bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra-Industry Information Transfers and Firm Value: Evidence From Ghana’s Banking Industry
Authors: Quaye Isaac , Sarbah Alfred , Nyamaah Joseph Boadi , Aidoo Mavis , Mu Yinping
Published: November 2020

The purpose of this study is to estimate the economic value of intra-industry information transfers within Ghana’s banking industry due to the collapse of seven banks. This is a short-term study with an event window [−10, +10] and an estimation period of 200 trading days. The event study methodology is adopted to estimate the cumulative abnormal return (CAR) gained by other rival industry banks as well as to calculate the cumulative average abnormal return (CAAR) for the entire Ghana Stock Exchange (GSE). The results of the study show that the collapse of the seven banks does convey information that the market uses in revising stock prices. However, most of the rival banks experienced an insignificant share price reaction. This insignificant reaction can be attributed to the fact that GSE is not efficient. The study recommended among others, for the GSE to be reformed to improve the efficiency of the market and secure the flow of information to market participants.
The inequity of morbidity: Disparities in the prevalence of morbidity between ethnic groups in New Zealand
Authors: Gurney Jason , Stanley James , Sarfati Diana
Published: November 2020

Objective:

The burden of chronic disease is not evenly shared within our society. In this manuscript, we use comprehensive national-level data to compare morbidity burden between ethnic groups in New Zealand.

Methods:

We investigated the prevalence of morbidity among all New Zealanders aged 18+ (n = 3,296,837), stratified by ethnic group (Māori, Pacific, Asian, Middle Eastern/Latin American/African, European/Other), using national-level hospitalisation and pharmaceutical data and two measures of morbidity (the M3 and P3 indices).

Results and Conclusions:

We observed substantial disparities for Māori and Pacific peoples compared to other ethnic groups for the vast majority of commonly-diagnosed morbidities. These disparities appeared strongest for the most-common conditions – meaning that Māori and Pacific peoples disproportionately shoulder an increased burden of these key conditions. We also observed that prevalence of these conditions emerged at earlier ages, meaning that Māori and Pacific peoples also experience a disproportionate impact of individual conditions on the quality and quantity of life. Finally, we observed strong disparities in the prevalence of conditions that may exacerbate the impact of COVID-19, such as chronic pulmonary, liver or renal disease. The substantial inequities we have presented here have been created and perpetuated by the social determinants of health, including institutionalised racism: thus solutions will require addressing these systemic issues as well as addressing inequities in individual-level care.
Analysis of Growth Accounting and Convergence in MENA Countries: Panel Cointegration Approach
Authors: Malik Mushtaq Ahmad , Masood Tariq
Published: November 2020

The objective of this study is to investigate the sources of output growth and their convergence in the Middle East and North African countries over the period 1970–2017. Towards this end, the study employs Levin et al. (2002, Journal of Econometrics, vol. 108, pp. 1–24), Fisher-type (Choi, 2001, Journal of International Money and Finance, vol. 20, pp. 249–272) and Im et al. (2003, Journal of Econometrics, vol. 115, pp. 53–74) panel unit root tests and Pedroni (2004, Econometric Theory, vol. 20, pp. 597–625), Kao (1999, Journal of Econometrics, vol. 90, pp. 1–44) and Johansen–Fisher cointegration tests. After estimating the production function using random effects estimator to obtain the share of physical capital in output, we employed standard growth accounting approach to measure and decompose growth of total output into contributions from growth in physical capital, labour, human capital and total factor productivity (TFP). Further, the study discusses the existence of stochastic and deterministic convergence of real output per worker and its sources (physical capital per worker, human capital and TFP). The statistical results of the article can be summarized as follows: The contribution of physical capital to output growth is found to be positive and higher than the contribution of labour, whereas the contribution of TFP was negative across the region with the exception of Egypt, Morocco, Tunisia and Turkey. However, when the contribution of human capital is netted out, the contribution of TFP becomes negative in all the countries except for Tunisia. In addition, the study found no clear evidence of deterministic convergence in output per worker (but stochastic convergence), human capital and factor productivity. However, the statistical results provide overwhelming evidence for stochastic and deterministic convergence in physical capital per worker.

JEL Classification: O4, O40, O47
The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores in 961 Japanese volunteers
Authors: Hosokawa Takafumi , Tajika Tsuyoshi , Suto Morimichi , Chikuda Hirotaka
Published: November 2020

Introduction:

Patient-reported outcomes recently have been used to assess treatment outcomes. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) is a particularly convenient and useful tools. However, data on the normative values of Japanese population are lacking, so the present study was conducted to gather this information.

Methods:

We assessed 1098 volunteers over 18 years of age (363 men and 735 women, average 50 years old) who had not received upper limb treatment in a medical facility. These participants included our institution’s staff, their family members, and the participants in the group meetings held by institution’s staff. Their occupations were also examined. We divided occupations into nonmanual and manual labor. These factors of the participants were then analyzed to clarify which (if any) influenced the QuickDASH.

Results:

Valid answers were obtained from 961 subjects (87.5%). The median score was 2 (mean: 4.8) in the overall population, 0 (mean: 2.6) in men, and 2.5 (mean: 6.0) in women. The scores increased with age and were higher in women than in men. There were no significant differences by manual labor. Female sex and older age were identified as factors that influenced the QuickDASH score in the multiple regression analysis. There were high correlations among QuickDASH, work and sports/music scores.

Conclusions:

The present study provided QuickDASH scores for Japanese volunteers who had not received upper limb treatment in a medical facility. The scores were associated with older age and female sex. This study helps us to know the degree of potential upper limb impairment in the general population, and will help in populational strategies as primary and secondary preventive medicine for upper limb-related diseases.
First Year’s Work Experiences of Foreign Educated Nurses Coming to Norway From Other European Countries
Authors: Solum Eva Merethe , Viken Berit , Lyberg Anne
Published: November 2020

Introduction

Nurses educated in the European Union and European Economic Area are automatically given professional authorization to work in all member states, facilitating workforce mobility between countries. Along with many other European countries, Norway faces nursing shortages in healthcare. European Foreign Educated Nurses are often recruited to work in Norway by agencies or apply for work themselves.

Aims

To explore the experiences Foreign Educated Nurses from European Union and European Economic Area had with their preparation and orientation programs and their first year of work in Norwegian elderly care institutions

Methods

The study followed a qualitative explorative design. Nine open, dialogue-based, semi-structured interviews were conducted with Foreign Educated Nurses from Poland, Lithuania, Latvia, Iceland, and Spain. Data were analyzed using qualitative content analysis.

Findings

One main theme, struggling to adjust to professional competence standards, and four subthemes emerged from our data (1) deficiencies in preparation and orientation by recruitment agencies and institutions, (2) language skills and communication challenges at work, (3) cultural differences in the nursing role in clinical practice, and (4) social interactions at work.

Conclusion

More comprehensive preparation and orientation programs regarding language skills and local healthcare systems are needed. Foreign Educated Nurses make important contributions to the Norwegian healthcare work force, but the challenges brought to light in this study negatively affected their work conditions and can possibly threaten patient safety. More research is suggested to address the lack of collaboration between agencies, healthcare institutions, and other stakeholders in establishing professional standards and appropriate support for Foreign Educated Nurses from European Union and European Economic Area.
Incompatible with life: Embodied borders, migrant fertility, and the UK’s ‘hostile environment’
Authors: Coddington Kate
Published: November 2020

In this piece, I consider the uncomfortable and intimate intersection of bodies and borders through an autoethnographic account of encountering UK migration controls while losing a pregnancy. While this encounter was not representative of the disproportionate targeting of refused asylum seeker and undocumented migrants by these policies, I argue that migrant fertility has become a key lens through which the embodiment of the border is made material, and that the post-2012 deployment of a UK-wide set of policies generating a “Hostile Environment” for migrants demonstrates how the UK is embracing discomfort as a political strategy to deter migrants. Migrant fertility becomes perceived as an anticipatory threat to the body politic that must be continually pre-empted by the state. The restrictive policies of the UK’s hostile environment have exacerbated the perceived threat of fertile migrants, and that the threat posed by these migrants has become both racialized and medicalized, with multi-scalar, material consequences for migrants.
The concept of solidarity in cohesion policies of the European Union and Hungary
Authors: Czirfusz Márton
Published: November 2020

This paper discusses cohesion policies of the EU and Hungary from the conceptual perspective of solidarity. Continuing recent debates positioned at the intersection of solidarity, welfare state and Europeanization, a multi-scalar approach of solidarity is explored. Although the notion of solidarity – i.e. overcoming inequalities across member states and their regions – was an important conceptual building block at the foundation of the EU, the usage of the term has decreased steadily in recent decades’ EU cohesion policies, and more significantly after the 2008 economic crisis. As a parallel trend, the concept’s meaning has shifted from a more general to a reduced one in narrow policy areas. Based on a document analysis, the paper reviews cohesion policy changes of recent EU programming periods and finds that solidarity has lost importance in main planning and legislative documents, a recent shift being the growth policy relaunch of past years. Contrasting these trends with the national scale, a case study of Hungary found that the concept of solidarity was mobilized according to EU-level cohesion policy ideas during the 1990s and early 2000s, but the current right-wing government put forward a new discourse of solidarity which they related with the refugee crisis.
Transparency and Accountability: Causal, Critical and Constructive Perspectives
Authors: Heimstädt Maximilian , Dobusch Leonhard
Published: November 2020

Given the excessive power of Google and other large technology firms, transparency and accountability have turned into matters of great concern for organization scholars. So far, most studies adopt either a causal or critical perspective on the relationship between the two concepts. These perspectives are pitted against each other but share some basic assumptions – a fact which limits organization theory’s ability to fully grasp the management of (digital) visibilities. To address these limitations, we therefore propose a third, constructive perspective on these concepts. A constructive perspective turns transparency and accountability from analytic resources into topics of inquiry, allowing organization scholars to study how people in and around organizations put them to work and with what consequences. We introduce sites of ethical contestation as a new methodological strategy to conduct surprising and unintuitive empirical research from a constructive perspective.
The Grand Challenge of Corporate Control: Opening strategy to the normative pressures of networked professionals
Authors: Whittington Richard , Yakis-Douglas Basak
Published: November 2020

We propose that the pre-eminent ‘grand challenge’ for organization theorists today is the societal control of powerful corporations. This grand challenge is the more urgent because of the contemporary inadequacies of markets, hierarchies and regulations as instruments of control. We argue for the potential role of ‘open strategy’ in mobilizing normative controls over big business. We develop a distinction between the managed and unmanaged practices of open strategy. Both can help expose corporations to normative pressures, but we highlight the unmanaged open practices of collective subpolitics and individualist whistleblowing. Especially when mobilized by globally networked professionals, these unmanaged practices can subject corporations to normative pressures where markets, hierarchies and regulations fail. We propose two broad research themes relevant to the effectiveness of managed and unmanaged practices of strategic openness: on the one hand, there are material issues to do with labour markets, organizing and technologies; on the other hand, there are discursive questions of authenticity, capability and identity.
The treatment of Burkitt lymphoma in adults
Authors: Crombie Jennifer , LaCasce Ann
Published: November 2020

Burkitt lymphoma (BL) is a highly aggressive, B-cell, non-Hodgkin lymphoma categorized into endemic, sporadic, and immunodeficiency-associated subtypes. BL has distinct pathologic and clinical features, characterized by rapidly progressive tumors with high rates of extranodal involvement. Next-generation-sequencing analyses have further characterized the genomic landscape of BL and our understanding of disease pathogenesis, although these findings have yet to influence treatment. Although most patients are cured with intensive combination chemotherapy, given the paucity of randomized trials, optimal therapy has not been defined. Furthermore, treatment of elderly patients, patients with central nervous system involvement, or those with relapsed disease remains an unmet need. In this review, we highlight the clinical, pathologic, and genomic features, as well as standard and emerging treatment options for adult patients with BL.
No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial
Authors: Akbarshahi Hamid , Ahmadi Zainab , Currow David C. , Sandberg Jacob , Vandersman Zac , Shanon-Honson Aaron , Ekström Magnus
Published: November 2020

Introduction

COPD is a major cause of morbidity and mortality. The prevalence, morbidity and mortality of COPD among females have increased. Previous studies indicate a possible gender bias in the diagnosis and management of COPD. The present study aims to determine if there is gender bias in the management of COPD in Sweden.

Methods

This was a double-blind, randomised (1:1), controlled, parallel-group, web-based trial using the hypothetical case scenario of a former smoker (40 pack-years and quit smoking 3 years ago) who was male or female. The participants were blind to the randomisation and the purpose of the trial. The case progressively revealed more information with associated questions on how the physician would manage the patient. Study participants chose from a list of tests and treatments at each step of the case scenario.

Results

In total, 134 physicians were randomised to a male (n=62) or a female (n=72) case. There was no difference in initial diagnosis (61 (98%) male cases and 70 (97%) female cases diagnosed with COPD) and planned diagnostic procedures between the male and female cases. Spirometry was chosen by all the physicians as one of the requested diagnostic tests. The management of the hypothetical COPD case did not differ by sex of the responding physician.

Conclusion

In Sweden, diagnosis and management of a hypothetical patient with COPD did not differ by the gender of the patient or physician.
SARS-CoV-2 and interferon blockade
Authors: Diamond Betty , Volpe Bruce T. , VanPatten Sonya , Al Abed Yousef
Published: November 2020

The response to viral infection generally includes an activation of the adaptive immune response to produce cytotoxic T cells and neutralizing antibodies. We propose that SARS-CoV-2 activates the innate immune system through the renin-angiotensin and kallikrein-bradykinin pathways, blocks interferon production and reduces an effective adaptive immune response. This model has therapeutic implications.
Downregulation of long noncoding RNA DLEU1 attenuates hypersensitivity in chronic constriction injury-induced neuropathic pain in rats by targeting miR-133a-3p/SRPK1 axis
Authors: Li Zhen , Li Aiyuan , Yan Liping , Yang Tian , Xu Wei , Fan Pengju
Published: November 2020

Background

Neuropathic pain belongs to chronic pain and is caused by the primary dysfunction of the somatosensory nervous system. Long noncoding RNAs (lncRNAs) have been reported to regulate neuronal functions and play significant roles in neuropathic pain. DLEU1 has been indicated to have close relationship with neuropathic pain. Therefore, our study focused on the significant role of DLEU1 in neuropathic pain rat models.

Methods

We first constructed a chronic constrictive injury (CCI) rat model. Paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) were employed to evaluate hypersensitivity in neuropathic pain. RT-qPCR was performed to analyze the expression of target genes. Enzyme-linked immunosorbent assay (ELISA) was conducted to detect the concentrations of interleukin‐6 (IL-6), tumor necrosis factor‐α (TNF-α) and IL-1β. The underlying mechanisms of DLEU1 were investigated using western blot and luciferase reporter assays.

Results

Our findings showed that DLEU1 was upregulated in CCI rats. DLEU1 knockdown reduced the concentrations of IL‐6, IL‐1β and TNF‐α in CCI rats, suggesting that neuroinflammation was inhibited by DLEU1 knockdown. Besides, knockdown of DLEU1 inhibited neuropathic pain behaviors. Moreover, it was confirmed that DLEU1 bound with miR-133a-3p and negatively regulated its expression. SRPK1 was the downstream target of miR-133a-3p. DLEU1 competitively bound with miR-133a-3p to upregulate SRPK1. Finally, rescue assays revealed that SRPK1 overexpression rescued the suppressive effects of silenced DLEU1 on hypersensitivity in neuropathic pain and inflammation of spinal cord in CCI rats.

Conclusion

DLEU1 regulated inflammation of the spinal cord and mediated hypersensitivity in neuropathic pain in CCI rats by binding with miR-133a-3p to upregulate SRPK1 expression.
Layer-by-Layer Assembly of Electroactive Dye/LDHs Nanoplatelet Matrix Film for Advanced Dual Electro-optical Sensing Applications
Authors: Lajevardi Esfahani Sepehr , Rouhani Shohre , Ranjbar Zahra
Published: November 2020

It proved that the most destructive effects of the toxic Al3+ ion on the human nervous system and disease that are involved with this system, such as Alzheimer's. The development of solid-state electrodes is still in its infancy during the sensor-based detection methods for Al3+. Hence, in this study, a novel flexible ITO/PET-based electrochemical solid-state sensor was designed and constructed. Modification of the surface of electrode bedding was done by layer-by-layer (LbL) assembly of Mg–Al LDH. nanoplatelets along with alizarin red S (ARS) in an interconnected matrix film. In the molecular design of sensing base of the electrode, the electroactive organic units (ARS molecules) present in the ITO/PET-layered (ARS/LDHs)n matrix are involved in electrochemical reactions when exposed to the target molecule (Al3+ ion), so the electrochemical changes of the new formed Al-chelated system are detectable. This type of sensor is used for sensitive and selective detection of Al3+. The minimum sheet resistance, morphology and high electrocatalytic activity of the modified matrix film are obtained in the fifth cycle of LbL assembly technique. In this electrochemical sensor, both electrochemical and optical methods were detected with high sensitivity and selectivity of Al3+, so that in a cyclic voltammetry electrochemical method, the lower detection limit of 10.1 nM with a linear range of [0.2–120 μM] was obtained compared to the fluorescence-based optical method.
RGG1, Involved in the Cytokinin Regulatory Pathway, Controls Grain Size in Rice
Authors: Tao Yajun , Miao Jun , Wang Jun , Li Wenqi , Xu Yang , Wang Fangquan , Jiang Yanjie , Chen Zhihui , Fan Fangjun , Xu Mengbin , Zhou Yong , Liang Guohua , Yang Jie
Published: November 2020

Heterotrimeric GTP binding proteins (G proteins) and cytokinin play important roles in regulating plant growth and development. However, little is known about the mechanism by which they coordinate the regulation of grain size in rice. We functionally characterized one gene,RGG1, encoding a type-A Gγ subunit. Strong GUS staining was detected in young panicles and spikelets, suggesting a role for this gene in modulating panicle-related trait development. Overexpression ofRGG1in Nipponbare (NIP) and Wuyunjing 30 (WYJ30) significantly decreased plant height, panicle length and grain length by regulating cell division. However,rgg1mutants generated by the CRISPR/Cas9 system exhibited no obvious phenotypic differences, which may be due to the extremely low expression level of this gene in vivo. The transcriptomes of young panicles of NIP, the NIP-rgg1–2mutant and the NIP-OE2 overexpression line were sequenced, and the results showed that many differentially expressed genes (DEGs) were associated with the cytokinin biosynthetic pathway. We confirmed this result by measuring the endogenous cytokinin levels and found that cytokinin content was lower in the overexpression lines. Additionally, increased expression ofRGG1decreased sensitivity to low concentrations of 6-benzylaminopurine (6-BA). Our results reveal a novel G protein—cytokinin module controlling grain size in rice and will be beneficial for understanding the mechanisms by which G proteins regulate grain size and plant development.
Double trouble: diagnostic dilemma in a rare association of proximal ureteric valve with orthotopic ureterocele—case report
Authors: Dumra Anuj , Shekar P. Ashwin , Patel Hardik
Published: November 2020

Background

Association of the ureterocele and proximal ureteral valve is a rare congenital anomaly which can lead to quick detoriation of renal function due to double obstruction. Though ureteral valves have been associated with other ureteral anomalies, this specific association is extremely rare.

Case presentation

A 7-month-old boy was referred to us for antenatally detected hydronephrosis. Provisional diagnosis of orthotopic ureterocele with pelviureteric junction (PUJ) obstruction was made based on preoperative imaging. Endoscopic incision of ureterocele was done and retrograde pyelography showed tight obstruction at PUJ which necessitated a pyeloplasty. Examination of resected specimen confirmed a ureteral valve. Postoperatively, the patient had good improvement in kidney function.

Conclusion

To conclude, congenital ureteral valves are a rare cause of ureteric obstruction and its association with ureterocele is rarer still. Identification of an ureterocele should not deter us from searching for an associated pathology like a ureteric valve when imaging shows more severe hydronephrosis suggestive of more proximal obstruction.
Investigating the accuracy of imputing autosomal variants in Nellore cattle using the ARS-UCD1.2 assembly of the bovine genome
Authors: Hermisdorff Isis da Costa , Costa Raphael Bermal , de Albuquerque Lucia Galvão , Pausch Hubert , Kadri Naveen Kumar
Published: November 2020

Background

Imputation accuracy among other things depends on the size of the reference panel, the marker’s minor allele frequency (MAF), and the correct placement of single nucleotide polymorphism (SNP) on the reference genome assembly. Using high-density genotypes of 3938 Nellore cattle from Brazil, we investigated the accuracy of imputation from 50 K to 777 K SNP density using Minimac3, when map positions were determined according to the bovine genome assemblies UMD3.1 and ARS-UCD1.2. We assessed the effect of reference and target panel sizes on the pre-phasing based imputation quality using ten-fold cross-validation. Further, we compared the reliability of the model-based imputation quality score (Rsq) from Minimac3 to the empirical imputation accuracy.

Results

The overall accuracy of imputation measured as the squared correlation between true and imputed allele dosages (R2dose) was almost identical using either the UMD3.1 or ARS-UCD1.2 genome assembly. When the size of the reference panel increased from 250 to 2000, R2dose increased from 0.845 to 0.917, and the number of polymorphic markers in the imputed data set increased from 586,701 to 618,660. Advantages in both accuracy and marker density were also observed when larger target panels were imputed, likely resulting from more accurate haplotype inference. Imputation accuracy increased from 0.903 to 0.913, and the marker density in the imputed data increased from 593,239 to 595,570 when haplotypes were inferred in 500 and 2900 target animals. The model-based imputation quality scores from Minimac3 (Rsq) were systematically higher than empirically estimated accuracies. However, both metrics were positively correlated and the correlation increased with the size of the reference panel and MAF of imputed variants.

Conclusions

Accurate imputation of BovineHD BeadChip markers is possible in Nellore cattle using the new bovine reference genome assembly ARS-UCD1.2. The use of large reference and target panels improves the accuracy of the imputed genotypes and provides genotypes for more markers segregating at low frequency for downstream genomic analyses. The model-based imputation quality score from Minimac3 (Rsq) can be used to detect poorly imputed variants but its reliability depends on the size of the reference panel and MAF of the imputed variants.
Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study
Authors: Roh Go Un , Kang Joon Gwon , Han Jung Youn , Chang Chul Ho
Published: November 2020

Background

Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOB intubation) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOB intubation could minimize the risk of desaturation and improve the visual field. Therefore, the aim of this prospective randomized controlled study was to evaluate the utility and safety of oxygen insufflation through the working channel during FOB intubation in apneic patients.

Methods

Thirty-six patients were randomly allocated to an N group (no oxygen insufflation) or an O group (oxygen insufflation). After preoxygenation, FOB intubation was performed with (O group) or without (N group) oxygen insufflation in apneic patients. The primary outcome was the velocity of decrease in the partial pressure of oxygen (PaO2) during FOB intubation (VPaO2, mmHg/sec) defined as the difference of PaO2 before and after intubation divided by the time to intubation. The secondary outcomes included the success rate for FOB intubation, time to intubation, visual field during FOB intubation, findings of arterial blood gas analysis, and occurrence of FOB intubation-related complications.

Results

We found that VPaO2 was significantly greater in the N group than in the O group (1.0 ± 0.4 vs. 0.4 ± 0.4; p < 0.001), while the visual field was similar between groups. There were no significant intergroup differences in the secondary outcomes.

Conclusions

These findings suggest that oxygen insufflation through the working channel during FOB intubation aids in extending the apneic window during the procedure.

Trial registration

ClinicalTrials.gov, NCT02625194, registered at December 9, 2015.
Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study
Authors: Spek Michelle , Cals Jochen W. L. , Oudhuis Guy J. , Savelkoul Paul H. M. , de Bont Eefje G. P. M.
Published: November 2020

Background

Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care.

Methods

We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management.

Results

A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions.

Conclusions

In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care.
Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting
for large and multiple biliary stones: Will it improve the outcomes?
Authors: Hormati Ahmad , Ghadir Mohammad Reza , Sarkeshikian Seyed Saeed , Alemi Faezeh , Moghaddam Majid , Ahmadpour Sajjad , Mohammadbeigi Abolfazl , Sivandzadeh Gholam Reza
Published: November 2020

Background

The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones.

Methods

Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group.

Results

A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05).

Conclusion

Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval.

Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.
Renal dysfunction is associated with decline of cognitive function in community-dwelling older adults: Korean frailty and aging cohort study
Authors: Kong Ji Yoon , Kim Jin Sug , Kang Min Hye , Hwang Hyeon Seok , Won Chang Won , Jeong Kyung Hwan
Published: November 2020

Background

Cognitive decline is common in older adults. Similarly, the prevalence of renal dysfunction is also increased in the elderly population. We conducted this study to clarify the relationship between renal dysfunction and decline of cognitive function in community-dwelling elderly population.

Methods

A cross-sectional analysis was performed using data from the Korean Frailty and Aging Cohort Study, a nationwide cohort study. Total 2847 (1333 men, 1514 women) eligible participants were enrolled for this study. The estimated glomerular filtration rate (eGFR, mL/min/1.73m2) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Global cognitive function was assessed with the Mini-mental State Examination-Korean version. Other domains of cognitive function were tested with the Consortium to Establish a Registry for Alzheimer’s disease and the Frontal Assessment Battery.

Results

The mean age of all participants was 76.0 ± 3.9 years and eGFR (all in mL/min/1.73 m2) was 77.5 ± 14.3. And the mean eGFR was 91.7 ± 3.2 in quartile 1, 84.9 ± 1.8 in quartile 2, 76.1 ± 3.7 in quartile 3, and 57.2 ± 10.8 in quartile 4. In baseline characteristics, participants with lower eGFR tend to have lower cognitive function scores than participant with higher eGFR. In linear regression analysis, eGFR was correlated with the word list memory (β = 0.53, P = 0.005), word list recall (β = 0.86, P < 0.001), and word list recognition (β = 0.43, P = 0.030) after adjustment of confounding variables. Moreover, after multivariate adjustment the association with cognitive impairment in quartile 2 was stronger (adjusted OR: 1.535, 95% CI: 1.111–2.120, P = 0.009), and the ORs of cognitive impairment were 1.501 (95% CI: 1.084–2.079, P = 0.014) in quartile 3 and 1.423 (95% CI: 1.022–1.983, P = 0.037) in quartile 4.

Conclusion

In older adults, the immediate, recent memory, and recognition domains were significantly related to renal function. Also, the mild renal dysfunction was independently associated with impairment of global cognitive function. These results suggest that the early stages of renal dysfunction could be an effective target to prevent worsening of cognitive impairment. Therefore, regular monitoring and early detection of mild renal dysfunction in elderly population might be needed.
Diversity of SCCmec elements and spa types in South African Staphylococcus aureus mecA-positive blood culture isolates
Authors: Singh-Moodley Ashika , Lowe Michelle , Mogokotleng Ruth , Perovic Olga
Published: November 2020

Background

The prevalence of Staphylococcus aureus varies depending on the healthcare facility, region and country. To understand its genetic diversity, transmission, dissemination, epidemiology and evolution in a particular geographical location, it is important to understand the similarities and variations in the population being studied. This can be achieved by using various molecular characterisation techniques. This study aimed to provide detailed molecular characterisation of South African mecA-positive S. aureus blood culture isolates by describing the SCCmec types, spa types and to lesser extent, the sequence types obtained from two consecutive national surveillance studies.

Methods

S. aureus blood culture isolates from a national laboratory-based and enhanced surveillance programme were identified and antimicrobial susceptibility testing was performed using automated systems. A real-time PCR assay confirmed the presence of the methicillin-resistance determinant, mecA. Conventional PCR assays were used to identify the SCCmec type and spa type, which was subsequently analysed using the Ridom StaphType™ software. Multilocus sequence typing was performed on selected isolates using conventional methods. MRSA clones were defined by their sequence type (ST), SCCmec type and spa type.

Results

A detailed description of findings is reported in this manuscript. SCCmec type III predominated overall followed by type IV. A total of 71 different spa types and 24 novel spa types were observed. Spa type t037 was the most common and predominated throughout followed by t1257. Isolates were multidrug resistant; isolates belonging to all SCCmec types were resistant to most of the antibiotics with the exception of type I; isolates with spa type t045 showed resistance to all antibiotics except vancomycin. The most diverse SCCmec-spa type complex was composed of the SCCmec type IV element and 53 different spa types.

Conclusion

Although ST data was limited, thereby limiting the number of clones that could be identified, the circulating clones were relatively diverse.
Gastric antral vascular ectasia in a patient with lupus undergoing hemodialysis: a case report
Authors: Kang Seok Hui , Kim A Young , Do Jun Young
Published: November 2020

Background

Gastric antral vascular ectasia (GAVE), associated with autoimmune diseases, such as systemic lupus erythematosus, and hepatic or renal disorders, is a rare cause of gastrointestinal bleeding. We report the case of a patient with lupus erythematosus undergoing hemodialysis with an uncorrectable anemia caused by GAVE.

Case presentation

A 76-year-old Korean woman with lupus undergoing hemodialysis frequently complained of symptoms or signs associated with anemia, such as dizziness, dyspnea, hypotension, melena, and hematemesis. Gastrointerstinal endoscopy revealed multiple erythematous and hyperemic mucosal lesions at the distal antrum without active bleeding, a finding compatible with GAVE. Although she frequently complained of symptoms or signs associated with anemia and had frequent gastrointestinal endoscopies with or without pre-emptive argon plasma coagulation, her clinical status is relatively stable, and she is undergoing maintenance hemodialysis without anticoagulants.

Conclusion

This clinical case suggests that GAVE should be considered as a cause of the anemia resistant to erythropoiesis-stimulating agents and iron supplementation in patients with chronic kidney disease and lupus.
Willingness to perform induced abortion and associated factors among graduating midwifery, medical, nursing, and public health officer students of University of Gondar, Northwest Ethiopia: institution based cross sectional study
Authors: Enyew Mihretu Molla
Published: November 2020

Background

In developing countries, abortion is often unsafe and a significant cause of maternal morbidity and mortality accounting for about 8% (4.7–13.2%) of maternal mortality worldwide. Internationally, safe abortion services are recognized as reducing maternal mortality, and liberalized abortion laws are associated with reduced mortality resulting from unsafe abortion procedures. However, health care providers have moral, social and gender-based reservations that affects their willingness towards providing induced abortion services. The purpose of this study was to assess willingness to perform induced abortion and associated factors among graduating Midwifery, Medical, Nursing, and Public health officer students of University of Gondar.

Methods

Institution based cross sectional study was conducted from March 29 to May 30, 2019. All graduating students available during data collection period were considered as study population. Stratified simple random sampling technique was used to select 424 study participants. Pre tested, semi- structured, self-administered questionnaire was used to collect data. Data analysis was done using SPSS version 20. Ethical clearance was obtained from School of midwifery under the delegation of institutional review board of university of Gondar.

Results

Two hundred ninety students out of 424 students were willing to perform induced abortion for indications supported by Ethiopian abortion law, making a proportion of 68.4% (95%Cl: 64.2, 72.9). Sex (Being male (AOR = 4.89, 95%CI: 3.02, 7.89)), religion (being orthodox than protestant (AOR = 10.41, 95%CI: 3.02, 21.57)), being Muslim than protestant (AOR = 5.73, 95%CI: 1.37, 15.92)) and having once or less a week religious attendance (AOR = 2.00, 95% CI: 1.20, 3.34) were factors associated with willingness towards performing induced abortion.

Conclusions

According to this study willingness of students towards providing induced abortion services was good. However female students, protestant followers and those students with more than once a week religious attendance should be encouraged to support women’s access to induced abortion services by referring them to other health care professionals willing to provide induced abortion services.
Combination of phenotype and polygenic risk score in breast cancer risk evaluation in the Spanish population: a case –control study
Authors: Triviño J. C. , Ceba A. , Rubio-Solsona E. , Serra D. , Sanchez-Guiu I. , Ribas G. , Rosa R. , Cabo M. , Bernad L. , Pita G. , Gonzalez-Neira A. , Legarda G. , Diaz J. L. , García-Vigara A. , Martínez-Aspas A. , Escrig M. , Bermejo B. , Eroles P. , Ibáñez J. , Salas D. , Julve A. , Cano A. , Lluch A. , Miñambres R. , Benitez J.
Published: November 2020

Background

In recent years, the identification of genetic and phenotypic biomarkers of cancer for prevention, early diagnosis and patient stratification has been a main objective of research in the field. Different multivariable models that use biomarkers have been proposed for the evaluation of individual risk of developing breast cancer.

Methods

This is a case control study based on a population-based cohort. We describe and evaluate a multivariable model that incorporates 92 Single-nucleotide polymorphisms (SNPs) (Supplementary Table S1) and five different phenotypic variables and which was employed in a Spanish population of 642 healthy women and 455 breast cancer patients.

Results

Our model allowed us to stratify two groups: high and low risk of developing breast cancer. The 9th decile included 1% of controls vs 9% of cases, with an odds ratio (OR) of 12.9 and a p-value of 3.43E-07. The first decile presented an inverse proportion: 1% of cases and 9% of controls, with an OR of 0.097 and a p-value of 1.86E-08.

Conclusions

These results indicate the capacity of our multivariable model to stratify women according to their risk of developing breast cancer. The major limitation of our analysis is the small cohort size. However, despite the limitations, the results of our analysis provide proof of concept in a poorly studied population, and opens up the possibility of using this method in the routine screening of the Spanish population.
Leukemia mortality in children from Latin America: trends and predictions to 2030
Authors: Torres-Roman J. Smith , Valcarcel Bryan , Guerra-Canchari Pedro , Santos Camila Alves Dos , Barbosa Isabelle Ribeiro , La Vecchia Carlo , McGlynn Katherine A. , de Souza Dyego Leandro Bezerra
Published: November 2020

Background

Reports suggest that Latin American and Caribbean (LAC) countries have not reduced leukemia mortality compared to high-income countries. However, updated trends remain largely unknown in the region. Given that leukemia is the leading cause of cancer-related death in LAC children, we evaluated mortality trends in children (0-14y) from 15 LAC countries for the period 2000–2017 and predicted mortality to 2030.

Methods

We retrieved cancer mortality data using the World Health Organization Mortality Database. Mortality rates (standardized to the world standard SEGI population) were analyzed for 15 LAC countries. We evaluated the average mortality rates for the last 5 years (2013–2017). Joinpoint regression analysis was used to evaluate leukemia mortality trends and provide an estimated annual percent change (EAPC). Nordpred was utilized for the calculation of predictions until 2030.

Results

Between 2013 and 2017, the highest mortality rates were reported in Venezuela, Ecuador, Nicaragua, Mexico, and Peru. Upward mortality trends were reported in Nicaragua (EAPC by 2.9% in boys, and EAPC by 2.0% in girls), and Peru (EAPC by 1.4% in both sexes). Puerto Rico experienced large declines in mortality among both boys (EAPC by − 9.7%), and girls (EAPC by − 6.0%). Leukemia mortality will increase in Argentina, Ecuador, Guatemala, Panama, Peru, and Uruguay by 2030.

Conclusion

Leukemia mortality is predicted to increase in some LAC countries by 2030. Interventions to prevent this outcome should be tailor to reduce the socioeconomic inequalities and ensure universal healthcare coverage.
Mean core to peripheral temperature difference and mean lactate levels in first 6 hours of hospitalisation as two indicators of prognosis: an observational cohort study
Authors: Gupta Aashish , Puliyel Jacob , Garg Bhawana , Upadhyay Pramod
Published: November 2020

Background

To study mean core to peripheral temperature difference (CPTD) and the mean lactate levels over the first 6 h of admission to hospital, as indicators of prognosis in critically ill children.

Methods

A prospective observational study in a tertiary level Pediatrics ICU in Delhi, India. Seventy eight paediatric patients from 1 month to 12 years were studied. Children with physical trauma, post-surgical patients and patients with peripheral vascular disease were excluded. Core temperature (skin over temporal artery) to peripheral temperature (big toe) difference was measured repeatedly every minute over 6 h and mean of temperature difference was calculated. Pediatric Risk of Mortality (PRISM) II, lactate clearance and mean lactate levels during that time were also studied. In-hospital mortality was used as the outcome measure.

Results

Mean temperature difference

During the first 6 h after admission the mean temperature difference was 9.37 ± 2 °C in those who died and 3.71 ± 2.27 °C in those who survived (p < 0.0001). The area under the receiver operating curve (AUROC) was 0.953 (p < 0.0001). The comparable AUROC of PRISM II was 0.999 (p < 0.0001).

Mean Lactate

Mean lactate level in the first 6 h was 7.1 ± 2.02 mg/dl in those who died compared to 2.86 ± 0.87 mg/dl in those who survived (p < 0.0001). The AUROC curve for mean lactate was 0.989 (95% CI = 0.933 to 0.999;p < 0.0001). AUROC for the lactate clearance was 0.682 (p = 0.0214).

Conclusions

The mean core to peripheral temperature difference over the first 6 h is an easy-to-use and non-invasive method that is useful to predict mortality in children admitted to the Pediatric ICU. The mean lactate during the first 6 h of Pediatric ICU admission is a better index of prognosis than the lactate clearance over the same time period. They may be used as components of a scoring system to predict mortality.