bluuebunny/crossref_metadata_2025 huggingface dataset:
Analisa Strategi Pemberdayaan Komponen Maritim dalam Mendukung Operasi Keamanan Laut Nasional
Authors: Ahmadi Ahmadi , Herdiawan Didit , Suharyo Okol Sri
Published: March 2020

Strategi pemberdayaan komponen maritim merupakan salah satu tugas pokok TNI AL, sebagai komponen perkuatan pertahanan dan keamanan di Laut. Salah satu case study yang bisa diangkat dalam pemberdayaan komponen maritim adalah pemberdayaan Selat Lombok. Selat Lombok merupakan salah satu pintu gerbang masuk jalur pelayaran Internasional yang mendapatkan prioritas keamanan maritim (maritime security) dan keselamatan maritim (maritime safety). Pemerintah Indonesia memberikan tugas untuk menjaga keamanan dan keselamatan maritim di Selat Lombok kepada komponen maritim antara lain TNI Angkatan Laut, Bakamla, Polairud, Dishubla, KSOP, Pemda serta institusi lain sebagainya. Untuk melaksanakan tugas tersebut, Pimpinan Angkatan Laut menginginkan agar Lanal di Selat Lombok dapat melaksanakan tugas dan fungsinya dengan optimal ditengah keterbatasan kemampuan yang dimiliki. Maka diperlukan strategi tentang pemberdayaan komponen maritim agar mendukung operasi keamanan laut di Selat Lombok. Penulisan paper ini bertujuan mengidentifikasi dan menentukan strategi pemberdayaan komponen maritim dalam mendukung operasi keamanan laut di Selat Lombok dengan metode pendekatan AHP-SWOT. Hasil analisa mengidentifikasi 26 kriteria dari 4 aspek yaitu Politik, Keamanan, Sosial-Ekonomi dan Teknis. Faktor pemenuhan informasi intelijen, peningkatan kekuatan kapal patroli, peningkatan fasilitas pelabuhan dan fasilitas dukungan administrasi menjadi faktor penentu keberhasilan operasi keamanan laut di Selat Lombok. Dengan segala keterbatasan Pangkalan Angkatan Laut maka strategi W-T (Defensif) menjadi strategi terbaik pada proses sinergitas komponen maritim. Meningkatkan kemampuan informasi intelijen (W-T4) menjadi prioritas rumusan strategi dengan bobot 21% dan skornya adalah 1,557. Secara keseluruhan sinergitas komponen maritim dalam mendukung operasi keamanan laut di Selat Lombok diharapkan dapat meningkatkan stabilitas keamanan maritim di wilayah teritorial Selat Lombok.Kata Kunci: Strategi Pemberdayaan, Komponen Maritim, SWOT.
Antimicrobial resistance and novel mutations detected in the gyrA and parC genes of Pseudomonas aeruginosa strains isolated from companion dogs
Authors: Park Youjin , Oh Jaeyoung , Park Sowon , Sum Samuth , Song Wonkeun , Chae Jongchan , Park Hee-Myung
Published: March 2020

Background: Fluoroquinolone agents, such as enrofloxacin and marbofloxacin, are commonly used for pseudomonal infection in veterinary medicine. However, the rate of resistance to fluoroquinolones is rapidly increasing, according to multiple studies in various countries. Point mutations in the quinolone resistance-determining region (QRDR) are closely related to the increased fluoroquinolone resistance of Pseudomonas aeruginosa. The aim of this study was to investigate current antimicrobial susceptibility and fluoroquinolone resistance in P. aeruginosa strains isolated from dogs. The presence of point mutations in the QRDR was confirmed by gyrA and parC polymerase chain reaction and nucleotide sequencing analysis.Results: A total of 84 nonduplicated P. aeruginosa strains were obtained from 228 healthy dogs (healthy group) and 260 dogs with clinical signs (infected group). Among these isolates, 38 strains from the healthy group were detected in several sample types, whereas 46 strains from the infected group were obtained mostly from dogs’ ears with otitis externa (41/260, 15.8%). All strains were resistant to nalidixic acid, while some were also resistant to enrofloxacin (23/84, 27.4%), marbofloxacin (17/84, 20.2%), levofloxacin (12/84, 14.3%), or ciprofloxacin (11/84, 13.1%). Enrofloxacin resistance was significantly higher in strains from the infected group than in those from the healthy group (p<0.05). Among the 23 fluoroquinolone-resistant strains, 8 and 4 different mutations were detected in the gyrA and parC genes, respectively. Mutations in gyrA were significantly common in the infected group (p<0.05). Hotspots for the gyrA and parC mutations were Thr83 (34.8%, 8/23) and Pro116 (91.3%, 21/23), respectively. Double and triple mutations were also found in 5 of the strains.Conclusion: Novel mutations in the gyrA and parC genes were first found in P. aeruginosa isolated from companion dogs in South Korea. These findings suggest that it is important to encourage prudent use of fluoroquinolone antibiotics in canine pseudomonal infection treatment.
Access to health care for people with disabilities in rural Malawi: what are the barriers?
Authors: Harrison Josephine , Thomson Rachael , Banda Hastings T. , Mbera Grace B. , Gregorius Stefanie , Stenberg Berthe , Marshall Tim
Published: March 2020

Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.
Knowledge and practices regarding tuberculosis infection control among nurses in Ibadan, South-West Nigeria: a cross-sectional study
Authors: Akande Patrick Aboh
Published: March 2020

Background: Nurses are particularly vulnerable to nosocomial tuberculosis (TB) infection because, being in the frontline of healthcare provision, they are frequently exposed to patients with infectious TB disease. Although cost-effective measures are available for TB infection control (TBIC), they are often poorly implemented. Knowledge of TBIC is known to positively influence the practice of the measures. There is, however, paucity of data on the knowledge and practices regarding TBIC among nurses in Nigeria. This study was aimed at determining the levels of TBIC-related knowledge and practices of nurses in Ibadan, and their associated socio-demographic factors. Methods: This cross-sectional study utilized a self-administered questionnaire to collect data from 200 nurses in two secondary health facilities, in May 2014. The mean knowledge and practice scores of the nurses were determined and logistic regression was utilized to explore the association between the scores and socio-demographic characteristics. Results: The respondents had mean knowledge and practice scores of 68.2% and 79.9% respectively. Using cut-off points of 80% and 100% for good knowledge and practice scores respectively, small proportions of the nurses had good scores – knowledge (10.5%) and practice (6%). Knowledge was not significantly associated with the socio-demographic characteristics of the nurses. Work experience was the only factor that was significantly associated with practices, with the more experienced nurses (>18 years of work experience) having lower odds of obtaining good practice scores (OR 0.25, 95% CI 0.06-0.94). There was also no significant association between knowledge and practice scores (the nurses were yet to be trained on the newly-introduced TBIC package at the time of the study). Conclusions: The study revealed that small proportions of the nurses had good knowledge and practice scores. Its findings will be useful for the designing of interventions to improve TBIC among nurses and other healthcare workers, and to benchmark evaluation of the interventions. It is recommended that nurses should be trained on TBIC to equip them with necessary knowledge and skills. This, together with appropriate policy directives, and adequate monitoring and supervision will contribute to optimal implementation of TB preventive measures.
Catastrophic health expenditure: A comparative study between hypertensive patients with and without complication in rural Shandong, China
Authors: Zhang Xinyi , Xu Qiongqiong , Guo Xiaolei , Jing Zhengyue , Sun Long , Li Jiajia , Zhou Chengchao
Published: March 2020

Background: Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. Methods: Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3,457 hypertensive patients registered in the NCDs management system in the sampling villages, 3,113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. Results: The incidence of CHE and impoverishment is 13.6% and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% ( R =0.000, OR=2.29 ) and 47.3% ( P =0.000, OR=3.60 ) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE ( R =0.000 ). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups ( P ＜ 0.05 ). Conclusions: CHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication.More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.
Effect of Smoking on Treatment Outcome Among Tuberculosis Patients in Malaysia; a Multicentre Study
Authors: Khan Amer Hayat , Sulaiman Syed Azhar Syed , Hassali Mohamed Azmi , Khan Kashif Ullah , Ming Long Chiau , Mateen Umer , Malik Obaid Ullah
Published: March 2020

Background: Smoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of poor TB treatment prognosis and outcomes.Objectives:To determine the prevalence of smoking and to assess the effects of smoking on treatment outcomes among TB patients.Methods: A multi-center retrospective study design was used to collect data from TB patients in four different states of Malaysia, namely Penang, Sabah, Sarawak, and Selangor. The study included medical records of TB patients admitted to the selected hospitals in the period from January 2006 to March 2009. Medical records with incomplete data were not included. Patient demographics and clinical data were collected using a validated data collection form.Results: Of all patients with TB (9337), the prevalence of smokers was 4313 (46.2%). Among smoker’s, 3584 (83.1%) were associated with pulmonary TB, while 729 (16.9%) were associated with Extra-pulmonary TB. Male gender (OR= 1.43, 95% CI 1.30-1.58), Chinese ethnicity (OR= 1.23, 95% CI 1.02-1.49), Sarawak indigenous ethnicity (OR= 0.74, 95% CI 0.58-0.95), urban residents (OR= 1.46, 95% CI 1.33-1.61), employed individuals (OR= 1.21, 95% CI 1.09-1.34), alcoholics (OR= 4.91, 95% CI 4.04-5.96), drug abusers (OR= 7.43, 95% CI 5.70-9.60) and presence of co-morbid condition (OR= 1.27, 95% CI 1.16-1.40) showed significant association with smoking habits. This study found that 3236 (75.0 %) patients were successfully treated in the smoker group, while 4004 (79.7 %) patients were non-smokers. The proportion of death rate 283 (6.6%), defaulters 284 (6.6%) and treatment interruption 204 (4.7%) was high in the smoker's group.Conclusions: Smoking had a strong influence on TB and is a major barrier towards treatment success (OR= 0.76, 95% CI 0.69-0.84, p< 0.001). Therefore, the findings point out that smoking cessations are an effective way to decrease treatment failure and drug resistance.
Lonely places or lonely people? Investigating the relationship between loneliness and place of residence
Authors: Victor Christina R , Pikhartova Jitka
Published: March 2020

Background: Loneliness in later life is largely presented as a problem of the individual focusing upon antecedents such as demographic or health factors. Research examining the role of the broader living environments is much rarer. We examined the relationship between loneliness and three dimensions of the lived environment: geographical region, deprivation, and area classification (urban or rural).Methods: Our sample consisted of 4,663 core members (44% males) aged 50+ (wave 7 mean age 72.8, S.D.= 7.1) present both in waves 3 (2006) and 7 (2014) of the English Longitudinal Study of Ageing (ELSA). Loneliness was measured using two approaches, individual and area-based, and both waves included these questions. Individual-based (self-reported) loneliness was assessed using the three item University of California Los Angeles (UCLA) scale (ranging from 3 =not lonely to 9= lonely with a score of 6+ defining loneliness. We also used a novel question which asked participants to evaluate how often they felt lonely in their area of residence (area-based; ranging from 1=often to 7=never, using cut off 4+ to define loneliness). The lived environment was classified in three different ways: the Index of Multiple Deprivation (IMD), Government Office Regions (GOR), and area classification (urban or rural). Covariates with established relationship with loneliness including demographic factors, social engagement and health, were included in the analyses. Results: In wave 7, the prevalence of individual-based loneliness was 18% and area-based was 25%. There was limited congruence between measures: 68% participants reported no individual- or area-based loneliness and 9% reported loneliness for both measures. After adjusting for individual co-variates only one significant relationship was observed between loneliness and area -based characteristics. A significant association was observed between area-based loneliness and deprivation score, with higher levels of loneliness in more deprived areas (OR=1.4 for highest quintile of deprivation). Conclusions: Our results indicate that loneliness in older adults is higher in the most deprived areas independent of individual-level factors. In order to develop appropriate interventions further research is required to investigate how area-level factors combine with individual-level loneliness vulnerability measures to generate increased levels of loneliness in deprived areas.
Are we doing enough? Improved breastfeeding practices at 14weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa
Authors: Horwood Christiane , Haskins Lyn , Engebretsen Ingunn Marie , Connolly Catherine , Coutsoudis Anna , Spies Lenore
Published: March 2020

Background KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support breastfeeding initiation and sustained breastfeeding implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in feeding practices in KZN over this time period. Methods Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N=4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N=900). All caregivers aged ≥ 15 years attending the clinic with infants aged 13- <16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points. Results At KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January-August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion of EBF was 44.6% and 50.5% (p= 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p=0.02). There were reductions in mixed feeding among all infants (23.2% vs 16.3%; p=0.016). Although there was no change in the proportion of carers reporting not breastfeeding (31.9% vs 32.8%; p= 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p=0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (AOR 3.76; 95% CI 3.1-4.6), this was similar among HIV positive mothers (AOR 2.1; 95% CI 1.7-2.6). Conclusion Despite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.
Strategic priorities for TB control in Bangladesh, Indonesia, and the Philippines – Comparative Analysis of National TB Prevalence Surveys
Authors: Kak Neeraj , Chakraborty Krishnapada , Sadaphal Swati , AlMossawi Hala Jassim , Calnan Marianne , Vikarunnessa Begum
Published: March 2020

Background: Philippines, Indonesia, and Bangladesh are three high TB burden countries in Asia which account for 18% of the estimated global TB incidence (1.787m) and 15% of TB related deaths (192,000). In 2017 alone, approximately 785,000 of the incident TB cases in these countries remained missing including diagnosed but not notified.
Methods: We reviewed the published data from the most recent TB prevalence surveys conducted in Bangladesh, Indonesia, and the Philippines. The prevalence rates established by the surveys were used to estimate the disease burden of these countries for 2017. The Global TB Report 2017 and WHO’s global TB database were sourced for collection of incidence and notification data by age groups and types of TB to estimate prevalence to notification gaps 2017.
Results: According to the surveys, the estimated prevalence rates of bacteriologically confirmed TB and smear-positive TB are 287 and 113 for Bangladesh (2015-16), 759 and 256 for Indonesia (2013-14) and 1159 and 434 for the Philippines (2016) per 100,000 population over the age of 15 years. The overall national TB prevalence estimates for all forms is 260 for Bangladesh, 660 for Indonesia, and 970 for the Philippines (2016). Compared with the incidence rate, the proportion of total notified cases is 67% Bangladesh, 52% for Indonesia, and 55% for Philippines. Bangladesh has been able to detect almost 100% of the prevalent pulmonary TB, while Indonesia and Philippines have detected only 30% and 22% of these infectious cases respectively. Although notification has been improving over the years, there is no impact on the incidence rate since a large proportion of the undiagnosed cases, and delayed diagnosis continue to feed the transmission process.
Conclusion: The surveys have provided data that is critical for developing realistic strategies for the countries to eliminate TB. In general, this paper recommends interventions for strengthening diagnosis of pulmonary TB, targeted communication programs and active case finding to reduce patient level delays, expanding public-private mix to increase access to TB services, use of rapid diagnostics, and social protection for vulnerable populations, to accelerate the countries’ progress towards achieving End TB goals.
A Drug Identification Model developed using Deep Learning Technologies: Experience of a Medical Center in Taiwan
Authors: Ting Hsien-Wei , Chung Sheng-Luen , Chen Chih-Fang , Chiu Hsin-Yi , Hsieh Yow-Wen
Published: March 2020

Background: Issuing of correct prescriptions is a foundation of patient safety. Medication errors represent one of the most important problems in health care, with ‘look-alike and sound-alike’ (LASA) being the lead error. Existing solutions to prevent LASA still have their limitations. Deep learning techniques have revolutionized identification classifiers in many fields. In search of better image-based solutions for blister package identification problem, this study using a baseline deep learning drug identification (DLDI) aims to understand how identification confusion of look-alike images by human occurs through the cognitive counterpart of deep learning solutions and thereof to suggest further solutions to approach them.
Methods: We collected images of 250 types of blister-packaged drug from the Out-Patient Department (OPD) of a medical center for identification. The deep learning framework of You Only Look Once (YOLO) was adopted for implementation of the proposed deep learning. The commonly-used F1 score, defined by precision and recall for large numbers of identification tests, was used as the performance criterion. This study trained and compared the proposed models based on images of either the front-side or back-side of blister-packaged drugs.
Results: Our results showed that the total training time for the front-side model and back-side model was 5 hours 34 minutes and 7 hours 42 minutes, respectively. The F1 score of the back-side model (95.99%) was better than that of the front-side model (93.72%).
Conclusions: In conclusion, this study constructed a deep learning-based model for blister-packaged drug identification, with an accuracy greater than 90%. This model outperformed identification using conventional computer vision solutions, and could assist pharmacists in identifying drugs while preventing medication errors caused by look-alike blister packages. By integration into existing prescription systems in hospitals, the results of this study indicated that using this model, drugs dispensed could be verified in order to achieve automated prescription and dispensing.
Key words: deep learning; drug identification; look-alike and sound-alike (lasa); medication error; patient safety.
Impact of social participation on health among middle-aged and elderly adults Evidence from longitudinal survey data in China
Authors: Ma Xinxin , Piao Xiangdan , Oshio Takashi
Published: March 2020

Background: Social participation (SP) is known to have a favourable impact on health. However, studies on this issue have been conducted mainly in advanced countries, and results in China have been mixed. This study examined the impact of SP on health outcomes of middle-aged and elderly adults in China, adjusted for simultaneity and heterogeneity biases.
Methods: In total, 57,417 observations of 28,935 individuals obtained from the population-based, three-wave panel survey, Chinese Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015 were used. The associations between one- or two-wave-lagged SP and health outcomes (mental health, self-rated health [SRH], activities of daily living [ADL], and diagnosed diseases) were examined by linear regression models. Individual-level heterogeneity was addressed by the random-effects estimation method.
Results: SP was found to have a positive impact on mental health and ADL. Specifically, one-wave-lagged SP improved mental health measure (range: 10–70) by 0.820 (standard error [SE]: 0.199, p < 0.001), the basic ADL measure (range: 6–24) by 0.147 (SE: 0.043, p < 0.001), and the instrumental ADL measure (range: 5–20) by 0.159 (SE: 0.035, p < 0.001). In contrast, SP did not significantly affect SRH or diagnosed diseases. The impact of SP differed by SP type; playing Mah-jong (Chinese traditional game), chess, or cards, or going to the community club had the most favourable effect. The impact of SP on health was also greater for women than men and greater for individuals aged 60–69 years than those aged 45–59 years and aged 70 and older.
Conclusions : SP had a positive, albeit selective, impact on health outcomes among middle-aged and elderly adults in China. The results suggest that policy measures to encourage these individuals to engage in SP are needed to enhance their health.
Whole Genome Sequencing of Nontuberculous Mycobacterium (NTM) Isolates from Sputum Specimens of Co-Habiting Patients with NTM Pulmonary Disease and NTM Isolates from Their Environment
Authors: Yoon Jung-Ki , Kim Taek Soo , Kim Jong-Il , Yim Jae-Joon
Published: March 2020

Background : Nontuberculous mycobacterium (NTM) species are ubiquitous microorganisms. NTM pulmonary disease (NTM-PD) is caused not by human-to-human transmission but by independent environmental acquisition. However, recent studies using next-generation sequencing (NGS) have reported trans-continental spread of Mycobacterium abscessus among patients with cystic fibrosis. Results : We investigated NTM genomes through NGS to examine transmission patterns in three pairs of co-habiting patients with NTM-PD who were suspected of patient-to-patient transmission. Three pairs of patients with NTM-PD co-habiting for at least 15 years were enrolled: a mother and a daughter with M. avium- PD, a couple with M. intracellulare- PD, and a second couple, one of whom was infection with M. intracellulare and the other of whom was infected with M. abscessus . Whole genome sequencing was performed using patients’ NTM isolates as well as environmental specimens. Genetic distances were estimated based on single nucleotide polymorphisms (SNPs). By comparison with the genetic distances among 78 publicly available NTM genomes, NTM isolates derived from the two pairs of patients infected with the same NTM species were not closely related to each other. In phylogenetic analysis, the NTM isolates from patients with M. avium -PD clustered with isolates from different environmental sources. Conclusions : In conclusion, considering the genetic distances between NTM strains, the likelihood of patient-to-patient transmission in pairs of co-habiting NTM-PD patients without overt immune deficiency is minimal.
Nurse practitioners in Swiss family practices as potentially autonomous providers of home visits: an exploratory study
Authors: Gysin Stefan , Bischofberger Iren , Meier Rahel , Vught Anneke van , Merlo Christoph , Essig Stefan
Published: March 2020

Background Switzerland is challenged by impending shortages of general practitioners (GPs) in rural areas and decreasing number of GP home visits. In Anglo-Saxon and many other countries, nurse practitioners (NPs) have been implemented and provide high quality, patient-centred home visits autonomously. In Switzerland, the NP role is new and there are currently only a handful of ongoing pilot projects in family practices. Hence, studies are lacking and data collection is challenging as NPs are not yet registered providers who could be identified in billing or health insurance data. Our aims were to gain insights in the frequency of home visits by NPs in Swiss family practices, and to determine their autonomy during visits and consultations based on the required level of GP supervision. Methods We used consultation data from two pilot practices in rural Switzerland. In “Practice A”, the NP was in postgraduate education and data was gathered electronically between August 2017 and 2018. In “Practice B”, the NP had completed her education, and had two years of work experience as a NP when data was collected manually between April and June 2018. We used a coding system based on five levels of GP supervision to identify NP consultations and home visits, and to determine the NPs’ autonomy in each consultation. Results We analysed data from 1375 consultations. The share of home visits in all NP consultations was 17% in Practice A and 51% in Practice B. Both NPs had a higher share of autonomously conducted consultations during home visits than in the office. In Practice A, the proportion of consultations in which the NP was autonomous increased from 0% in the first month of her employment to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of her consultations. Conclusions First cases provide some evidence that after completing postgraduate education with clinical supervision by GPs, and few years of practical experience in their role, NPs could reach a relatively high degree of autonomy and might pose a potential solution to the decreasing numbers of GP home visits in Swiss primary care.
Indigenous uses of wild and tended plant biodiversity maintain ecosystem services in agricultural landscapes of the Terai Plains of Nepal
Authors: Thorn Jessica P. R. , Thornton Thomas F. , Helfgott Ariella , Willis Katherine J.
Published: March 2020

Background Despite a rapidly accumulating evidence base quantifying ecosystem services, the role of biodiversity in the maintenance of ecosystem services in shared human-nature environments is still understudied, as is how indigenous and agriculturally dependent communities perceive, use and manage biodiversity. The present study aims to document traditional ethnobotanical knowledge of the ecosystem service benefits derived from wild and tended plants in rice-cultivated agroecosystems, compare this to botanical surveys, and analyse the extent to which ecosystem services contribute social-ecological resilience in the Terai Plains of Nepal.

Method Sampling was carried out in four landscapes, 22 Village District Committees and 40 wards in the monsoon season. Data collection was based on transects walks to collect plant specimens, structured and semi-structured interviews, and participatory fieldwork in and around home gardens, farms, and production landscapes. We asked 180 farmers to free-list vernacular names and describe use-value of wild and tended plants in rice-cultivated agroecosystems. Uses were categorized into eight broad groupings, and 61 biomedical ailment classifications. We assessed if knowledge of plant species diversity and abundance differed with regard to caste, age and gender.

Results Nepalese farmers have a deep knowledge of the use and management of the 391 vascular plant specimens identified, which provide key provisioning, regulating, supporting and cultural ecosystem services. Altogether, plants belong to 76 distinct plant species from 49 phylogenetic families: 56 are used to cure 61 ailments, 27 for rituals, 25 for food, 20 for timber, 17 for fuel, 17 for fodder, 11 for soil enhancement, and 8 for pesticides. Four caste groups have statistically different knowledge, and younger informants report a lower average number of useful plants.

Conclusion Agricultural landscapes in Nepal are reservoirs of biodiversity. The knowledge of the use of wild and tended plant species in and around these farms differs by the caste and age group of land manager. Conducting research on agroecosystems will contribute to a deeper understanding of how nature is perceived by locals, to more efficient management and conservation of the breadbasket of Nepal, and to the conservation of valuable, but disappearing traditional knowledge and practice.
Community-based rehabilitation service in Chengdu, southwest China: a cross-sectional general survey
Authors: Chen Siliang , Lei Yi , Dai Hua , Wu Jia , Yang Ziyu , Liao Xiaoyang
Published: March 2020

Background
World Health Organization initiated community-based rehabilitation (CBR) in 1978, and by now, it has been an essential process of medical services worldwide. China had strengthened primary health care on building more than 35,000 community health centers (CHCs) in cities, and more than 34,000 township health centers (THCs) in the rural area. Nevertheless, it remains unclear that if these primary health centers could provide optional rehabilitation services for disabilities. And this study aims at evaluating the supply capacity of rehabilitation service in primary health centers of Chengdu, a regional center city of southwest China.

Method
We conducted a general investigation of primary health centers in Chengdu, a city located in southwest China with more than 15 million population, our investigation covered all of Chengdu’s 390 primary health centers from October to November 2016. We researched these primary health centers on basic rehabilitation services, diseases, and rehabilitation equipment quantity and quality, and traditional Chinese medicine (TCM) physiotherapy

Result
Rehabilitation therapy is available in 88.9% (337 of 379) of all primary health centers. Meanwhile, CHCs slightly surpass THCs with an available rate of 92.2% (106 of 115) and 87.5% (231 of 264), respectively. Traditional Chinese Medicine (TCM) physiotherapy is available in 97.1% (368 of 379) of all primary health centers, 97.3% (112 of 115) of CHCs and 97.0% (256 of 264) of THCs. Quantitative analysis showed that substantial factors which could make an impact on the number of patients per year contain: categories of rehabilitation disease (P<0.001, 95% confidence interval (CI) [-1.571, -0.702]),number of rehabilitation bed (P<0.001, 95%CI [-1.249, -0.290])

Conclusion
CBR and TCM physiotherapy has become accessible for disabilities in most basic health centers of Chengdu City, whereas, available rate of CBR in THCs is lesser than in CHCs, which suggests an imbalance in primary health service development between rural and urban area. Categories of rehabilitation diseases, and the number of rehabilitation beds constitute co-factors that make an impact on the CBR capacity of basic health centers.
Synthesis and biological evaluation of 4-substituted aryl-piperazine derivatives of 1,7,8,9-tetrachloro-10,10-dimethoxy-4-azatricyclo [5.2.1.02,6] dec-8-ene-3,5-dione as anti-cancer and anti-angiogenesis agents
Authors: Guo Lifang , Xu Benshan , Wan Zirui , Ren Lulu , Zhang Jie , Zhang Wen , Liu He , Liu Lihong
Published: March 2020

The authors have requested that this preprint be removed from Research Square.
The effect of a pre- and post- operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial.
Authors: Tully Roisin , Loughney Lisa , Bolger Jarlath C , Sorensen Jan , Mcanena Oliver J , Collins Chris G , Carroll Paul A , Arumugasamy Mayilone , Murphy Thomas J , Robb William B
Published: March 2020

Background: Advances in peri-operative oncological treatment, surgery and peri-operative care have improved survival for patients with oesophagogastric cancers. Neoadjuvant cancer treatment (NCT) reduces physical fitness, which may reduce both compliance and tolerance of NCT as well as compromising post-operative outcomes. This is particularly detrimental in a patient group where malnutrition is common and surgery is demanding. The aim of this trial is to assess the effect on physical fitness and clinical outcomes of a comprehensive exercise training programme in patients undergoing NCT and surgical resection for oesophagogastric malignancies.
Methods: The PERIOP-OG trial is a pragmatic, multi-centre, randomised controlled trial comparing a programme of peri-operative exercise with standard care in patients with oesophagogastric cancers treated with NCT and surgery. The intervention group undergo a formal exercise training programme and the usual care group receive standard clinical care (no formal exercise advice). The training programme is initiated at cancer diagnosis, continued during NCT, between NCT and surgery, and then resumed again after surgery. All participants undergo assessments at: baseline, post-NCT, pre-surgery and at 4 and 10 weeks after surgery. The primary endpoint is cardiorespiratory fitness measured by demonstration of a 15% difference in 6-minute walk test assessed at the pre-surgery time point. Secondary endpoints include measures of physical health (upper and lower body strength tests), body mass index, frailty, activity behavior, psychological and health related quality of life outcomes. Exploratory endpoints include a health economics analysis, assessment of clinical health by post-operative morbidity scores, hospital length of stay, nutritional status, immune and inflammatory markers, and response to NCT. Rates of NCT toxicity, tolerance and compliance will also be assessed.
Discussion: The PERIOP-OG trial will determine whether, when compared to usual care, exercise training initiated at diagnosis and continued during NCT, prior to surgery and then during recovery, can maintain or improve cardiorespiratory fitness and other physical, psychological and clinical health outcomes. This trial will inform both the prescription of exercise regimes as well as the design of a larger prehabilitation and rehabilitation trial to investigate whether exercise in combination with nutritional and psychological interventions elicit greater benefits.
Behavioral Sensitization Induced by Methamphetamine Causes Differential Alterations in Gene Expression and Histone Acetylation of the Prefrontal Cortex in Rats
Authors: Li Hui , Chen Jing-An , Ding Qian-Zhi , Lu Guan-Yi , Wu Ning , Su Rui-Bin , Li Fei , Li Jin
Published: March 2020

Background:Methamphetamine (METH) is one of the most widely abused illicit substances around the world; unfortunately, its addiction mechanism remains unclear. Increasing evidence indicates that the change in gene expression and the involvement of chromatin modifications might be related to the lasting effects of METH on the brain. In this study, we took advantage of METH-induced behavioral sensitization as an animal model that reflects some aspects of drug addiction and examined the transcription and histone acetylation changes in gene expression in the prefrontal cortex (PFC) of adult rats.Methods:We conducted mRNA microarray and chromatin immunoprecipitation (ChIP) coupled to DNA microarray (ChIP-chip) analysis to test and screen transcriptional changes and histone acetylation modifications. Functional enrichment analysis, including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), was performed to analyze the differentially expressed genes. We then further identified alterations in ANP32A (acidic leucine-rich nuclear phosphoprotein-32A) and POU3F2 (POU domain, class 3, transcription factor 2) by qPCR and ChIP-PCR assays.Results:In the rat model of METH-induced behavioral sensitization, METH challenge caused 275 differentially expressed genes and a number of hyperacetylations (821 genes with H3 acetylation and 10 genes with H4 acetylation). Based on mRNA microarray and GO and KEGG enrichment analysis, 24 genes may be involved in METH-induced behavioral sensitization, and 7 of them were confirmed by qPCR. We further tested the alterations in ANP32A and POU3F2 transcription and histone acetylation at the different periods of METH-induced behavioral sensitization. The results showed that H4 hyperacetylation contributed to the increased mRNA of ANP32A and that H3/H4 hyperacetylation contributed to the increased mRNA of POU3F2 induced by METH challenge-induced behavioral sensitization but not by acute METH exposure.Conclusions: The present results revealed alterations in transcription and histone acetylation in the rat PFC by METH exposure and provided evidence that modifications of histone acetylation contributed to the alteration of gene expression caused by METH-induced behavioral sensitization.
Efficient production of (S)-1-phenyl-1, 2-ethanediol using xylan as co-substrate by a coupled multi-enzyme Escherichia coli system
Authors: Rao Junchao , Zhang Rongzhen , Xu Guanyu , Li Lihong , Xu Yan
Published: March 2020

Background: ( S )-1-phenyl-1,2-ethanediol is an important chiral intermediate in the synthesis of liquid crystals and chiral biphosphines.(S)-carbonyl reductase II from Candida parapsilosis catalyzes the conversion of 2-hydroxyacetophenone to ( S )-1-phenyl-1,2-ethanediol with NADPH as a cofactor. Glucose dehydrogenase with a Ala258Phe mutation is able to catalyze the oxidation of xylose with concomitant reduction of NADP + to NADPH, while endo-β-1,4-xylanase 2 catalyzes the conversion of xylan to xylose. In the present work, the Ala258Phe glucose dehydrogenase mutant and endo-β-1,4-xylanase 2 were introduced into the ( S )-carbonyl reductase II-mediated chiral pathway to strengthen cofactor regeneration by using xylan as a naturally abundant co-substrate.
Results: We constructed several coupled multi-enzyme systems by introducing ( S )-carbonyl reductase II, the A258F glucose dehydrogenase mutant and endo-β-1,4-xylanase 2 into Escherichia coli . Different strains were produced by altering the location of the encoding genes on the plasmid. Only recombinant E. coli /pET-G-S-2 expressed all three enzymes, and this strain produced ( S )-1-phenyl-1,2-ethanediol from 2-hydroxyacetophenone as a substrate and xylan as a co-substrate. The optical purity was 100% and the yield was 98.3% (6 g/L 2-HAP) under optimal conditions of 35°C, pH 6.5 and a 2:1 substrate-co-substrate ratio. The introduction of A258F glucose dehydrogenase and endo-β-1,4-xylanase 2 into the ( S )-carbonyl reductase II-mediated chiral pathway caused a 54.6% increase in yield, and simultaneously reduced the reaction time from 48 h to 28 h.
Conclusions: This study demonstrates efficient chiral synthesis using a pentose as a co-substrate to enhance cofactor regeneration. This provides a new approach for enantiomeric catalysis through the inclusion of naturally abundant materials.
Impacts of skull stripping on construction of three-dimensional T1-weighted imaging-based brain structural network in full-term neonates
Authors: Wang Geliang , Hu Yajie , Li Xianjun , Wang Miaomiao , Liu Congcong , Yang Jian , Jin Chao
Published: March 2020

Background: Skull stripping remains a challenge for neonatal brain MR image analysis. However, little is known about how accuracy of the skull stripping affects the neonatal brain tissue segmentation and subsequent network construction. This paper therefore aimed to clarify this issue by comparing two automatic (FMRIB Software Library's Brain Extraction Tool, BET; Infant Brain Extraction and Analysis Toolbox, iBEAT) and a semiautomatic (iBEAT with manual correction) processes in constructing 3D T1-Weighted Imaging (T1WI)-based brain structural network. Methods: Twenty-two full-term neonates (gestational age, 37-42 weeks; boys/girls, 13/9) without abnormalities on MRI who underwent brain 3D T1WI were retrospectively recruited. Two automatic (BET and iBEAT) and a semiautomatic preprocessing (iBEAT with manual correction) workflows were separately used to perform the skull stripping. Brain tissue segmentation and volume calculation were performed by a John Hopkins atlas-based method. Sixty-four gray matter regions were selected as nodes; volume covariance network and its properties (clustering coefficient, C p ; characteristic path length, L p ; local efficiency, E local ; global efficiency, E global ) were calculated by GRETNA. Analysis of variance (ANOVA) was used to compare the differences in the calculated volume between three workflows. Results: There were significant differences in volumes of 50 brain regions between three workflows ( P <0.05). Three neonatal brain structural networks presented small-world topology. The semiautomatic workflow showed remarkably decreased C p , increased L p , decreased E local , and decreased E global , in contrast to two automatic ones. Conclusions: Imperfect skull stripping indeed affected the accuracy of brain structural network in full-term neonates.
Nosocomial Infections Due to Multidrug-Resistant Bacteria in Cancer Patients: A Six-Year Experience of an Oncology Center of Western China
Authors: Jiang Ai-Min , Shi Xin , Liu Na , Gao Huan , Ren Meng-Di , Zheng Xiao-Qiang , Fu Xiao , Liang Xuan , Ruan Zhi-Ping , Yao Yu , Tian Tao
Published: March 2020

Background: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate characteristics, antibiotic-resistant patterns, and prognosis of nosocomial infections caused by multidrug-resistant (MDR) bacteria in cancer patients. Methods: This retrospective observational study analyzed cancer patients with MDR bacteria caused nosocomial infections from August 2013 to May 2019. The extracted clinical data were recorded in a standardized form and compared based on the patient’s survival status after infection during hospitalization. Data were analyzed by using independent samples t-test, Chi-square test, and binary logistic regression. P -values < 0.05 were considered statistically significant. Results: Overall, 257 cancer patients developed nosocomial infections caused by MDR bacteria. Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) was the most frequently isolated multidrug-resistant Gram-negative bacteria (MDRGNB), followed by Acinetobacter baumannii , and Stenotrophomonas maltophilia . Smoking history, cancer patients who received intrapleural/abdominal infusion within 30 days, presence of indwelling urinary catheter, and haemoglobin were independent factors for in-hospital mortality in the study population. The isolated MDR bacteria were mainly sensitive to amikacin, meropenem, imipenem, tigecycline, and piperacillin/tazobactam. Conclusions: This study confirms that MDR bacteria caused nosocomial infections were widely prevalent in cancer patients. ESBL-PE was the most commonly MDR bacteria, and the isolated MDR strains were mainly sensitive to amikacin, meropenem, imipenem, tigecycline, and piperacillin/tazobactam. Former smokers, cancer patients who received intrapleural/abdominal infusion within 30 days, presence of indwelling urinary catheter, and anemia were associated with increased in-hospital mortality. Our findings suggest that clinicians should think highly of nosocomial infections caused by MDR in cancer patients and advise policymakers to develop a guideline.