acoustic emission and the charge signal accumulation have a significantly proportional relationship with the fractal dimension. Both the acoustic emission and charge signal reveal coal breakage evolution process, which will help in obtaining the precursor information on coal failure. Furthermore, the monitoring results can predict the extent of coal mass instability.
Heritability of Mammographic Breast Density, Density Change, Microcalcifications, and Masses
Authors: Holowko Natalie , Eriksson Mikael , Kuja-Halkola Ralf , Azam Shadi , He Wei , Hall Per , Czene Kamila
Published: April 2020

Mammographic features influence breast cancer risk and are used in risk prediction models. Understanding how genetics influence mammographic features is important because the mechanisms through which they are associated with breast cancer are not well known. Here, using mammographic screening history and detailed questionnaire data from 56,820 women from the KARMA prospective cohort study, we investigated the association between a genetic predisposition to breast cancer and mammographic features among women with a family history of breast cancer (N = 49,674) and a polygenic risk score (PRS, N = 9,365). The heritability of mammographic features such as dense area (MD), microcalcifications, masses, and density change (MDC, cm2/year) was estimated using 1,940 sister pairs. Heritability was estimated at 58% [95% confidence interval (CI), 48%–67%) for MD, 23% (2%–45%) for microcalcifications, and 13% (1%–25%)] for masses. The estimated heritability for MDC was essentially null (2%; 95% CI, −8% to 12%). The association between a genetic predisposition to breast cancer (using PRS) and MD and microcalcifications was positive, while for masses this was borderline significant. In addition, for MDC, having a family history of breast cancer was associated with slightly greater MD reduction. In summary, we have confirmed previous findings of heritability in MD, and also established heritability of the number of microcalcifications and masses at baseline. Because these features are associated with breast cancer risk and can improve detecting women at short-term risk of breast cancer, further investigation of common loci associated with mammographic features is warranted to better understand the etiology of breast cancer.

Significance:

These findings provide novel data on the heritability of microcalcifications, masses, and density change, which are all associated with breast cancer risk and can indicate women at short-term risk.
Local Health Units in Portugal: The Influence of Chronic Conditions on Inpatient Readmissions
Authors: Brito Fernandes Óscar , Lopes Sílvia , Marques Ana Patrícia , Moita Bruno , Sarmento João , Santana Rui
Published: April 2020

Background: In Portugal, a public policy established the Local Health Units (LHUs), merging primary and hospital care providers. LHUs are expected to provide better continuity and coordination of care, thus decreasing the number of unplanned readmissions among those with chronic conditions. This study aims to evaluate the influence of chronic conditions on the risk of readmission at LHUs. Methods: We used inpatient care administrative databases for the years 2002–2014 (n = 1,679,634). We assessed the effects of chronic conditions on the risk of readmission with a difference-in-differences technique, comparing LHUs with a control group. Multivariate Cox regression was used to evaluate time to readmission. Results: The risk of readmission decreased in four LHUs, but significantly only in two. Individuals with more chronic conditions presented a lesser risk of read­mission at LHUs, in contrast to those in the control group. Conclusions: After adjusting for the number of chronic conditions and comorbidities, we concluded that LHUs may successfully decrease unplanned readmissions. Several challenges still have to be addressed to achieve a larger and long-lasting effect. Further investigation is needed to account for contextual and organizational effects that may explain differences across LHUs.
Assessment of Hearing Aid Benefit Using Patient-Reported Outcomes and Audiologic Measures
Authors: Dornhoffer James R. , Meyer Ted A. , Dubno Judy R. , McRackan Theodore R.
Published: April 2020

Purpose: To determine the contributions to hearing aid benefit of patient-reported outcomes and audiologic measures. Methods: Independent review was conducted on audiologic and patient-reported outcomes of hearing aid benefit collected in the course of a middle ear implant FDA clinical trial. Unaided and aided data were extracted from the preoperative profiles of 95 experienced hearing aid users, and the relationships between a patient-reported outcome and audiologic measures were assessed. The following data were extracted: unaided and aided pure-tone or warble-tone thresholds (PTA), word recognition in quiet (NU-6), Speech Perception in Noise (low-/high-context SPIN), and patient-reported benefit (Abbreviated Profile of Hearing Aid Benefit, APHAB). Hearing aid benefit was defined as the difference in thresholds or scores between unaided and aided conditions, as measured in the sound field. Correlations were computed among audiologic measures and global APHAB and subscale scores of hearing aid benefit. Results: Significant improvements in all audiologic measures and APHAB scores were observed comparing unaided to aided listening (all p < 0.001). However, correlations between audiologic and patient-reported measures of aided performance or hearing aid benefit were low-to-weak or absent. No significant correlations were found between aided audiologic measures (PTA, NU-6, SPIN) and any aided APHAB scores (all p > 0.0125), and significant relationships for hearing aid benefit were absent with only few exceptions. Hearing aid benefit defined by global APHAB using NU-6 and SPIN scores showed significant but weak positive correlations (r = 0.37, p < 0.001; r = 0.28, p = 0.005, respectively) and ease of communication APHAB subscale scores (r = 0.32, p < 0.001; r = 0.33, p = 0.001, respectively). Conclusion: Hearing aid benefit assessed with audiologic measures were poor predictors of patient-reported benefit. Thus, patient-reported outcomes may provide a unique assessment of patient-perceived benefit from hearing aids, which can be used to direct hearing aid programming, training, or recommendations of alternative hearing services.
Competing Effects of Renin Angiotensin System Blockade and Sodium-Glucose Cotransporter-2 Inhibitors on Erythropoietin Secretion in Diabetes
Authors: Marathias Katerina P. , Lambadiari Vaia A. , Markakis Konstantinos P. , Vlahakos Vassilios D. , Bacharaki Dimitra , Raptis Athanasios E. , Dimitriadis George D. , Vlahakos Demetrios V.
Published: April 2020

Background: Anaemia is a common finding in diabetes, particularly in those patients with albuminuria or renal dysfunction and is associated with impaired erythropoietin (EPO) secretion. This review focuses on mechanisms involved in the regulation of erythropoiesis in diabetic patients in an effort to elucidate the competing effects of the renin angiotensin system (RAS) blockade and sodium-glucose cotransporter-2 (SGLT2) inhibitors on haemoglobin concentration and hematocrit values. Summary: The RAS shows significant activation in diabetic subjects. Angiotensin II, its active octapeptide, causes renal tubulointerstitial hypoxia, which stimulates hypoxia-inducible factors (HIF) and increases EPO secretion and erythropoiesis. As expected, drugs that inactivate RAS, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB) are associated with a significant hematocrit-lowering effect and/or anaemia in various clinical conditions, including diabetes. Dual blockade by a combination of ACEi and ARB in diabetic patients achieves a better RAS inhibition, but at the same time a worse drop of haemoglobin concentration. Increased glucose reabsorption by SGLTs in diabetic subjects generates a high-glucose environment in renal tubulointerstitium, which may impair HIF-1, damage renal erythropoietin-producing cells (REPs) and decrease EPO secretion and erythropoiesis. SGLT2 inhibitors, which inhibit glucose reabsorption, may attenuate glucotoxicity in renal tubulointerstitium, allowing REPs to resume their function and increase EPO secretion. Indeed, EPO levels increase within a few weeks after initiation of therapy with all known SGLT2 inhibitors, followed by increased reticulocyte count and a gradual elevation of haemoglobin concentration and hematocrit level, which reach zenith values after 2–3 months. Key Messages: The competing effects of RAS blockade and SGLT2 inhibitors on erythropoiesis may have important clinical implications. The rise of hematocrit values by SGLT2 inhibitors given on top of RAS blockade in recent outcome trials may significantly contribute to the cardiorenal protection attained. The relative contribution of each system to erythropoiesis and outcome remains to be revealed in future studies.