bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool
Authors: Picco Louisa , Middleton Melissa , Bruno Raimondo , Kowalski Michala , Nielsen Suzanne
Published: August 2020

Objective

The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool.

Design and Setting

Cross-sectional analysis of an online sample.

Subjects

Participants comprised those with chronic noncancer pain who regularly used prescription opioids.

Methods

Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time.

Results

A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55–0.73) with their longer counterparts. Test-retest reliability was fair (0.58–0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored.

Conclusion

The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.
Developing a cell-bound detection system for the screening of oxidase activity using the fluorescent peroxide sensor roGFP2-Orp1
Authors: Herzog P L , Borghi E , Traxlmayr M W , Obinger C , Sikes H D , Peterbauer C K
Published: August 2020

Accurate yet efficient high-throughput screenings have emerged as essential technology for enzyme engineering via directed evolution. Modern high-throughput screening platforms for oxidoreductases are commonly assisted by technologies such as surface display and rely on emulsification techniques to facilitate single-cell analysis via fluorescence-activated cell sorting. Empowered by the dramatically increased throughput, the screening of significantly larger sequence spaces in acceptable time frames is achieved but usually comes at the cost of restricted applicability. In this work, we tackle this problem by utilizing roGFP2-Orp1 as a fluorescent one-component detection system for enzymatic H2O2 formation. We determined the kinetic parameters of the roGFP2-Orp1 reaction with H2O2 and established an efficient immobilization technique for the sensor on Saccharomyces cerevisiae cells employing the lectin Concanavalin A. This allowed to realize a peroxide-sensing shell on enzyme-displaying cells, a system that was successfully employed to screen for H2O2 formation of enzyme variants in a whole-cell setting.
The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative
Authors: Alenazi Aqeel M , Alshehri Mohammed M , Alothman Shaima , Alqahtani Bader A , Rucker Jason , Sharma Neena K , Bindawas Saad M , Kluding Patricia M
Published: August 2020

Objective

Osteoarthritis (OA) and diabetes mellitus (DM) often coexist and can result in negative outcomes. DM can affect pain and walking speed in people with knee OA; however, the impact of DM on OA is understudied. The purpose of this study was to investigate the association between diabetes and knee pain locations, pain severity while walking, and walking speed in people with knee OA.

Methods

A cross-sectional analysis was used. Data from 1790 individuals from the Osteoarthritis Initiative (mean [SD] age = 69 [8.7] years) with knee pain were included and grouped into knee OA and diabetes (n = 236) or knee OA only (n = 1554). Knee pain locations were categorized as no pain, localized pain, regional pain, or diffuse pain. Knee pain during a 20-m walk test was categorized as no pain, mild, moderate, or severe knee pain. Walking speed was measured using the 20-m walk test. Multinomial and linear regression analyses were performed.

Results

Diabetes was associated with regional knee pain (odds ratio [OR] = 1.77; 95% CI = 1.01–3.11). Diabetes was associated only with moderate (OR = 1.78; 95% CI = 1.02–3.10) or severe (OR = 2.52; 95% CI = 1.01–6.28) pain while walking. Diabetes was associated with decreased walking speed (B = −0.064; 95% CI = −0.09 to −0.03).

Conclusions

Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA.

Impact

Clinicians can use a knee pain map for examining knee pain locations for people with diabetes and knee OA. Knee pain during walking and walking speed should be screened for people with knee OA and diabetes because of the influence of diabetes on these parameters in this population.

Lay Summary

Diabetes might be associated with specific knee pain locations, pain during activities such as walking, and reduced walking speed in people with knee OA.
Characteristics of Professional Physical Therapist Faculty and Doctor of Physical Therapy Programs, 2008-2017: Influences on Graduation Rates and First-Time National Physical Therapy Examination Pass Rates
Authors: Dickson Tara , Taylor Barrett , Zafereo Jason
Published: August 2020

Objective

Graduation rates and first-time National Physical Therapy Examination (NPTE) pass rates among Doctor of Physical Therapy (DPT) programs have ranged from 30% to 100% and 0% to 100% between 2008 and 2017, respectively. Prior studies on predictors of graduation rates and NPTE pass rates from DPT programs have used cross-sectional data and have not studied faculty data. This study sought to understand how trends in DPT faculty and program characteristics correlated with graduation rates and first-time NPTE pass rates.

Methods

This study was a retrospective panel analysis of yearly data from 231 programs between 2008 and 2017. Random effects models estimated the correlations between faculty and program characteristics regarding graduation rates and first-time NPTE pass rates.

Results

Graduation rates peaked when programs devoted 25% of faculty time, on average, to scholarship. The number of peer-reviewed publications was positively correlated with graduation rates; however, the trend was logarithmic, indicating a diminishing rise in graduation rates as the number of publications exceeded 1 per faculty full-time equivalent. Tenure-track status, faculty of color, and part-time faculty were all negatively correlated with first-time NPTE pass rates. However, these 3 trends are likely not meaningful, because the predicted rates of decline in pass rates were minimal.

Conclusions

Faculty engagement in scholarly activities can positively influence graduation rates, but only up to a certain level of faculty time devoted to scholarship.

Impact

This is the first study to provide data on the influence of faculty on DPT student outcomes and will help education programs develop strategies to improve those outcomes.
A first insight about spatial dimension of COVID-19: analysis at municipality level
Authors: Arauzo-Carod Josep-Maria
Published: August 2020

Background

This paper is about spatial patterns of by corona virus disease-2019 (COVID-19).

Methods

Using data for the first 21 weeks from municipalities in Catalonia, we analyse whether reported positive cases appear randomly or following some kind of spatial dependence. Global and local measures of spatial autocorrelation are used.

Results

There are some clusters alongside Catalan municipalities that change over time.

Conclusions

Use of spatial analysis techniques is suggested to identify spatial disease patterns and to provide spatially disaggregated public health policy recommendations.
Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction
Authors: Wang I-K , Yen T -H , Chen C -H , Hsu S -P , Sun Y , Lien L -M , Chang W -L , Lai T -C , Chen P -L , Chen C -C , Huang P -H , Lin C -H , Su Y -C , Lin M -C , Li C -Y , Sung F -C , Hsu C Y ,   Taiwan Stroke Registry Investigators
Published: August 2020

Objective

This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction.

Design

We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and <60 ml/min/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale ≥2) was calculated for patients with tPA treatment (N = 705), compared to those without tPA treatment (N = 2820), by eGFR levels, at 1, 3 and 6 months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels.

Results

Among patients with eGFR levels of <60 ml/min/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42–0.87) at 6 months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment.

Conclusions

tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.
Search for asymptomatic carriers of SARS-CoV-2 in healthcare workers during the pandemic: a Spanish experience
Authors: Olalla J , Correa A M , Martín-Escalante , M D , Hortas M L , Martín-Sendarrubias M J , Fuentes V , Sena , G , García-Alegría J ,   the ROBLE Group, Aguilera Alicia Jon , Al-Torgoman Alfonso , del Arco Ana M , Álvarez José A , Bernal Adolfo , Galán Julia M , Guzmán Inmaculada , López-Rodríguez Jairo , Luque Elena Martín , Bautista Milagros , Navarro María Ángeles , Onieva M , Ángeles Pérez-Aisa Christian , del Rio Francisco , Rivas Lucía , Robles Silvia , Soler Nicolás , Jiménez-García David , Sánchez-Megolla Ana I , Vallecillo
Published: August 2020

Background

Asymptomatic carriers of SARS-CoV-2 can be a vehicle for transmission of the infection. This fact is of particular importance in the case of healthcare workers (HCWs).

Design

Cross-sectional study in HCWs in a medium size hospital in the South of Spain.

Methods

Between 15 and 25 April 2020, naso- and oropharyngeal PCR determination was performed together with IgG and IgM antibody determination by immunochromatography to the HCWs of the Costa del Sol Hospital in Marbella of the units involved in patient care with COVID-19: Emergencies, Intensive Care and Anesthesia, Internal Medicine and Pneumology. Other units not directly involved in the care of these patients were offered to participate. On the day of sampling, a health questionnaire was answered, reporting symptoms on the same day and in the previous 14 days.

Results

Four hundred and ninety-eight HCWs were studied. Two individuals were detected with PCR for SARS-CoV2 positive. Both were asymptomatic on the day of sampling, but one of them had had a COVID-19 compatible picture in the previous two weeks and had positive IgG and IgM; therefore, only one subject was truly asymptomatic carrier (0.2%). Nine workers with positive IgG (1.8%) were detected.

Conclusions

The prevalence of asymptomatic carriers among health workers of the services directly involved in the care of patients with COVID-19 was very low in our center. This type of strategy can be one more tool in controlling the pandemic.
Vascular inflammation and endothelial injury in SARS-CoV-2 infection: the overlooked regulatory cascades implicated by the ACE2 gene cluster
Authors: Shovlin C L , Vizcaychipi M P
Published: August 2020

Coronavirus disease 2019 (COVID-19) has presented physicians with an unprecedented number of challenges and mortality. The basic question is why, in contrast to other ‘respiratory’ viruses, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in such multi-systemic, life-threatening complications and a severe pulmonary vasculopathy. It is widely known that SARS-CoV-2 uses membrane-bound angiotensin-converting enzyme 2 (ACE2) as a receptor, resulting in internalization of the complex by the host cell. We discuss the evidence that failure to suppress coronaviral replication within 5 days results in sustained downregulation of ACE2 protein expression and that ACE2 is under negative-feedback regulation. We then expose openly available experimental repository data that demonstrate the gene for ACE2 lies in a novel cluster of inter-regulated genes on the X chromosome including PIR encoding pirin (quercetin 2,3-dioxygenase), and VEGFD encoding the predominantly lung-expressed vascular endothelial growth factor D. The five double-elite enhancer/promoters pairs that are known to be operational, and shared read-through lncRNA transcripts, imply that ongoing SARS-CoV-2 infection will reduce host defences to reactive oxygen species, directly generate superoxide O2·− and H2O2 (a ‘ ROS storm’), and impair pulmonary endothelial homeostasis. Published cellular responses to oxidative stress complete the loop to pathophysiology observed in severe COVID-19. Thus, for patients who fail to rapidly suppress viral replication, the newly appreciated ACE2 co-regulated gene cluster predicts delayed responses that would account for catastrophic deteriorations. We conclude that ACE2 homeostatic drives provide a unified understanding that should help optimize therapeutic approaches during the wait until safe, effective vaccines and antiviral therapies for SARS-CoV-2 are delivered.
Mimics of vasculitis
Authors: Maningding Ernest , Kermani Tanaz A
Published: August 2020

While prompt diagnosis of vasculitis is important, recognition of vasculitis mimics is equally essential. As in the case of vasculitis, an approach to mimics based on the anatomic size of vessels can be useful. Infections can mimic vasculitis of any vessel size, including the formation of aneurysms and induction of ANCAs. Genetic disorders and vasculopathies are important considerations in large and medium vessel vasculitis. Cholesterol emboli, thrombotic conditions and calciphylaxis typically affect the medium and small vessels and, like vasculitis, can cause cutaneous, renal and CNS manifestations. Reversible cerebral vasoconstriction syndrome is important to distinguish from primary angiitis of the CNS. As an incorrect diagnosis of vasculitis can result in harmful consequences, it is imperative that the evaluation of suspected vasculitis includes consideration of mimics. We discuss the above mimics and outline a systematic and practical approach for differentiating vasculitis from its mimics.
Long-term maintenance rituximab for ANCA-associated vasculitis: relapse and infection prediction models
Authors: McClure Mark E , Zhu Yajing , Smith Rona M , Gopaluni Seerapani , Tieu Joanna , Pope Tasneem , Kristensen Karl Emil , Jayne David R W , Barrett Jessica , Jones Rachel B
Published: August 2020

Objectives

Following a maintenance course of rituximab (RTX) for ANCA-associated vasculitis (AAV), relapses occur on cessation of therapy, and further dosing is considered. This study aimed to develop relapse and infection risk prediction models to help guide decision making regarding extended RTX maintenance therapy.

Methods

Patients with a diagnosis of AAV who received 4–8 grams of RTX as maintenance treatment between 2002 and 2018 were included. Both induction and maintenance doses were included; most patients received standard departmental protocol consisting of 2× 1000 mg 2 weeks apart, followed by 1000 mg every 6 months for 2 years. Patients who continued on repeat RTX dosing long-term were excluded. Separate risk prediction models were derived for the outcomes of relapse and infection.

Results

A total of 147 patients were included in this study with a median follow-up of 63 months [interquartile range (IQR): 34–93]. Relapse: At time of last RTX, the model comprised seven predictors, with a corresponding C-index of 0.54. Discrimination between individuals using this model was not possible; however, discrimination could be achieved by grouping patients into low- and high-risk groups. When the model was applied 12 months post last RTX, the ability to discriminate relapse risk between individuals improved (C-index 0.65), and once again, clear discrimination was observed between patients from low- and high-risk groups. Infection: At time of last RTX, five predictors were retained in the model. The C-index was 0.64 allowing discrimination between low and high risk of infection groups. At 12 months post RTX, the C-index for the model was 0.63. Again, clear separation of patients from two risk groups was observed.

Conclusion

While our models had insufficient power to discriminate risk between individual patients they were able to assign patients into risk groups for both relapse and infection. The ability to identify risk groups may help in decisions regarding the potential benefit of ongoing RTX treatment. However, we caution the use of these prediction models until prospective multi-centre validation studies have been performed.
Making Room for the Needy: The Credit-Reallocation Effects of the ECB’s Corporate QE*
Authors: Arce Óscar , Mayordomo Sergio , Gimeno Ricardo
Published: August 2020

We analyze how the ECB’s purchases of corporate bonds under its Corporate Sector Purchase Programme (CSPP) affected the financing of Spanish firms. We first document that the announcement of the CSPP in March 2016 raised firms’ propensity to issue bonds. The flipside was a drop in the demand for bank loans by bond issuers. Around 75% of the drop in loans previously made to debt issuers was redirected to other, smaller nonbond issuing firms. This reallocation process was led by banks with weaker liquidity positions experiencing credit outflows, which extended credit to the same firms they were rationing prior to the CSPP. This positive credit supply shock raised the real investment of nonissuing firms. The concomitant ECB’s Targeted Longer-Term Refinancing Operations (TLTRO-II) is estimated to have contributed to amplifying the credit-reallocation effect triggered by the CSPP.
ESTIMATION OF PHOTON ENERGY AND DIRECTION DISTRIBUTIONS AT JAPANESE NUCLEAR POWER PLANTS BASED ON LITERATURE SURVEY FOR J-EPISODE STUDY
Authors: Furuta Hiroshige , Nishide Akemi , Kudo Shin'ichi , Saigusa Shin
Published: August 2020

In order to reconstruct organ-absorbed dose from recorded dose for risk estimation in nuclear worker cohort, the preceding study of the International Agency for Research on Cancer (IARC) 15-Country Collaborative Study estimated the organ dose conversion factor from the recorded dose of Hp(10) under the assumption that on average, in the nuclear power plants (NPPs), 10% of the dose received by workers was due to photon energies ranging from 100 to 300 keV and 90% from photon energies ranging from 300 to 3000 keV, with the average geometry being 50% in the antero-posterior geometry and 50% in the isotropic geometry. Similar examination was conducted at the Japanese Epidemiological Study on Low-Dose Radiation Effects (J-EPISODE).

Literature survey disclosed that Japanese electric power companies had jointly conducted the research on energy distribution and incidence direction distribution of gamma rays in working environments during periodical inspection and maintenance as well as during operation in the 1980s. The analysis of the survey results on photon energy and geometry distribution of Japanese NPPs demonstrated appropriateness in applying the IARC study assumption for nuclear workers in Japan and reconstructing organ-absorbed dose in the J-EPISODE. These results in Japan also provide strong evidence to support the robustness and generality of the IARC study assumption, which was estimated based on the judgment of experts at nuclear facilities around the world.
PeSNAC-1 a NAC transcription factor from moso bamboo (Phyllostachys edulis) confers tolerance to salinity and drought stress in transgenic rice
Authors: Hou Dan , Zhao Zhongyu , Hu Qiutao , Li Ling , Vasupalli Naresh , Zhuo Juan , Zeng Wei , Wu Aimin , Lin Xinchun
Published: August 2020

NAC (NAM, AFAT and CUC) proteins play necessary roles in plant response to environmental stresses. However, the functional roles of NAC genes in moso bamboo (Phyllostachys edulis), an essential economic perennial woody bamboo species, are not well documented. In this study, we retrieved 152 PeNAC genes from the moso bamboo V2 genome, and PeSNAC-1 was isolated and functionally characterized. PeSNAC-1 was localized in the nucleus and had no transactivation activity in yeast. PeSNAC-1 extremely expressed in rhizome and young roots (0.1 and 0.5 cm) and was significantly induced by drought and salt treatments but repressed by abscisic acid (ABA), methyl jasmonate and high temperature (42 °C) in moso bamboo. Under water shortage and salinity conditions, survival ratios, Fv/Fm values, physiological indexes such as activities of superoxide dismutase, peroxidase and catalase and contents of malondialdehyde, H2O2 and proline were significantly higher in transgenic rice than the wild type, which suggests enhanced tolerance to drought and salt stress in PeSANC-1 overexpressed plants. Transcript levels of Na+/H+ antiporter and Na+ transporter genes (OsSOS1, OsNHX1 and OsHKT1;5), ABA signaling and biosynthesis genes (OsABI2, OsRAB16, OsPP2C68, OsLEA3-1, OsLEA3, OsNCED3, OsNCED4 and OsNCED5) and ABA-independent genes (OsDREB1A, OsDREB1B and OsDREB2A) were substantially higher in transgenic as compared with the wild type. Moreover, protein interaction analysis revealed that PeSNAC-1 could interact with stress responsive PeSNAC-2/4 and PeNAP-1/4/5 in both yeast and plant cells, which indicates a synergistic effect of those proteins in regulating the moso bamboo stress response. Our data demonstrate that PeSNAC-1 likely improved salt and drought stress tolerance via modulating gene regulation in both ABA-dependent and independent signaling pathways in transgenic rice. In addition, PeSNAC-1 functions as an important positive stress regulator in moso bamboo, participating in PeSNAC-1 and PeSNAC-2/4 or PeSNAC-1 and PeNAP-1/4/5 interaction networks.
Metabolome adjustments in ectomycorrhizal Populus × canescens associated with strong promotion of plant growth by Paxillus involutus despite a very low root colonization rate
Authors: Szuba Agnieszka , Marczak Łukasz , Ratajczak Izabela
Published: August 2020

It is believed that resource exchange, which is responsible for intensified growth of ectomycorrhizal plants, occurs in the fungus–plant interface. However, increasing evidence indicates that such intensified plant growth, especially root growth promotion, may be independent of root colonization. Nevertheless, the molecular adjustments in low-colonized plants remain poorly understood. Here, we analysed the metabolome of Populus × canescens microcuttings characterized by significantly increased growth triggered by inoculation with Paxillus involutus, which successfully colonized only 2.1 ± 0.3% of root tips. High-throughput metabolomic analyses of leaves, stems and roots of Populus × canescens microcuttings supplemented with leaf proteome data were performed to determine ectomycorrhiza-triggered changes in N-, P- and C-compounds. The molecular adjustments were relatively low in low-colonized (M) plants. Nevertheless, the levels of foliar phenolic compounds were significantly increased in M plants. Increases of total soluble carbohydrates, starch as well as P concentrations were also observed in M leaves along with the increased abundance of the majority of glycerophosphocholines detected in M roots. However, compared with the leaves of the non-inoculated controls, M leaves presented lower concentrations of both N and most photosynthesis-related proteins and all individual mono- and disaccharides. In M stems, only a few compounds with different abundances were detected, including a decrease in carbohydrates, which was also detected in M roots. Thus, these results suggest that the growth improvement of low-colonized poplar trees is independent of an increased photosynthesis rate, massively increased resource (C:N) exchange and delivery of most nutrients to leaves. The mechanism responsible for poplar growth promotion remains unknown but may be related to increased P uptake, subtle leaf pigment changes, the abundance of certain photosynthetic proteins, slight increases in stem and root amino acid levels and the increase in flavonoids (increasing the antioxidant capacity in poplar), all of which improve the fitness of low-colonized poplars.
Nutrition Status of School Children in Punjab, India: Findings from School Health Surveys
Authors: Verma Madhur , Sharma Priyanka , Khanna Poonam , Srivastava Rachana , Sahoo Soumya Swaroop
Published: August 2020

Background

School-going children and adolescents are rarely targeted in nutrition surveys, despite the significant impact of nutritional status on their health, cognition, educational achievements and future economic productivity. The present secondary data analysis evaluated the nutritional status of children and adolescents in the 5–18 years age group.

Materials and methods

The anthropometric measurements of children and adolescents studying in the government and government-aided schools were collected under the ‘Rashtriya Bal Swasthya Karyakram’ in the District Fatehgarh Sahib of Punjab, India between March and August 2018. It was analyzed using SPSS version 21. Mean and standard deviation for weight-for-age, height-for-age, body mass index (BMI) for age z-scores were calculated using World Health Organization’s Anthro-plus software.

Results

A total of 897 children’s data were included in the study. Out of 352 children in 5–9 years age group, mean weight, height and BMI were 15.7 ± 3.8 kg, 110.7 ± 10.6 cm and 12.7 ± 2.1 kg/m2. About 58.8%, 37.4% and 31.8% of the children were categorized as severely underweight, stunted and thin, respectively. In the 10–18 years age group, mean weight, height and BMI were 30.5 ± 9.5 kg, 140 ± 13.4 cm and 15.2 ± 2.6 kg/m2. Severe stunting was present in 19.4% of adolescents, while 26.9% were severely thin.

Conclusion

Our study depicts a high level of undernutrition in school-going children and adolescents. There is a need to strengthen the nutrition interventions for middle childhood and adolescence period that can help in a healthy transition from childhood to adulthood and break the intergenerational cycle of malnutrition.

Lay summary

National and state-level health-priorities focus mainly on improving the nutrition status of under-5-year children, while the school-going children and adolescents are usually neglected. The present secondary data analysis estimates the burden of malnutrition in school-going children and adolescents. These data were collected under one of India's national health programs that intend to tackle childhood illnesses. Our study depicts a high level of undernutrition in school-going children and adolescents. We found that girls were affected more by malnutrition in middle childhood, i.e. during 5–9 years (both by stunting and thinness) compared to boys. But in middle and late adolescence, males were more stunted and thin compared to females. Programs to support adolescents' nutrition interventions could provide an opportunity for a healthy transition from childhood to adulthood and could be an essential step in breaking the intergenerational cycle of malnutrition.
Addressing the Sub-Optimal Use of Oral Rehydration Solution for Childhood Diarrhoea in the Tropics: Findings From a Rural Setting in Nigeria
Authors: Abolurin Olufunmilola O , Olaleye Atinuke O , Adekoya Adesola O
Published: August 2020

Background

Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria.

Aim

To identify barriers to the optimal use of ORS for childhood diarrhoea in Nigeria and recommend appropriate interventions to improve uptake of ORS at community and facility levels.

Methods

A quantitative cross-sectional survey of 400 mothers with children under 5 years of age was conducted in Nigeria to explore reasons for suboptimal utilization of ORS for childhood diarrhoea. An interviewer-administered questionnaire was used for data collection. Data were analysed using the statistical software SPSS version 21.0®.

Results

Sixty-one (15.3%) of the respondents were unaware of ORS. Of the 339 that were aware, their source of information was mainly hospital/health workers (81.1%). Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Nineteen mothers (5.6%) had difficulty getting ORS when needed, whereas 13 (3.8%) reported that it was difficult for them to remember how to prepare ORS. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported.

Conclusion

There is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. We recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged.

Lay summary

Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. A quantitative cross-sectional study was carried out among 400 mothers to identify barriers to the optimal use of ORS for childhood diarrhoea and recommend appropriate interventions. Sixty-one (15.3%) of the respondents were unaware of ORS. Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Some mothers had difficulty getting ORS when needed, while some found it difficult to remember how to prepare it. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. The study showed that there is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. Hence, we recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged.
Neglecting the effect of COVID-19 on neglected tropical diseases: the Ethiopian perspective
Authors: Abdela Seid Getahun , van Griensven Johan , Seife Fikre , Enbiale Wendemagegn
Published: August 2020

Countries around the world are facing an enormous challenge due to the COVID-19 pandemic. The pressure that the pandemic inflicts on health systems could certainly impact on the care, control, and elimination of neglected tropical diseases (NTDs). From mid-January 2020, Ethiopia started to prepare for the prevention and treatment of COVID-19. The Federal Ministry of Health pledged to continue essential healthcare, including NTD care, during this pandemic. However, some hospitals have been closed for other healthcare services and have been turned into isolation and treatment centers for COVID-19. In addition to the healthcare facility measures, all community-based health promotion and disease prevention services have been stopped. The current shift in attention towards COVID-19 is expected to have a negative impact on NTD prevention and care.
Association of gene polymorphisms and environmental factors in tuberculosis patients and their household contacts
Authors: Chen Yue , Peng Wen Hui , Lai Shi Feng , Luo Fang , Luo Dan , Wang Bao Guo
Published: August 2020

Background

Tuberculosis (TB) is an important public health problem in China and environmental and genetic factors have an impact on its occurrence and development. We explored the relationship between environmental factors, genetic susceptibility genes and gene–environment interactions and the incidence of TB, as well as their high-risk combination, which can provide a scientific basis for prevention of the disease.

Methods

The 242 individuals, which included 82 TB patients, 67 family genetically related patients and 93 healthy controls, all of whom were of the Han population in Guangdong Province. The basic information of subjects was collected, including general conditions, behaviour habits, family environmental factors and blood samples. Two single nucleotides with potential functions (interleukin-10 [IL-10] rs1800896, interferon-γ [IFN-γ] rs2430561) were screened by bioinformatics tools and identified by polymerase chain reaction–restriction fragment length polymorphism.

Results

We found that gender, education, TB exposure history, fitness activities, residential areas and indoor hygiene conditions were all associated with the occurrence of TB. In the dominant model, AG+GG of IL-10 and AA of IFN-γ are high-risk genotypes. Multifactor dimensionality reduction (MDR) analysis of TB-prone families shows that a combination of male sex, IL-10 AA and AG genotypes and smoking history are elements of high risk for TB infection (prediction accuracy 62.45%, cross-validation consistency 10/10). The MDR analysis of the TB patients group and the healthy control group showed that the combination of low education level, history of TB exposure, and IFN-γ AA genotype represented a higher risk of TB infection (prediction accuracy 80.34%, cross-validation consistency 10/10).

Conclusions

The occurrence of TB in TB-prone families in the Han population of Guangdong Province is related to environmental factors as well as cytokines IL-10 and IFN-γ. We also found high-risk combinations of genes and environmental factors, providing clues for the timely detection of high-risk groups.
Phylogeny and biogeography of the pantropical whip spider family Charinidae (Arachnida: Amblypygi)
Authors: De Miranda Gustavo Silva , Giupponi Alessandro P L , Scharff Nikolaj , Prendini Lorenzo
Published: August 2020

The present contribution addresses the phylogeny and biogeography of the pantropical whip spider family Charinidae Quintero, 1986, the most species-rich in the arachnid order Amblypygi Thorell, 1883, based on morphology and multilocus DNA sequences, analysed simultaneously using parsimony, maximum likelihood and Bayesian inference. The morphological matrix comprises 138 characters, scored for four outgroup taxa and 103 ingroup terminals representing all genera and 64% of the species of Charinidae. The multilocus dataset comprises sequences from two nuclear and three mitochondrial gene loci for four outgroup taxa and 48 ingroup representing 30 (23%) taxa of Charinidae. Charinidae are monophyletic, with Weygoldtia Miranda et al., 2018 sister to a monophyletic group comprising Charinus Simon, 1892 and Sarax Simon, 1892, neither of which are reciprocally monophyletic. Charinidae diverged from other amblypygid families in the Late Carboniferous, c. 318 Mya, on the supercontinent Pangaea. Weygoldtia diverged from the common ancestor of Charinus and Sarax during the Late Permian, c. 257 Mya, when changes in climate reduced tropical forests. The divergence of Charinus and Sarax coincides with the fragmentation of Pangaea, c. 216 Mya. Sarax colonized South-East Asia via Australia. The charinid fauna of New Caledonia originated before the Oligocene, when the island separated from Australia, c. 80 Mya.
Corticosteroids in the Management of Pregnant Patients With Coronavirus Disease (COVID-19)
Authors: Saad Antonio F. , Chappell Lucy , Saade George R. , Pacheco Luis D.
Published: August 2020

Recent evidence supports the use of an early, short course of glucocorticoids in patients with COVID-19 who require mechanical ventilation or oxygen support. As the number of coronavirus disease 2019 (COVID-19) cases continues to increase, the number of pregnant women with the disease is very likely to increase as well. Because pregnant women are at increased risk for hospitalization, intensive care unit admission, and mechanical ventilation support, obstetricians will be facing the dilemma of initiating maternal corticosteroid therapy while weighing its potential adverse effects on the fetus (or neonate if the patient is postpartum and breastfeeding). Our objective is to summarize the current evidence supporting steroid therapy in the management of patients with acute respiratory distress syndrome and COVID-19 and to elaborate on key modifications for the pregnant patient.
Evaluating Pediatric Sepsis Definitions Designed for Electronic Health Record Extraction and Multicenter Quality Improvement*
Authors: Scott Halden F. , Brilli Richard J. , Paul Raina , Macias Charles G. , Niedner Matthew , Depinet Holly , Richardson Troy , Riggs Ruth , Gruhler Heidi , Larsen Gitte Y. , Huskins W. Charles , Balamuth Fran ,   for the Improving Pediatric Sepsis Outcomes (IPSO) Collaborative Investigators.
Published: August 2020

Objectives:

To describe the Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes sepsis definitions and the identified patients; evaluate the definition using a published framework for evaluating sepsis definitions.

Design:

Observational cohort.

Setting:

Multicenter quality improvement collaborative of 46 hospitals from January 2017 to December 2018, excluding neonatal ICUs.

Patients:

Improving Pediatric Sepsis Outcomes Sepsis was defined by electronic health record evidence of suspected infection and sepsis treatment or organ dysfunction. A more severely ill subgroup, Improving Pediatric Sepsis Outcomes Critical Sepsis, was defined, approximating septic shock.

Interventions:

Participating hospitals identified patients, extracted data, and transferred de-identified data to a central data warehouse. The definitions were evaluated across domains of reliability, content validity, construct validity, criterion validity, measurement burden, and timeliness.

Measurements and Main Results:

Forty hospitals met data quality criteria across four electronic health record platforms. There were 23,976 cases of Improving Pediatric Sepsis Outcomes Sepsis, including 8,565 with Improving Pediatric Sepsis Outcomes Critical Sepsis. The median age was 5.9 years. There were 10,316 (43.0%) immunosuppressed or immunocompromised patients, 4,135 (20.3%) with central lines, and 2,352 (11.6%) chronically ventilated. Among Improving Pediatric Sepsis Outcomes Sepsis patients, 60.8% were admitted to intensive care, 26.4% had new positive-pressure ventilation, and 19.7% received vasopressors. Median hospital length of stay was 6.0 days (3.0–13.0 d). All-cause 30-day in-hospital mortality was 958 (4.0%) in Improving Pediatric Sepsis Outcomes Sepsis; 541 (6.3%) in Improving Pediatric Sepsis Outcomes Critical Sepsis. The Improving Pediatric Sepsis Outcomes Sepsis definitions demonstrated strengths in content validity, convergent construct validity, and criterion validity; weakness in reliability. Improving Pediatric Sepsis Outcomes Sepsis definitions had significant initial measurement burden (median time from case completion to submission: 15 mo [interquartile range, 13–18 mo]); timeliness improved once data capture was established (median, 26 d; interquartile range, 23–56 d).

Conclusions:

The Improving Pediatric Sepsis Outcomes Sepsis definitions demonstrated feasibility for large-scale data abstraction. The patients identified provide important information about children treated for sepsis. When operationalized, these definitions enabled multicenter identification and data aggregation, indicating practical utility for quality improvement.
Early Arterial Embolization and Mortality in Mechanically Ventilated Patients With Hemoptysis: A Nationwide Retrospective Cohort Study
Authors: Ando Takahiro , Kawashima Masahiro , Jo Taisuke , Masuda Kimihiko , Yamauchi Yasuhiro , Tanaka Goh , Kage Hidenori , Suzukawa Maho , Nagai Hideaki , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo , Nagase Takahide
Published: August 2020

Objectives:

Hemoptysis, a symptom common across various respiratory diseases, can cause airway obstruction leading to a life-threatening condition. Arterial embolization has been used to control bleeding from the lower airways. However, limited studies have evaluated its effects on in-hospital mortality in patients with hemoptysis requiring mechanical ventilation. The objective of this study was to clarify whether early intervention by arterial embolization reduced mortality in mechanically ventilated patients with hemoptysis.

Design:

Retrospective cohort study from July 2010 to March 2017.

Setting:

More than 1,200 acute-care hospitals, comprising approximately 90% of all tertiary-care emergency hospitals in Japan.

Patients:

The study cohort was patients with pulmonary diseases hospitalized for hemoptysis and mechanically ventilated within 2 days of admission.

Interventions:

We compared patients who had undergone arterial embolization within 3 days of endotracheal intubation (early embolization group) with patients who did not (control group).

Measurements and Main Results:

A total of 12,287 patients with hemoptysis requiring mechanical ventilation were analyzed. After 1:4 propensity score matching, there were 226 and 904 patients in the early embolization and control groups, respectively. The early embolization group was associated with lower 7-day and 30-day mortalities (7-d mortality: 1.3% vs 4.0%; odds ratio, 0.39; 95% CI, 0.16–0.97;p= 0.044 and 30-d mortality: 7.5% vs 16.8%; odds ratio, 0.45; 95% CI, 0.28–0.73;p= 0.001) and shorter duration of mechanical ventilation (median 6 d, interquartile range 4–13 d vs 8 d, interquartile range 4–19 d;p= 0.003) compared with the control group.

Conclusions:

Our results show that early intervention by arterial embolization may be effective in reducing 7-day and 30-day mortalities in patients with life-threatening hemoptysis requiring mechanical ventilation.
Hysteresis and Lung Recruitment in Acute Respiratory Distress Syndrome Patients: A CT Scan Study*
Authors: Chiumello Davide , Arnal Jean-Michel , Umbrello Michele , Cammaroto Antonio , Formenti Paolo , Mistraletti Giovanni , Bolgiaghi Luca , Gotti Miriam , Novotni Dominik , Reidt Sascha , Froio Sara , Coppola Silvia
Published: August 2020

Objectives:

Hysteresis of the respiratory system pressure-volume curve is related to alveolar surface forces, lung stress relaxation, and tidal reexpansion/collapse. Hysteresis has been suggested as a means of assessing lung recruitment. The objective of this study was to determine the relationship between hysteresis, mechanical characteristics of the respiratory system, and lung recruitment assessed by a CT scan in mechanically ventilated acute respiratory distress syndrome patients.

Design:

Prospective observational study.

Setting:

General ICU of a university hospital.

Patients:

Twenty-five consecutive sedated and paralyzed patients with acute respiratory distress syndrome (age 64 ± 15 yr, body mass index 26 ± 6 kg/m2, Pao
2/Fio
2 147 ± 42, and positive end-expiratory pressure 9.3 ± 1.4 cm H2O) were enrolled.

Interventions:

A low-flow inflation and deflation pressure-volume curve (5–45 cm H2O) and a sustained inflation recruitment maneuver (45 cm H2O for 30 s) were performed. A lung CT scan was performed during breath-holding pressure at 5 cm H2O and during the recruitment maneuver at 45 cm H2O.

Measurements and Main Results:

Lung recruitment was computed as the difference in noninflated tissue and in gas volume measured at 5 and at 45 cm H2O. Hysteresis was calculated as the ratio of the area enclosed by the pressure-volume curve and expressed as the hysteresis ratio. Hysteresis was correlated with respiratory system compliance computed at 5 cm H2O and the lung gas volume entering the lung during inflation of the pressure-volume curve (R
2 = 0.749, p < 0.001 and R
2 = 0.851, p < 0.001). The hysteresis ratio was related to both lung tissue and gas recruitment (R
2 = 0.266, p = 0.008, R
2 = 0.357, p = 0.002, respectively). Receiver operating characteristic analysis showed that the optimal cutoff value to predict lung tissue recruitment for the hysteresis ratio was 28% (area under the receiver operating characteristic curve, 0.80; 95% CI, 0.62–0.98), with sensitivity and specificity of 0.75 and 0.77, respectively.

Conclusions:

Hysteresis of the respiratory system computed by low-flow pressure-volume curve is related to the anatomical lung characteristics and has an acceptable accuracy to predict lung recruitment.
National Trends and Variation of Functional Status Deterioration in the Medically Critically Ill*
Authors: Ingraham Nicholas E. , Vakayil Victor , Pendleton Kathryn M. , Robbins Alexandria J. , Freese Rebecca L. , Northrop Elise F. , Brunsvold Melissa E. , Charles Anthony , Chipman Jeffrey G. , Tignanelli Christopher J.
Published: August 2020

Objectives:

Physical and psychologic deficits after an ICU admission are associated with lower quality of life, higher mortality, and resource utilization. This study aimed to examine the prevalence and secular changes of functional status deterioration during hospitalization among nonsurgical critical illness survivors over the past decade.

Design:

We performed a retrospective longitudinal cohort analysis.

Setting:

Analysis performed using the Cerner Acute Physiology and Chronic Health Evaluation outcomes database which included manually abstracted data from 236 U.S. hospitals from 2008 to 2016.

Patients:

We included nonsurgical adult ICU patients who survived their hospitalization and had a functional status documented at ICU admission and hospital discharge. Physical functional status was categorized as fully independent, partially dependent, or fully dependent.

Interventions:

None.

Measurements and Main Results:

Functional status deterioration occurred in 38,116 patients (29.3%). During the past decade, functional status deterioration increased in each disease category, as well as overall (prevalence rate ratio, 1.15; 95% CI, 1.13–1.17; p < 0.001). Magnitude of functional status deterioration also increased over time (odds ratio, 1.03; 95% CI, 1.03–1.03; p < 0.001) with hematological, sepsis, neurologic, and pulmonary disease categories having the highest odds of severe functional status deterioration.

Conclusions:

Following nonsurgical critical illness, the prevalence of functional status deterioration and magnitude increased in a nationally representative cohort, despite efforts to reduce ICU dysfunction over the past decade. Identifying the prevalence of functional status deterioration and primary etiologies associated with functional status deterioration will elucidate vital areas for further research and targeted interventions. Reducing ICU debilitation for key disease processes may improve ICU survivor mortality, enhance quality of life, and decrease healthcare utilization.