bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence in Dentistry: Chances and Challenges
Authors: Schwendicke F. , Samek W. , Krois J.
Published: April 2020

The term “artificial intelligence” (AI) refers to the idea of machines being capable of performing human tasks. A subdomain of AI is machine learning (ML), which “learns” intrinsic statistical patterns in data to eventually cast predictions on unseen data. Deep learning is a ML technique using multi-layer mathematical operations for learning and inferring on complex data like imagery. This succinct narrative review describes the application, limitations and possible future of AI-based dental diagnostics, treatment planning, and conduct, for example, image analysis, prediction making, record keeping, as well as dental research and discovery. AI-based applications will streamline care, relieving the dental workforce from laborious routine tasks, increasing health at lower costs for a broader population, and eventually facilitate personalized, predictive, preventive, and participatory dentistry. However, AI solutions have not by large entered routine dental practice, mainly due to 1) limited data availability, accessibility, structure, and comprehensiveness, 2) lacking methodological rigor and standards in their development, 3) and practical questions around the value and usefulness of these solutions, but also ethics and responsibility. Any AI application in dentistry should demonstrate tangible value by, for example, improving access to and quality of care, increasing efficiency and safety of services, empowering and enabling patients, supporting medical research, or increasing sustainability. Individual privacy, rights, and autonomy need to be put front and center; a shift from centralized to distributed/federated learning may address this while improving scalability and robustness. Lastly, trustworthiness into, and generalizability of, dental AI solutions need to be guaranteed; the implementation of continuous human oversight and standards grounded in evidence-based dentistry should be expected. Methods to visualize, interpret, and explain the logic behind AI solutions will contribute (“explainable AI”). Dental education will need to accompany the introduction of clinical AI solutions by fostering digital literacy in the future dental workforce.
Marrow-derived mesenchymal stem cells regulate the inflammatory response and repair alveolar type II epithelial cells in acute lung injury of rats
Authors: Li Qianying , Chen Xianyang , Li Jiujun
Published: April 2020

Objective

We investigated the effect of untransplantable bone marrow-derived mesenchymal stem cells (BMSCs) in acute lung injury (ALI) and whether BMSCs attenuate damage of lipopolysaccharide (LPS) to alveolar type II epithelial cells (AECIIs).

Methods

ALI models were prepared by nebulizing LPS and then BMSCs were infused 1 hour later. We observed histopathological changes of lung tissue and evaluated inflammatory exudation by the wet/dry weight ratio, bronchiolar lavage fluid cell count, and protein concentration determination. Inflammatory and vascular factors were detected by immunohistochemistry and western blotting. For in vitro experiments, AECIIs were stimulated with 10 μg/mL LPS for 4 hours and then BMSCs were seeded in transit inserts to co-culture for 24 hours. The activity of AECIIs was detected.

Results

In the LPS + BMSCs group, histopathological examination showed that the degree of lung injury was significantly reduced compared with the LPS group. Protein expression of inflammatory and vascular factors was significantly lower with treatment. Optical density values and cell viability of the LPS + BMSCs group were significantly higher than those of the LPS group.

Conclusions

Untransplanted-BMSCs can inhibit the inflammatory response in ALI and promote repair of AECIIs. This might be due to substances secreted by BMSCs and interaction between these substances.
Identification of potential crucial genes in monocytes for atherosclerosis using bioinformatics analysis
Authors: Zhang Yuan-Meng , Meng Ling-Bing , Yu Si-Jun , Ma Dong-Xing
Published: April 2020

Objective

To use bioinformatics tools to screen for gene biomarkers from monocytes, which play an important role in the pathogenesis of atherosclerosis.

Methods

Two expression profiling datasets (GSE27034 and GSE10195) were obtained from the Gene Expression Omnibus dataset and the differentially expressed genes (DEGs) between atherosclerotic human peripheral blood mononuclear cells (PBMC) samples and control subjects were screened using GEO2R. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted for the DEGs. STRING and MCODE plug-in of Cytoscape were used for constructing a protein–protein interaction network and analysing hub genes.

Results

The two datasets had 237 DEGs in common between non-atherosclerotic- and atherosclerotic PBMC samples. Functional annotation demonstrated that these DEGs were mainly enriched in protein binding, positive regulation of transcription from RNA polymerase II promoter, nucleus and viral carcinogenesis. Five hub genes, FBXL4, UBOX5, KBTBD6, FZR1 and FBXO2, were identified.

Conclusion

This present bioinformatics analysis identified that the FBXL4, UBOX5, KBTBD6 and FBXO21 genes might play vital roles in the pathogenesis of atherosclerosis. These four genes might represent new biomarkers for the diagnosis and treatment of atherosclerosis.
Comparative analysis of locking plates versus hook plates in the treatment of Neer type II distal clavicle fractures
Authors: Wang Hong-Kai , Liang Li-Sheng , He Ren-Gao , Su Yu-Bin , Mao Peng , Hu Jun-Zu
Published: April 2020

Objective

This study was performed to compare the clinical effects of locking plates (LPs) with those of hook plates (HPs) in the treatment of Neer type II distal clavicle fractures.

Methods

From August 2014 to April 2018, 64 patients with Neer type II distal clavicle fractures were treated in our department. The clinical effects were assessed with respect to the operation time, intraoperative blood loss, incision length, fracture healing, postoperative pain, postoperative complications, and postoperative shoulder joint function.

Results

There were no significant differences in the healing time, operation time, or intraoperative blood loss between the LP and HP groups. The incision length was significantly shorter in the LP than HP group, and the postoperative complication rate was significantly lower in the LP than HP group. The visual analog scale score, Constant–Murley score, and University of California Los Angeles score were significantly better in the LP than HP group.

Conclusions

Compared with HPs, the use of LPs involves a smaller incision in the treatment of Neer type II distal clavicle fractures and significantly reduces postoperative pain and complications. Therefore, priority can be given to the use of LPs in the treatment of Neer type II distal clavicle fractures.
Effect of unilateral testicular torsion at different ages on male fertility
Authors: Zhang Xinyu , Zhang Jianzhong , Cai Zhonglin , Wang Xiyou , Lu Wenhong , Li Hongjun
Published: April 2020

Objective

To investigate the effect of early-life unilateral testicular torsion on adult male fertility.

Methods

Clinical information was collected for 122 patients who had experienced unilateral testicular torsion at a median age of 15.5 years. The recent pregnancy rate and time to pregnancy experienced by the patients’ female partners were assessed by structured interviews. Data were analyzed by the chi-squared test and Student’s t-test.

Results

Seventy-two patients with testicular torsion met the criteria for inclusion in our analyses; 49 had undergone orchiectomy, while 23 had undergone surgical repositioning/orchiopexy. The pregnancy rate and median time to pregnancy were 83.67% (41/49) and 1.6 years, respectively, in the orchiectomy group, whereas they were 91.30% (21/23) and 0.75 years, respectively, in the repositioning/orchiopexy group. The recent pregnancy rate was higher in patients with torsion in childhood than in patients with torsion in adolescence; it was lowest in patients with torsion in adulthood. Surgical repositioning/orchiopexy yielded a significantly better recent pregnancy rate among the three groups, based on age at the time of torsion, and a shorter time to pregnancy than orchiectomy in patients with torsion in adolescence.

Conclusion

Onset of unilateral testicular torsion early in life has a negligible effect on adult male fertility.
Effects of comprehensive and intensive pulmonary rehabilitation and nutritional support on quality of life and functional status in patients with chronic obstructive pulmonary disease
Authors: Korkmaz Celalettin , Demirbas Soner , Vatansev Hulya , Yildirim Elif , Teke Turgut , Zamani Adil
Published: April 2020

Objective

To investigate the effects of pulmonary rehabilitation (PR) and combined nutritional support therapy on quality of life (QoL) and functional status in patients with chronic obstructive pulmonary disease (COPD).

Methods

This pre-and post-intervention prospective exploratory study involved 64 patients with stable stage three to four COPD. Oral nutritional support and personalized diet were combined with an intense and comprehensive PR program. Baseline and 8-week follow-up scores were compared for the 6-minute walk test (6MWT), incremental shuttle walking test (ISWT), St. George’s Respiratory Questionnaire (SGRQ), pulmonary function tests (PFT), PImax-PEmax, arterial blood gas (ABG), respiratory rate (RR), handgrip strength, Borg and modified Medical Research Council dyspnoea scale scores and fat-free mass index.

Results

Significant improvements were found in functional status (6MWT: 86.72 m, ISWT: 76.24 m), QoL (SGRQ total: 13.86), PFT, ABG, RR, dyspnoea, upper extremity muscle strength and hand-body composition.

Conclusion

Nutritional support with comprehensive and intensive PR can significantly improve physical performance, QoL, dyspnoea and body composition in COPD. The improvement in QoL was greater than that reported in previous studies. Because two modalities were combined in this study, future randomized controlled studies are needed to confirm the extent and contribution of these modalities to the outcomes.
From the archive: Clarence King’s Mountaineering in the Sierra Nevada (1871 and 1902)
Authors: Butler David R
Published: April 2020

Clarence King’s Mountaineering in the Sierra Nevada, based on exploration and mountaineering exploits undertaken in the 1860s and 1870s, is a somewhat forgotten piece of literature that is worthy of rediscovery. The book provides still-accurate general descriptions of the physical geography of the Sierra Nevada as well as Mount Shasta in the US state of California. This “from the archive” piece examines this book as well as the life and career of its author, Clarence King.
Politics of interconfessional empathy and Schadenfreude in Lebanon
Authors: Ash Konstantin , Dolan Thomas M.
Published: April 2020

We analyze the sources of two politically relevant, yet opposing emotions: empathy and Schadenfreude. We propose that group and individual-level political factors affect empathy and Schadenfreude toward other groups. Using a survey experiment conducted in Lebanon we find that, when presented with a prompt about political repression, respondents are less likely to express empathy and more likely to express Schadenfreude when victims of political repression were from the out-group perceived as their group’s most recent antagonist. At the individual level, those more involved in their in-group’s community are generally more likely to feel Schadenfreude and less likely to express empathy.
Can Bad Be Good? The Attraction of a Darker Self
Authors: Krause Rebecca J. , Rucker Derek D.
Published: April 2020

To avoid threats to the self, people shun comparisons with similar—yet immoral, mentally unstable, or otherwise negatively viewed—others. Despite this prevalent perspective, we consider a contrarian question: Can people be attracted to darker versions of themselves? We propose that with self-threat assuaged, similarity signals self-relevance, which draws people toward those who are similar to them despite negative characteristics. To test this general idea, we explored a prevalent context that may offer a safe haven from self-threat: stories. Using a large-scale proprietary data set from a company with over 232,000 registered users, we demonstrated that people have a preference for villains—unambiguously negative individuals—who are similar to themselves, which suggests that people are attracted to such comparisons in everyday life. Five subsequent lab experiments ( N = 1,685) demonstrated when and why similarity results in attraction toward—rather than repulsion from—negative others.
Design guidelines and optimization of ultra-high-performance fibre-reinforced concrete blast protection wall panels
Authors: Sherif Mohtady , Othman Hesham , Marzouk Hesham , Aoude Hassan
Published: April 2020

Ultra-high-performance fibre-reinforced concrete is the latest generation of structural concrete, having outstanding fresh and hardened properties; this includes the ease of placement and consolidation with ultra-high mechanical properties, as well as toughness, volume stability, durability, higher flexural and tensile strength, and ductility. As more research is being focused on it, the material behaviour and characteristics are getting more understood, and the research demand for the special applications of the ultra-high-performance fibre-reinforced concrete is growing higher. One special application that ultra-high-performance fibre-reinforced concrete is thought to have an outstanding performance at is in the field of protective structures, specifically against blast loads. This article presents part of a study that is concerned with the behaviour and response of ultra-high-performance fibre-reinforced concrete wall panels under blast load. Size and shape optimization techniques were combined in this study to optimize the design of a 200-MPa ultra-high-performance fibre-reinforced concrete under blast loads using finite element modelling. This design optimization aims to maximize stiffness and minimize the cost while satisfying both design stresses and construction requirements. The design variable to be optimized for are the thickness ranging from 100 to 300 mm at 25 mm increments, in addition to the reinforcement ratio of 0%, 0.2%, 1% and 3%, and aspect ratio of 1, 1.5 and 2; the boundary condition is four edges fixed and restrained. The numerical simulation has been performed using an explicate finite element software package. The complete behaviour of an ultra-high-performance fibre-reinforced concrete is defined using the concrete damaged plasticity model. The concrete constitutive model has been developed considering the contribution of tensile hardening response, fracture energy and crack-band width approaches to accurately represent the tensile behaviour and guarantee mesh independence of results. The blast load is applied using the Conventional Weapons method of the US Army Corps of Engineers that is readily available in the finite element software. The validity of the numerical model used is verified by comparing numerical results to experimental data.
Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries
Authors: Griffiths Frances , Watkins Jocelyn Anstey , Huxley Caroline , Harris Bronwyn , Cave Jonathan , Pemba Senga , Chipwaza Beatrice , Lilford Richard , Ajisola Motunrayo , Arvanitis Theodoros N. , Bakibinga Pauline , Billah Muntasir , Choudhury Nazratun , Davies David , Fayehun Olufunke , Kabaria Caroline , Iqbal Romaina , Omigbodun Akinyinka , Owoaje Eme , Rahman Omar , Sartori Jo , Sayani Saleem , Tabani Komal , Yusuf Rita , Sturt Jackie
Published: April 2020

Objective

The poorest populations of the world lack access to quality healthcare. We defined the key components of consulting via mobile technology (mConsulting), explored whether mConsulting can fill gaps in access to quality healthcare for poor and spatially marginalised populations (specifically rural and slum populations) of low- and middle-income countries, and considered the implications of its take-up.

Methods

We utilised realist methodology. First, we undertook a scoping review of mobile health literature and searched for examples of mConsulting. Second, we formed our programme theories and identified potential benefits and hazards for deployment of mConsulting for poor and spatially marginalised populations. Finally, we tested our programme theories against existing frameworks and identified published evidence on how and why these benefits/hazards are likely to accrue.

Results

We identified the components of mConsulting, including their characteristics and range. We discuss the implications of mConsulting for poor and spatially marginalised populations in terms of competent care, user experience, cost, workforce, technology, and the wider health system.

Conclusions

For the many dimensions of mConsulting, how it is structured and deployed will make a difference to the benefits and hazards of its use. There is a lack of evidence of the impact of mConsulting in populations that are poor and spatially marginalised, as most research on mConsulting has been undertaken where quality healthcare exists. We suggest that mConsulting could improve access to quality healthcare for these populations and, with attention to how it is deployed, potential hazards for the populations and wider health system could be mitigated.
Executive Functions and Impulsivity Are Genetically Distinct and Independently Predict Psychopathology: Results From Two Adult Twin Studies
Authors: Friedman Naomi P. , Hatoum Alexander S. , Gustavson Daniel E. , Corley Robin P. , Hewitt John K. , Young Susan E.
Published: April 2020

Laboratory executive function (EF) constructs, such as response inhibition, are often conceptually linked with self-report measures of impulsivity, yet their empirical correlations are low. We examined, in two twin studies ( ns = 749 and 761 individuals with EF data), the phenotypic and genetic overlap of three EF latent variables (a Common EF factor predicting response inhibition, working memory updating, and mental set-shifting tasks and Updating- and Shifting-Specific factors) with five impulsivity dimensions (negative and positive urgency, lack of premeditation and perseverance, and sensation seeking). In both samples, impulsivity dimensions were only modestly correlated phenotypically ( rs = −.20–.11) and genetically ( rAs = −.44–.04) with Common EF. In both samples, Common EF and multiple impulsivity dimensions, particularly negative urgency, independently predicted Externalizing psychopathology, and multiple impulsivity dimensions but not Common EF predicted Internalizing psychopathology. These results suggest that EFs and self-reported impulsivity tap different aspects of control that are both relevant for psychopathology.
Performance of the Patient-Reported Outcome Measurement Information System in Patients With Patellofemoral Instability
Authors: Hajewski Christina J. , Baron Jacqueline E. , Glass Natalie A. , Duchman Kyle R. , Bollier Matthew , Wolf Brian R. , Westermann Robert W.
Published: April 2020

Background:

The Patient-Reported Outcome Measurement Information System (PROMIS) was developed to improve patient-reported outcome measures (PROMs) and administration through a computer adaptive test (CAT). The PROMIS physical function-CAT (PF-CAT) has not been investigated in patients with patellofemoral instability (PFI).

Purpose/Hypothesis:

The purpose of this study was to evaluate the construct validity of the PROMIS PF-CAT with previously validated tools for measuring PROMs in patients with a diagnosis of PFI. We hypothesized that the PF-CAT will have the strongest correlations with other PROMs that evaluated PF as well as moderate correlations with PROMs that measured other health domains.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Patients enrolled in this study who underwent operative intervention for PFI completed the following evaluations preoperatively: PROMIS PF-CAT, 36-Item Short Form Health Survey (SF-36), Knee injury and Osteoarthritis Outcome Score (KOOS), EuroQol-5 dimensions (EQ-5D), and Kujala Anterior Knee Pain Scale (AKPS). Correlation coefficients and the percentage of patients achieving the highest and lowest possible outcome score of each instrument were calculated to assess floor and ceiling effects. Statistical significance was defined as P < .05.

Results:

In total, 91 participants (63.7% females; mean age, 20.1 ± 7.2 years) completed the questionnaires. PF-CAT had the lowest number of questions (4.3 ± 1.1). The strongest correlations were between the PF-CAT and SF-36 PF subscale ( r = 0.78; P < .01), AKPS ( r = 0.68; P < .01), and KOOS Activities of Daily Living subscale ( r = 0.68; P < .01). Correlation was moderate between the PF-CAT and the KOOS subscales of Sports/Recreation ( r = 0.58; P < .01), Quality of Life ( r = 0.53; P < .01), and Symptoms ( r = 0.47; P < .01). The PROMIS PF-CAT demonstrated no floor or ceiling effects.

Conclusion:

In patients with PFI, construct validity of the PROMIS PF-CAT was supported by strong correlations demonstrated between the PF-CAT and PROMs evaluating PF and moderate correlations with those assessing other health domains. Our results demonstrated a low respondent burden and no floor or ceiling effects associated with the PROMIS PF-CAT. The PROMIS PF-CAT may be considered a beneficial alternative to previously established PF PROMs for preoperative evaluation of patients with PFI.
Rolling Back Climate Regulation: Trump’s Assault on the Planet
Authors: Kramer Ronald C.
Published: April 2020

The Donald Trump administration has engaged in a number of crimes related to climate change. This article examines these climate crimes, in particular, the administration’s organized denial of global warming and its political omissions concerning the mitigation of greenhouse gas emissions that result in the rollback of existing regulatory policies related to the climate crisis. This criminality is explored through the lens of the concept of state–corporate crime, a concept utilized by a number of green criminologists to analyze environmental harms. The Trump administration’s rollback of climate change regulations is first located within its historical, political, and social contexts. Then, the specific actions and political omissions that constitute these rollbacks are described and analyzed as state–corporate environmental crimes.
EVI1 and GATA2 misexpression induced by inv(3)(q21q26) contribute to megakaryocyte-lineage skewing and leukemogenesis
Authors: Yamaoka Ayaka , Suzuki Mikiko , Katayama Saori , Orihara Daiki , Engel James Douglas , Yamamoto Masayuki
Published: April 2020

Chromosomal rearrangements between 3q21 and 3q26 elicit high-risk acute myeloid leukemia (AML), which is often associated with elevated platelet and megakaryocyte (Mk) numbers. The 3q rearrangements reposition a GATA2 enhancer near the EVI1 (or MECOM) locus, which results in both EVI1 overexpression and GATA2 haploinsufficiency. However, the mechanisms explaining how the misexpression of these 2 genes individually contribute to leukemogenesis are unknown. To clarify the characteristics of differentiation defects caused by EVI1 and GATA2 misexpression and to identify the cellular origin of leukemic cells, we generated a system to monitor both inv(3) allele-driven EVI1 and Gata2 expression in 3q-rearranged AML model mice. A cell population in which both EVI1 and Gata2 were highly induced appeared in the bone marrows before the onset of frank leukemia. This population had acquired serial colony-forming potential. Because hematopoietic stem/progenitor cells (HSPCs) and Mks were enriched in this peculiar population, we analyzed the independent EVI1 and GATA2 contributions to HSPC and Mk. We found that inv(3)-driven EVI1 promotes accumulation of Mk-biased and myeloid-biased progenitors, Mks, and platelets, and that Gata2 heterozygous deletion enhanced Mk-lineage skewing of EVI1-expressing progenitors. Notably, inv(3)-directed EVI1 expression and Gata2 haploinsufficient expression cooperatively provoke a leukemia characterized by abundant Mks and platelets. These hematological features of the mouse model phenocopy those observed in human 3q AML. On the basis of these results, we conclude that inv(3)-driven EVI1 expression in HSPCs and Mks collaborates with Gata2 haploinsufficiency to provoke Mk-lineage skewing and leukemogenesis with excessive platelets, thus mimicking an important feature of human AML.
Hierarchical Porous Carbon with Interconnected Ordered Pores from Biowaste for High-Performance Supercapacitor Electrodes
Authors: Bai Xiaoxia , Wang Zhe , Luo Jingying , Wu Weiwei , Liang Yanping , Tong Xin , Zhao Zhenhuan
Published: April 2020

Using biowastes as precursors for the preparation of value-added nanomaterials is critical to the sustainable development of devices. Lignosulphonates are the by-products of pulp and paper-making industries and usually discarded as wastes. In the present study, lignosulphonate is used as the precursor to prepare hierarchical ordered porous carbon with interconnected pores for the electrochemical energy storage application. The unique molecular structure and properties of lignosulphonate ensure the acquisition of high-quality porous carbon with a controllable pore structure and improved physical properties. As a result, the as-prepared hierarchical order porous carbon show excellent energy storage performance when used to assemble the symmetric supercapacitor, which exhibits high-specific capacitance of 289 F g−1 at a current density of 0.5 A g−1, with the energy density of 40 Wh kg−1 at the power density of 900 W kg−1. The present study provides a promising strategy for the fabrication of high-performance energy storage devices at low cost.
Combination of Biodata Mining and Computational Modelling in Identification and Characterization of ORF1ab Polyprotein of SARS-CoV-2 Isolated from Oronasopharynx of an Iranian Patient
Authors: Zolfaghari Emameh Reza , Nosrati Hassan , Taheri Ramezan Ali
Published: April 2020

Background

Coronavirus disease 2019 (COVID-19) is an emerging zoonotic viral infection, which was started in Wuhan, China, in December 2019 and transmitted to other countries worldwide as a pandemic outbreak. Iran is one of the top ranked countries in the tables of COVID-19-infected and -mortality cases that make the Iranian patients as the potential targets for diversity of studies including epidemiology, biomedical, biodata, and viral proteins computational modelling studies.

Results

In this study, we applied bioinformatic biodata mining methods to detect CDS and protein sequences of ORF1ab polyprotein of SARS-CoV-2 isolated from oronasopharynx of an Iranian patient. Then through the computational modelling and antigenicity prediction approaches, the identified polyprotein sequence was analyzed. The results revealed that the identified ORF1ab polyprotein belongs to a part of nonstructural protein 1 (nsp1) with the high antigenicity residues in a glycine-proline or hydrophobic amino acid rich domain.

Conclusions

The results revealed that nsp1 as a virulence factor and crucial agent in spreading of the COVID-19 among the society can be a potential target for the future epidemiology, drug, and vaccine studies.
Effects of audio and visual distraction on patients’ vital signs and tolerance during esophagogastroduodenoscopy: a randomized controlled trial
Authors: Sogabe Masahiro , Okahisa Toshiya , Fukuya Akira , Kagemoto Kaizo , Okada Yasuyuki , Adachi Yuka , Kurihara Takeshi , Nii Toru , Teramae Satoshi , Tanaka Hironori , Tomonari Tetsu , Okamoto Koichi , Miyamoto Hiroshi , Nakasono Masahiko , Takayama Tetsuji
Published: April 2020

Background

Esophagogastroduodenoscopy (EGD) provides an indispensable and unambiguous inspection allowing the discovery upper gastrointestinal lesions. However, many patients are anxious about undergoing EGD. Few studies have investigated the influence on patients’ vital signs and tolerance during EGD using subjective and objective assessments. This study was a prospective randomized controlled study that investigated the influence of audio and visual distraction on EGD.

Methods

We randomly divided 289 subjects who underwent EGD into 4 groups (control group, audio group, visual group, combination group) and examined their vital signs, heart rate variability (HRV), psychological items, and acceptance of distraction.

Results

Pulse rate (PR) at post-distraction and post-EGD in the 3 distraction groups were significantly lower than those of control group (p <  0.001 and p <  0.01, respectively). Blood pressure (BP) during and post-EGD was significantly higher than that at pre-EGD in control group (p <  0.05), but no significant elevation of BP was observed during the latter half of EGD and post-EGD in the 3 distraction groups. BP at post-distraction improved significantly compared to pre-distraction in the 3 distraction groups (p <  0.05). There was a significant difference in the low-frequency (LF) power/ high-frequency (HF) power at post-distraction and post-EGD among the 4 groups (p <  0.001 and p <  0.001, respectively). The LF power/HF power at post-distraction and post-EGD in the 3 distraction groups was significantly lower than that in control group (p <  0.05). Several items of profile of mood states (POMS) and the impression of EGD at post-distraction improved significantly compared to those at pre-distraction among the 3 distraction groups (p <  0.05). Visual analog scale (VAS) of willingness for the next use of distraction in the 3 distraction groups was excellent because VAS was more than 70.

Conclusions

Distractions effectively improved psychological factors, vital signs and some of HRV at pre and post-EGD. Distractions may suppress BP elevation during the latter half of EGD and lead to stability of HRV on EGD.

Trial registration

This prospective trial was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000029637. Registered on 20 October 2017.
Clinical pictures, treatments, and resource use of norovirus gastroenteritis in long-term care facilities: a survey with a chart review in Japan
Authors: Fujiki Saori , Ishizaki Tatsuro , Nakayama Takeo
Published: April 2020

Background

Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment and resource use of norovirus gastroenteritis in long-term care facilities.

Methods

Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100).

Results

Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients’ medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50 to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6.

Conclusion

Clinical course was similar to those of norovirus cases examined at other long-term care facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.
Confirmatory factor analysis of adverse childhood experiences (ACEs) among a community-based sample of parents and adolescents
Authors: Afifi Tracie O. , Salmon Samantha , Garcés Isabel , Struck Shannon , Fortier Janique , Taillieu Tamara , Stewart-Tufescu Ashley , Asmundson Gordon J. G. , Sareen Jitender , MacMillan Harriet L.
Published: April 2020

Background

Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health.

Methods

Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models.

Results

The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16–3.25 among parents and 1.12–8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health.

Conclusions

Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).
Can unhealthy food purchases at checkout counters be discouraged by introducing healthier snacks? A real-life experiment in supermarkets in deprived urban areas in the Netherlands
Authors: Huitink Marlijn , Poelman Maartje P. , Seidell Jacob C. , Pleus Milan , Hofkamp Tom , Kuin Carlijn , Dijkstra S. Coosje
Published: April 2020

Background

The checkout area in supermarkets is an unavoidable point of purchase where impulsive food purchases are likely to be made. However, the product assortment at the checkout counters is predominantly unhealthy. The aim of this real life experiment was to investigate if unhealthy food purchases at checkout counters in supermarkets in deprived urban areas in the Netherlands can be discouraged by the introduction of the Healthy Checkout Counter (HCC). In addition, we examined customers’ perceptions towards the HCC.

Methods

The HCC was an initiative of a leading supermarket chain in the Netherlands that consisted of displays with a selection of healthier snacks that were placed at the checkouts. We used a real life quasi-experimental design with 15 intervention and 9 control supermarkets. We also performed a cross-sectional customer evaluation in 3 intervention  supermarkets using oral surveys to investigate customers' perceptions towards the HCC (n=134). The purchases of unhealthy and healthier snacks at checkouts were measured with sales data.

Results

During the intervention period, customers purchased on average 1.7 (SD: 0.08) unhealthy snacks per 100 customers in the intervention supermarket and 1.4 (SD: 0.10) in the control supermarket. Linear regression analyses revealed no statistically significant difference in the change during the control and intervention period of sales of unhealthy snacks between the control and intervention supermarkets (B = − 0.008, 95% CI = − 0.15 to 0.14). The average number of healthier snacks purchased was 0.2 (SD: 0.3) items per 100 customers in the intervention supermarkets during the intervention period. Of the intervention customers, 41% noticed the HCC and 80% of them were satisfied or very satisfied with the intervention.

Conclusions

This real life experiment in supermarkets showed that the placement of healthier snacks at checkouts did not lead to the substitution of unhealthy snack purchases with healthier alternatives. Although supermarket customers positively evaluated the HCC, future studies are needed to investigate other strategies to encourage healthier food purchases in supermarkets.
A case report of Fontan procedure-related hepatocellular carcinoma: pure laparoscopic approach by low and stable pneumoperitoneum
Authors: Yokota Yuki , Noda Takehiro , Kobayashi Shogo , Matsumoto Kenichi , Sakano Yoshihiro , Iwagami Yoshifumi , Tomimaru Yoshito , Akita Hirofumi , Gotoh Kunihito , Umeshita Koji , Doki Yuichiro , Eguchi Hidetoshi
Published: April 2020

Background

The Fontan procedure has become the standard operation for patients with single ventricle physiology. Due to cardiac hypokinesis and high central venous pressure, laparoscopic approach, especially in hepatectomy, was considered as controversial after the Fontan procedure. We presented a case of hepatocellular carcinoma (HCC) that was successfully treated by pure laparoscopic hepatectomy with stable pneumoperitoneum after the Fontan procedure.

Case presentation

An 18-year-old man was referred to our hospital for examination of a hepatic tumor. The patient underwent the Fontan procedure for single ventricle physiology at 6 years of age. Abdominal contrast-enhanced computed tomography (CT) revealed a hypovascular mass in segment 2 and a hypervascular mass in segment 4 of the arterial phase, followed by a delayed washout. CT arteriography revealed that both masses showed hypervascular tumors, and CT during arterial portography showed that both were low-density masses. The patient’s general condition was good, and cardiac and respiratory functions were well maintained. Pure laparoscopic hepatectomy was safely performed by keeping the pneumoteritoneum pressure under 6–8 mmHg and monitoring central venous pressure (11–21 mmHg) and end-tidal carbon dioxide. The Pringle maneuver was applied during hepatic resection. The non-anatomical resections were completed without intraoperative complications. The patient was discharged on the 9th postoperative day without postoperative complications.

Conclusions

Our report suggests that treatment of HCC by pure laparoscopic hepatectomy after Fontan circulation can be safely performed in patients under sufficient circulatory management.
How to recover from a bad start: size at metamorphosis affects growth and survival in a tropical amphibian
Authors: Székely Diana , Cogălniceanu Dan , Székely Paul , Armijos-Ojeda Diego , Espinosa-Mogrovejo Valentina , Denoël Mathieu
Published: April 2020

Background

In species with complex life cycles, size at metamorphosis is a key life-history trait which reflects the complex interactions between costs and benefits of life in the aquatic and terrestrial environments. Whereas the effects of a deteriorating larval habitat (e.g. pond desiccation) on triggering an early metamorphosis have been extensively investigated in amphibians, the consequences of the resulting reduced size at metamorphosis on fitness in the post-metamorphic terrestrial stage remain poorly understood. We tested the hypothesis that a smaller size at metamorphosis negatively affects performance and survival in the ensuing terrestrial stage. Using as model a tropical amphibian (Ceratophrys stolzmanni) showing a large phenotypic plasticity in metamorphosing traits, we evaluated the effects of size at metamorphosis on fitness-related trophic and locomotor performance traits, as well as on growth and survival rates.

Results

Our results support the hypothesis that a larger size at metamorphosis is correlated with better survival and performance. The survival rate of large metamorphosing individuals was 95%, compared to 60% for those completing metamorphosis at a small size. Locomotor performance and gape size were positively correlated with body size, larger animals being more mobile and capable to ingest larger prey. However, smaller individuals achieved higher growth rates, thus reducing the size gap.

Conclusions

Overall, size at metamorphosis affected profoundly the chances of survival in the short term, but smaller surviving individuals partly compensated their initial disadvantages by increasing growth rates.
The policy implementation gap of school oral health programmes in Tshwane, South Africa: a qualitative case study
Authors: Molete Mpho , Stewart Aimee , Bosire Edna , Igumbor Jude
Published: April 2020

Background

School going children across the world continue to experience high levels of untreated dental diseases. The South African Oral Health policy documents present measures to address the oral health needs of children in school settings, yet the burden of oral disease in the country is over 50% among primary school children.

Methods

Our study therefore sought to assess the implementation of school oral health programmes in Tshwane in line with policy recommendations using the Walt & Gilson policy analysis triangle. A qualitative explanatory case study was undertaken using a combination of data from direct observations and interviews. The case analysis involved assessing the processes of providing school oral health programmes that were offered at 10 schools in Tshwane. The measuring tools included process maps and an interview guide.

Results

The results found that policy implementation was affected by poor prior planning, inadequate resources, poor school infrastructure and lack of support from key stakeholders. Furthermore, inconsistencies in policy interpretation by management, coupled with the fact that the oral hygienists were not conversant with the policy hampered delivery of the policy content. The variations in policy implementation observed were often at the discretion of the oral hygienist in response to contextual challenges.

Conclusion

There was policy and practice misalignment and variations in the processes of implementing oral health programmes across the 10 schools. Hence regular monitoring, evaluation and root cause analysis is recommended for such programmes in order to make informed decisions on contextually relevant and standardised programme modifications.
Protocol for a randomised trial testing a community fibrosis assessment service for patients with suspected non-alcoholic fatty liver disease: LOCal assessment and triage evaluation of non-alcoholic fatty liver disease (LOCATE-NAFLD)
Authors: Brain David , O’Beirne James , Hickman Ingrid J. , Powell Elizabeth E. , Valery Patricia C. , Kularatna Sanjeewa , Tulleners Ruth , Farrington Alison , Horsfall Leigh , Barnett Adrian
Published: April 2020

Background

Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease in Australia and its recent increase mirrors the obesity and type 2 diabetes epidemics. Currently, many patients who present to primary care with abnormal liver function tests or steatosis on liver ultrasound are referred for assessment in secondary care. Due to the large number of patients with NAFLD, this results in long waits for clinical and fibrosis assessment, placing unnecessary burden on the public hospital system.

Methods

We will conduct a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD. Participants will be randomised to usual care or the LOCal Assessment and Triage Evaluation (LOCATE) model of care and followed for 1 year. We will recruit patients from the non-neighbouring Sunshine Coast and Metro South Hospital and Health Services (HHSs) in Queensland, Australia. Our primary outcome of interest is time to diagnosis of high-risk NAFLD, based on the number of participants in each arm of the study who receive a diagnosis of clinically significant fibrosis. Two hundred and 34 participants will give us a 95% power to detect a 50% reduction in the primary outcome of time to diagnosis of high-risk disease. We will also conduct an economic evaluation, evaluating the cost-effectiveness of the new model of care. We will also evaluate the implementation of the new model of care.

Discussion

It is anticipated that the results of this study will provide valuable new information regarding the management of NAFLD in the Australian setting. A relatively simple change to care could result in earlier identification of patients with significant liver disease and lower overall costs for the health system. Results will be directly disseminated to key staff for further distribution to consumers, policy- and decision-makers in the form of evidence briefs, plain language summaries and policy recommendations.

Trial registration

The trial was registered on 30 January, 2020 and can be found via ANZCTR - number ACTRN12620000158965.
Economic costs analysis of uncomplicated malaria case management in the Peruvian Amazon
Authors: Moreno-Gutierrez Diamantina , Rosas-Aguirre Angel , Llanos-Cuentas Alejandro , Bilcke Joke , Barboza José Luis , Hayette Marie-Pierre , Contreras-Mancilla Juan , Aguirre Kristhian , Gamboa Dionicia , Rodriguez Hugo , Speybroeck Niko , Beutels Philippe
Published: April 2020

Background

Case management is one of the principal strategies for malaria control. This study aimed to estimate the economic costs of uncomplicated malaria case management and explore the influence of health-seeking behaviours on those costs.

Methods

A knowledge, attitudes and practices (KAP) survey was applied to 680 households of fifteen communities in Mazan-Loreto in March 2017, then a socio-economic survey was conducted in September 2017 among 161 individuals with confirmed uncomplicated malaria in the past 3 months. Total costs per episode were estimated from both provider (Ministry of Health, MoH) and patient perspectives. Direct costs were estimated using a standard costing estimation procedure, while the indirect costs considered the loss of incomes among patients, substitute labourers and companions due to illness in terms of the monthly minimum wage. Sensitivity analysis evaluated the uncertainty of the average cost per episode.

Results

The KAP survey showed that most individuals (79.3%) that had malaria went to a health facility for a diagnosis and treatment, 2.7% received those services from community health workers, and 8% went to a drugstore or were self-treated at home. The average total cost per episode in the Mazan district was US$ 161. The cost from the provider’s perspective was US$ 30.85 per episode while from the patient’s perspective the estimated cost was US$ 131 per episode. The average costs perPlasmodium falciparumepisode (US$ 180) were higher than those perPlasmodium vivaxepisode (US$ 156) due to longer time lost from work by patients withP. falciparuminfections (22.2 days) than by patients withP. vivaxinfections (17.0 days). The delayed malaria diagnosis (after 48 h of the onset of symptoms) was associated with the time lost from work due to illness (adjusted mean ratio 1.8; 95% CI 1.3, 2.6). The average cost per malaria episode was most sensitive to the uncertainty around the lost productivity cost due to malaria.

Conclusions

Despite the provision of free malaria case management by MoH, there is delay in seeking care and the costs of uncomplicated malaria are mainly borne by the families. These costs are not well perceived by the society and the substantial financial impact of the disease can be frequently undervalued in public policy planning.