bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavioral Problems of Pediatric Recovered Patients Infected with COVID-19 in Wuhan, China
Authors: Xiao Han , Liu Qi , Mei Hong , Xue Qi , Cai Xiaonan , Xie Xinyan , Xia Zhiguo , Zhou Yu , Li Hui , Zhu Kaiheng , Wan Zihao , Liu Zhisheng , Song Ranran
Published: August 2020

Background: Coronavirus disease 2019 (COVID-19) is profoundly affecting lives around the globe, and up to now, a large of patients have clinically recovered from their initial illness. As the vulnerable population to adverse events, the effect of the COVID-19 outbreak on pediatric recovered patients are of great concern, but relevant researches are limited. We aimed to investigate the prevalence of behavioral problems among pediatric patients with COVID-19 infection after discharge. Methods: A total of 122 children who were suspected or confirmed COVID-19 cases and hospitalized for treatment were enrolled in the study between April 2020 and May 2020 in Wuhan, China. We collected related information about hospitalization and discharge for the children and emotional symptoms for their parents through electronic medical records and questionnaire. The behavioral problems for children were examined applying the parent-reported the Strengths and Difficulties Questionnaire (SDQ).Results: The participant children were discharged from hospital for about two months. Among them, 76 (62%) were boys, and the mean age were 6.71 years old. The highest prevalence of behavioral problems among pediatric children with COVID-19 was 15% (prosocial behavior), followed by 13% (total difficulties), 11% (emotional symptoms), 10% (hyperactivity), 9% (conduct problems), and 1% (peer problems). With regarding to their parents, 26% of them reported having anxiety symptoms and 23% having depression symptoms. Compared with children without anxious or depressive parents, the scores of SDQ were higher in children whose parents have emotional problems.Conclusions: The long-term follow up studies on the psychological and behavioral problems of children infected with COVID-19 and their parents are warranted.
A Reproductive Health Care program for Surrogate Mothers: A Mixed Methods study
Authors: Goli Marjan , Kohan Shahnaz , Oloonabadi Seiied Mahdi Ahmadi , Farajzadegan Ziba , Heidari Zeinab
Published: August 2020

Background: Surrogacy has become an alternative family formation option for women who are unable to carry a pregnancy. There is no comprehensive care program despite the different nature of this pregnancy. The present study aimed to develop a reproductive health care program for surrogate mothers within the cultural and social context of Iran.Methods: In the present sequential exploratory mixed methods study, first through a qualitative approach surrogate mothers, care providers, and policy makers of reproductive health services were selected purposefully. Data were collected by using the in-depth semi-structured interviews and analyzed. A care program draft was designed by integrating results of the qualitative study and reviewing the literature and guidelines, then appropriateness of each proposed care was assessed by a two- rounds Delphi technique (RAM) and the final reproductive health care program for surrogate mothers was developed.Results: The surrogate mothers' reproductive health needs were summarized in four main categories: surrogate mothers' extra care, educational training, psychological support, and protecting against surrogacy`s social and familial consequences. The reproductive health care program for surrogate mothers were developed in four sections: pre-pregnancy health screenings and legal counseling; special care during embryo transfer until pregnancy confirmation; psychological support and prenatal care of surrogacy until delivery and follow-up postpartum care.Discussion: Women face many challenges in surrogacy and need special cares such as legal counseling, reproductive health care, and psychological support. Implementation of this care program seems to help improve the reproductive health of these mothers.
Deciphering Disparities in Childhood Stunting in an Underdeveloped State in India: an Investigation Applying the Unconditional Quantile Regression Method
Authors: Ghosh Saswata , Sharma Santosh Kumar , Bhattacharya Debarshi
Published: August 2020

BackgroundUnacceptably high rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar. Despite various programmatic interventions, nearly half of the under-five children (numerically about 10 million) are still stunted in this resource-constrained state. Data and MethodsUsing four successive rounds of National Family Health Survey (NFHS) data spread over more than two decades and by employing quantile regressions and counterfactual decomposition (QR-CD), the present study aims to assess effects of various endowments as well as returns to those endowments in disparities in childhood stunting over the period. Results The results show that although child’s height-for-age Z-scores (HAZ) disparity was largely accounted for differing levels of endowments during earlier decade, in the later periods, inadequate access to the benefits from various development programmes was also found responsible for HAZ disparities. Moreover, effects of endowments and their returns vary across quantiles. We argue that apart from equalizing endowments, ensuring adequate access to different nutrition-centric programmes are essential to lessen the burden of childhood stunting. ConclusionThe state must focus on intersectoral convergence of different schemes in the form of state nutrition mission, and, strengthen nutrition-centric policy processes and their political underpinnings to harness better dividend.
Present and Future Suitability of the Lake Tana Biosphere Reserve (LTBR) in Ethiopia for the Nile monitor (Varanus niloticus) using the MaxEnt Mode
Authors: Ejigu Dessalegn , Tassie Nega
Published: August 2020

BackgroundThe Nile monitor (Varanus niloticus) is a reptile native to Sub-Saharan Africa along the Nile River. The species inhabits a wide variety of habitats including woodlands, grasslands, mangroves, and swamps. Although the practice is not common in the Lake Tana Biosphere Reserve (LTBR) , the species is being hunted in Sahelian Africa for its leather, food, pet trade and fat-content. Consequently, the species is listed under the Convention on International Trade in Endangered Species. MethodsData collection was based on original onsite GIS aided presence recording. Each record of the species was first vetted for data quality. A multicollinearity analysis was conducted before fitting the MaxEnt model to the 19 bioclimatic variables. Since it provides good coverage for Africa, the Hadley Global Environment Model 2-Atmosphere Ocean (HadGEM2-AO) model was used for extracting future climate scenarios. The jackknife test was selected to measure the contribution of each environmental variable to the MaxEnt model for the species. Area under the curve of the receiver operating characteristic was used to evaluate the performance of MaxEnt model. Resultson average 2750 individuals were recorded within the LTBR. Mean annual temperature, precipitation and temperature were the most important predictors that limit the potential distribution of V. niloticus. Most of its suitable habitats were mainly predicted in the northern and southern parts of the Lake. The ecological niche model produced an average AUC of 0.85. Notable records of the species were found in the vicinity of the lake and wetlands nearby. Future projection of potential suitable areas revealed that the currently available suitable area will decline in both 2050 and 2070 under both RCP 6.5 and RCP 8.5, of which the decline in suitable area under the business as usual scenario is the greatest. ConclusionsThe potential distribution map for V. niloticus can help in planning land use management around its existing habitat range, discover new populations or set priorities to restore its natural habitat for more effective conservation. Extensive reductions in the amount of suitable areas under future climate scenarios suggest that the species may become threatened in future if effective conservation measures are not implemented.
Analysis of Peripherally Inserted Central Catheter-Related Complications and Causes: a Retrospective Study of 2974 Children Blood Disease Patients in Single Center in China
Authors: Chang Li-Xian , Chen Yu-Wen , Wang Meng-Chuan , Zhao Su-Yu , Wang Min , Tian Yang , Tang Li , Wang Jun-Xia , Yang Miao-Miao , Zhu Xiao-Fan , Zhang Hui-Min
Published: August 2020

Background: The peripherally inserted central catheter (PICC) has been widely used. However, there is still a lack of large sample size-based relevant risk factor investigation in children with blood diseases in china. Methods: We performed a retrospective, the single-center cohort study of child blood disease patients with PICC insertion. Totally, 2974 patients were enrolled for our study. Results: B-ultrasound plus Seldinger technology significantly improved the success rate of PICC insertion. The most common non-infectious complications were rash, followed by catheter blockage, mechanical phlebitis, and catheter broke. the male, 1-3 years old, Power PICC solo catheter and spring are risk factors for the rash. The power PICC solo catheter was the most important risk factor for catheter blockage. Insertion site under the elbow was the most important risk factor for phlebitis and catheter damage. Conclusion: Our finding first shed new light on the risk factors associated with PICC complications for Chinese blood disease children.
Empowering Traditional Birth Attendants as Agents of Maternal and Neonatal Immunization Uptake in a Developing Country: a Repeated Measures Design.
Authors: IWU Chinedu Anthony , Uwakwe Kenechi , Oluoha Uchechukwu Raphael , Duru chukwuma , NWAIGBO ERNEST
Published: August 2020

Background: Adequate immunization coverage in rural communities remain a challenge. Traditional birth attendants (TBAs) form an integral part of the social, cultural and religious fabric in most rural communities in Nigeria. Despite their limitations in handling the complications of childbirth, TBAs are widely accepted and patronized, especially in rural areas. The objectives of the project were to empower TBAs and assess the use of a culturally adapted audio-visual workshop intervention to change their knowledge, attitude and willingness to promote immunization uptake. Methods: A repeated-measures design that used a convenience sampling technique to select 90 TBAs from the three geopolitical zones of Imo State, Nigeria. The TBAs were engaged through a culturally adapted audio-visual workshop. Data were collected pre and post intervention using a pretested questionnaire. Chi square test was done to determine any significant association with the zone of practice and paired sample t-test analysis to determine any significant pre and post intervention change. Level of significance was set at p ≤ ·05.Results: More than half of the TBAs had at most, a secondary level of education (54·4 %). The average length of time they practiced as TBAs was 16 years with an average of ten birth deliveries per month. After the intervention, all the respondents (100%) reported a willingness to always promote immunization uptake and also, there was a statistically significant increase in Knowledge (p<·000). Similarly, the level of knowledge in the post intervention period appeared to be significantly associated with the zone of practice (p= ·027). Conclusion: The workshop intervention empowered the TBAs irrespective of their zones of residence by successfully improving their knowledge, though at varying levels; and consequently, their willingness to always promote immunization uptake.
Molecular Characteristics of Rotavirus Genotypes Circulating in the South of Benin, 2016-2018
Authors: Agbla Jijoho Michel , Esona Mathew D , Agbankpé Alidéhou Jerrold , Capo-Chichi Annick , Gautam Rashi , Dougnon Tamègnon Victorien , Razack Osseni , Bowen Michael D , Bankolé Honoré Sourou
Published: August 2020

ObjectiveRotavirus remains the main causative agent of gastroenteritis in young children in countries that have not yet introduced the vaccine. In Benin, rotavirus vaccine was introduced late December 2019 into the EPI. This study aims to provide pre-vaccination era rotavirus genotyping data in Benin. These data can supplement data from the surveillance system of Ministry of Health of Benin which is supported by the World Health Organization (WHO). ResultsOf the 420 diarrheal stool samples, actively collected in southern Benin from July 2016 through November 2018 from children under five years old and suffering from gastroenteritis, 167 (39.8%) samples were rotavirus EIA positive. 186 (44.3%) samples contained amplifiable rotavirus RNA detected by qRT-PCR method and were genotyped using one-step RT-PCR multiplex genotyping method. G1P[8] represents the predominant genotype (32%) followed by the G2P[4] (26%), G3P[6] (16%), G12P[8] (13%) and mixed G and P types (1%). Four samples (2%) could not be assigned both G and P type speciﬁcity.
The German Corona Consensus Dataset (GECCO): A standardized dataset for COVID-19 research
Authors: Thun Sylvia , Sass Julian , Bartschke Alexander , Lehne Moritz , Essenwanger Andrea , Rinaldi Eugenia , Rudolph Stefanie , Heitmann Kai U. , Vehreschild Jörg J. , von Kalle Christof
Published: August 2020

Background: The current COVID-19 pandemic has led to a surge of research activity. While this research provides important insights, the multitude of studies results in an increasing segmentation of information. To ensure comparability across projects and institutions, standard datasets are needed. Here, we introduce the “German Corona Consensus Dataset” (GECCO), a uniform dataset that uses international terminologies and health IT standards to improve interoperability of COVID-19 data.Methods: Based on previous work (e.g., the ISARIC-WHO COVID-19 case report form) and in coordination with experts from university hospitals, professional associations and research initiatives, data elements relevant for COVID-19 research were collected, prioritized and consolidated into a compact core dataset. The dataset was mapped to international terminologies, and the Fast Healthcare Interoperability Resources (FHIR) standard was used to define interoperable, machine-readable data formats.Results: A core dataset consisting of 81 data elements with 281 response options was defined, including information about, for example, demography, anamnesis, symptoms, therapy, medications or laboratory values of COVID-19 patients. Data elements and response options were mapped to SNOMED CT, LOINC, UCUM, ICD-10-GM and ATC, and FHIR profiles for interoperable data exchange were defined.Conclusion: GECCO provides a compact, interoperable dataset that can help to make COVID-19 research data more comparable across studies and institutions. The dataset will be further refined in the future by adding domain-specific extension modules for more specialized use cases.
Paternal and Maternal Support on Children's Weekday and Weekend Moderate-to-vigorous Physical Activity: a Cross-sectional Study
Authors: An Meijing , Chen Tianjiao , Zhou Qianling , Ma Jun
Published: August 2020

Background: Most studies about parental support behaviors for physical activity (PA) on children’s moderate-to-vigorous intensity physical activity (MVPA) were conducted in developed countries, and most of them focused on mother’s or parent’s (with no differentiation between father’s or mother’s) support behaviors. Besides, children’s MVPA time interval was not differentiated adequately. This paper aimed at investigating the associations between paternal and maternal support behaviors for PA, and children’s MVPA on weekdays, weekends and the whole week in China.Methods: Cross-sectional data of 517 father-child dyads and 1,422 mother-child dyads were analyzed. Children’s consecutive 7-day PA diary were recorded to assess their MVPA time, and MVPA time on weekdays, weekends and the whole week were further calculated, respectively. Father or mother completed a questionnaire on their support behaviors for children’s PA. Multivariate logistic regression was conducted to investigate the independent effect of paternal and maternal support behaviors for PA on children’s meeting MVPA recommendation on weekdays, weekends and the whole week, respectively.Results: The proportion of children’s meeting MVPA recommendation on weekends (37.8%) was significantly lower than that on weekdays (62.8%). Higher paternal (OR[95%CI]:1.098[1.009,1.195]) and maternal (OR[95%CI]:1.076[1.021,1.134]) total scores of support behaviors for PA were associated with children’s higher odds of meeting MVPA recommendation on weekends, after controlling for covariates. Paternal sharing PA knowledge with child was significantly associated with children’s meeting MVPA recommendation on weekends (OR[95%CI]:1.319[1.055,1.649]), and marginally associated with children’s meeting MVPA recommendation on weekdays (OR[95%CI]:1.220[0.974,1.528], P=0.084) and on the whole week (OR[95%CI]:1.218[0.977,1.519], P=0.080). Maternal reserving PA time for child was associated with children’s higher likelihood of meeting MVPA recommendation on weekdays (OR[95%CI]:1.160[1.025,1.313]), weekends (OR[95%CI]:1.241[1.097,1.403]) and the whole week (OR[95%CI]:1.214[1.076,1.369]), respectively.Conclusions: On weekends, paternal and maternal total support behaviors for PA deserves more practices for promoting children’s MVPA. To promote children’s MVPA on weekdays, weekends and the whole week, father’s sharing PA knowledge with child and mother’s reserving PA time for child are recommended. Longitudinal researches are needed to verify the effect of paternal and maternal support behaviors on children’s MVPA.
Association Between Caregivers’ Knowledge and Perceptions and Whether their Children Complete Tuberculosis Preventive Treatment
Authors: Zeladita Jhon Alex , Yuen Courtney M. , Zegarra-Chapoñan Roberto , Curisinche-Rojas Maricela , Egusquiza-Pozo Vicente
Published: August 2020

Background: Giving preventive therapy to children living in the households of TB patients to prevent them from developing TB themselves is important for reducing morbidity and mortality in this high-risk group. Children’s adherence to medications is likely dependent on their caregivers. We conducted a study to assess the association between caregivers’ knowledge and perceptions around isoniazid preventive therapy (IPT) and whether their children completed IPT. Methods: We conducted a retrospective medical record review of children who initiated IPT during 2017-2018 in 50 health facilities in south Lima, Peru. We administered structured surveys to caregivers of the children and about their knowledge and perceptions around IPT. To determine factors associated with IPT completion, we used a modified Poisson regression with generalized estimating equations to account for clustering by household. Results: We included in the study 550 children, of whom 31% did not complete IPT. Independent factors associated with not completing IPT were: low caregiver knowledge about TB and IPT (adjusted risk ratio [aRR]: 1.41; 95% confidence interval [CI]: 1.06-1.78), low caregiver perception of the importance of IPT (aRR: 1.76; 95% CI: 1.30-2.39), low caregiver satisfaction with the health services (aRR: 1.57; 95% CI: 1.14-2.16), experiencing adverse events (aRR: 2.08; 95% CI: 1.51-2.87), and living in a household with moderate or severe family dysfunction (aRR: 1.53; 95% CI: 1.07-2.19). Conclusions: IPT completion among children was associated with the knowledge and perceptions of their caregivers, as well as whether they experienced adverse events. To improve IPT completion among children, health care providers should prioritize education and counseling for caregivers, promote positive interpersonal relationships with them, and monitor adverse events.
Altered Striatal Dopamine Levels in Parkinson’s Disease VPS35 D620N Mutant Transgenic Aged Mice
Authors: Vanan Sarivin , Zeng Xiaoxia , Chia Sook Yoong , Varnäs Katarina , Ke Zhang , Mei Jiang , Padmanabhan Parasuraman , Yu Wei-Ping , Zhou Zhi-Dong , Halldin Christer , Gulyás Balázs , Tan Eng-King , Li Zeng
Published: August 2020

Vacuolar protein sorting 35 (VPS35) is a major component of the retromer complex that mediates the retrograde transport of cargo proteins from endosomes to the trans-Golgi network. Mutations such as D620N in the VPS35 gene have been identified in patients with autosomal dominant Parkinson’s disease (PD). However, it remains poorly understood whether and how VPS35 deficiency or mutation contributes to PD pathogenesis; specifically, the studies that have examined VPS35 thus far have differed in results and methodologies. We generated a VPS35 D620N mouse model using a Rosa26-based transgene expression platform to allow expression in a spatial manner, so as to better address these discrepancies. Here, aged (20-months-old) mice were first subjected to behavioral tests. Subsequently, DAB staining analysis of substantia nigra (SN) dopaminergic neurons with the marker for tyrosine hydroxylase (TH) was performed. Next, HPLC was used to determine dopamine levels, along with levels of its two metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), in the striatum. Western blotting was also performed to study the levels of key proteins associated with PD. Lastly, autoradiography (ARG) evaluation of [3H]FE-PE2I binding to the striatal dopamine transporter DAT was carried out. We found that VPS35 D620N Tg mice displayed a significantly higher dopamine level than NTg counterparts. All results were then compared with that of current VPS35 studies to shed light on the disease pathogenesis. Our model allows future studies to explicitly control spatial expression of the transgene which would generate a more reliable PD phenotype.
Consolidated Bioprocessing of Cellulose to Itaconic Acid by a Co-Culture of Trichoderma Reesei and Ustilago Maydis.
Authors: Schlembach Ivan , Tehrani Hamed , Blank Lars Mathias , Büchs Jochen , Wierckx Nick , Regestein Lars , Rosenbaum Miriam
Published: August 2020

Background: Itaconic acid is a bio-derived platform chemical with uses ranging from polymer synthesis to biofuel production. The efficient conversion of cellulosic waste streams into itaconic acid could thus enable the sustainable production of a variety of substitutes for fossil oil based products. However, the realization of such a process is currently hindered by an expensive conversion of cellulose into fermentable sugars. Here, we present the stepwise development of a fully consolidated bioprocess (CBP), which is capable to directly convert recalcitrant cellulose into itaconic acid without the need for separate cellulose hydrolysis including the application of commercial cellulases. The process is based on a synthetic microbial consortium of the cellulase producer Trichoderma reesei and the itaconic acid producing yeast Ustilago maydis. Results: The efficiency of the process was compared to a simultaneous hydrolysis and fermentation setup (SSF). Because of the additional substrate consumption of T. reesei in the CBP, the itaconic acid yield was significantly lower in the CBP than in the SSF. In order to increase yield and productivity of itaconic acid in the CBP, the population dynamics was manipulated by varying the inoculation delay between T. reesei and U. maydis. Surprisingly, neither inoculation delay nor inoculation density significantly affected the population development or the CBP performance. Instead, the substrate availability was the most important parameter. U. maydis was only able to grow and to produce itaconic acid when the cellulose concentration and thus, the sugar supply rate, was high. Finally, the metabolic processes during fed-batch CBP were analyzed in depth by online respiration measurements. A method was developed to estimate cellulose consumption, itaconic acid formation as well as the actual itaconic acid production yield online. Again, substrate availability was the key factor also controlling itaconic acid yield. In summary, an itaconic acid titer of 34 g/L with a total productivity of up to 0.07 g/L/h and a yield of 0.16 g/g could be reached during fed-batch cultivation. Conclusion: This study demonstrates the feasibility of consortium based CBP for itaconic acid production and also lays the fundament for the development and improvement of similar microbial consortia for cellulose based organic acid production.
Assessing the evidence on the differential impact of menthol versus non-menthol cigarette use on smoking cessation: A systematic review
Authors: Kim Mimi , Curtin Geoffrey
Published: August 2020

Background: This systematic review followed PRISMA guidelines to examine the Key Question: Does menthol cigarette use have a differential impact on smoking cessation compared with non-menthol cigarette use?Methods: The original protocol was registered on March 22, 2016 (updated January 10, 2019; PROSPERO: CRD42019119301). Six databases were queried from inception to December 14, 2018.Results: Fifty-seven studies (27 rated “good”, 27 rated as “fair”, and three studies rated as “poor” individual study quality) that compared menthol and non-menthol smokers were qualitatively synthesized across the following cessation measures (total adjusted studies; strength of evidence grade): duration of abstinence (2; low); quit attempts (14; insufficient); rate of abstinence/quitting (28; moderate); change in smoking quantity/frequency (3; insufficient); and return to smoking/relapse (2; insufficient). Overall, the qualitative synthesis failed to show a consistent trend for the association of menthol cigarette use and smoking cessation across the outcomes. Further, meta-analytic results found no difference between menthol and non-menthol cigarette use and the two measures of quit attempts and duration of abstinence.Implications: The overall strength of evidence for an association between menthol cigarette use and smoking cessation was graded as “low”, based on deficiencies of indirectness and inconsistency in the available body of evidence. Therefore, there is no consistent, significant, or differential association between menthol cigarette use and smoking cessation.
Alectinib Treatment Improves Photodynamic Therapy in Cancer Cell Lines of Different Origin
Authors: Gillissen Bernhard , Richter Antje , Kemmner Wolfgang
Published: August 2020

Background: Photodynamic therapy with a photosensitizer such as protoporphyrin-IX, a light sensitive metabolite of heme synthesis, is a highly selective treatment for various carcinomas. In previous studies, we found a significant down regulation of the relevant enzyme ferrochelatase in gastrointestinal carcinomas leading to an accumulation of protoporphyrin-IX within the tumor cells. Recent studies showed that a novel anti-cancer drug, Alectinib, an orally available, highly selective, potent second-generation inhibitor of anaplastic lymphoma tyrosinkinase binds to ferrochelatase. Therefore, we were interested to see whether Alectinib treatment might lead to an accumulation of protoporphyrin IX. Methods : Tumor cells of different origin were cultured, treated with LED-light and Alectinib. Results were gained by flow cytochemistry, immunohistochemistry and western blotting. Apoptosis was determined by flow cytometric analysis of Annexin V-FITC stained cells. In addition, cells were counterstained with propidium iodide (PI) to distinguish early apoptotic cells (Annexin V-positive/PI-negative) and late apoptosis/necroptotic cells.Results: Here, we report that photodynamic treatment of tumor cell lines of different origin in combination with Alectinib increased protoporphyrin-IX specific fluorescence and concomitantly cell death. Conclusions: The usage of Alectinib might be a crucial step for enhancing the effectiveness of photodynamic therapy. Further experiments will show whether photodynamic therapy in combination with Alectinib could be a new strategy for the treatment of e.g. peritoneal disseminated carcinomas.
Relationship between the Severity of Endometriosis Symptoms (Dyspareunia, Dysmenorrhea and Chronic pelvic pain) with the Spread of the Disease on Ultrasound
Authors: Kor Elham , Mostafavi Seyed Reza Saadat , Mazhin Zahra Ahmadian , Dadkhah Adeleh , Kor Anis , Habibi Shirin , Noroozi Shima Ghafourian , Sadri Ghazal
Published: August 2020

Objectives
The prevalence of endometriosis among women of childbearing age is about 10–15%. Although many patients with endometriosis do not have any symptoms, they may suffer from dysmenorrhea, dyspareunia, and chronic pelvic pain. our aim of this study is to investigate the relationship between the severity of symptoms of endometriosis with the spread of disease on ultrasonography as well as the stage of the disease.
Results
Regarding the various analyzes were performed, the cumulative size of posterior DIE less than 1 cm significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more in patients with complete stenosis of Douglas pouch comparing with cases with incomplete Douglas pouch stenosis. The incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than patients without stenosis. This study demonstrated only dyspareunia is related to the stage of endometriosis and patients with dyspareunia are 5 times more at risk of a higher stage of the disease.
Association between Afterhours Discharge from the Intensive Care Unit and Hospital Mortality: A Multi-Centre Retrospective Cohort Study
Authors: Hall Adam , Wang Xioaming , Zuege Danny J , Opgenorth Dawn , Scales Damon C , Stelfox Henry T , Bagshaw Sean M
Published: August 2020

Background: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. Methods: We performed a multi-centre retrospective cohort study of 10,463 adults discharged from nine mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a two-stage modelling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. Results: Of 10,463 patients, 23.7% (n=2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. Greater SOFA score in the 72 hours prior to discharge was not associated with afterhours discharge; however, was associated with hospital mortality (adjusted-OR 1.23; 95%CI,1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR 1.19; 95%CI, 1.01-1.39), increased hospital stay (adjusted-OR 1.10; 95%CI,1.09-1.11) and increased post-ICU stay (adjusted-OR 1.16; 95%CI,1.14-1.17).Conclusions: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.
The Associations of Active Travel to School with Physical Activity and Screen Time Among Adolescents: Do Individual and Parental Characteristics Matter?
Authors: Huang Caihong , Memon Aamir Raoof , Liang Chaomei , Hong Jin-Tao , Lin Youliang , Chen Si-Tong
Published: August 2020

Background: Little is known about the relationship of active travel to school (ATS) with physical activity (PA) and screen time (ST) by individual and parental characteristics among adolescents, especially in China. To address the research gap, this study aimed to explore the difference of sex, age, geographical location, parental occupation and education level in the relationship of ATS with PA and ST among students of grades 7-12 using cross-sectional data.Methods: In 13 cities of Hubei province, China, students from 39 public schools were recruited to engage in the survey. In total, 5898 students (response rate = 89.6%) were invited into this study. Participants were required to report their ATS (including its types), PA and ST as well as sociodemographic information using validated questionnaire. Descriptive analyses were used to report the information of all variables. Regression models were used to analyze the relationships of ATS and its types with PA and ST.Results: In a total of 4128 participants (boy: 50.9%; younger adolescents: 61.9%) included in the final analysis, the proportion of those with ATS was 47.3%. Regarding the types of ATS, walking accounted for over 30%, while cycling was 13.2%. Participants with ATS were more likely to have sufficient PA (OR = 1.26, 95% CI: 1.14-1.39), especially among boys, younger adolescents and those with lower parental education level. However, ATS was not associated with ST (OR = 0.94, 95% CI: 0.86-1.01). Participants with cycling had higher odds ratio of being physically active (OR for cycling = 1.47, 95% CI: 1.27-1.70; OR for walking = 1.18, 95% CI: 1.06-1.32). The association of ATS types with PA and ST differed by gender, age, geographical location and parental educational level as well as occupations.Conclusions: ATS may be a useful approach to increase PA among adolescents, but this should be explained by individual and parental characteristics.
Comparison of deep learning with regression analysis in creating predictive models for SARS-CoV-2 outcomes
Authors: Abdulaal Ahmed , Patel Aatish , Charani Esmita , Denny Sarah , Alqahtani Saleh , Davies Gary W , Mughal Nabeela , Moore Luke SP
Published: August 2020

Background Accurately predicting patient outcomes in Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could aid patient management and allocation of healthcare resources. There are a variety of methods which can be used to develop prognostic models, ranging from logistic regression and survival analysis to more complex machine learning algorithms and deep learning. Despite several models having been created for SARS-CoV-2, most of these have been found to be highly susceptible to bias. We aimed to develop and compare two separate predictive models for death during admission with SARS-CoV-2.MethodBetween March 1 - April 24, 2020, 398 patients were identified with laboratory confirmed SARS-CoV-2 in a London teaching hospital. Data from electronic health records were extracted and used to create two predictive models using: 1) a Cox regression model and 2) an artificial neural network (ANN). Model performance profiles were assessed by validation, discrimination, and calibration.Results Both the Cox regression and ANN models achieved high accuracy (83.8%, 95% confidence interval (CI): 73.8 - 91.1 and 90.0%, 95% CI: 81.2 - 95.6, respectively). The area under the receiver operator curve (AUROC) for the ANN (92.6%, 95% CI: 91.1 - 94.1) was significantly greater than that of the Cox regression model (86.9%, 95% CI: 85.7 - 88.2), p=0.0136. Both models achieved acceptable calibration with Brier scores of 0.13 and 0.11 for the Cox model and ANN, respectively. ConclusionWe demonstrate an ANN which is non-inferior to a Cox regression model but with potential for further development such that it can learn as new data becomes available. Deep learning techniques are particularly suited to complex datasets with non-linear solutions, which make them appropriate for use in conditions with a paucity of prior knowledge. Accurate prognostic models for SARS-CoV-2 can provide benefits at the patient, departmental and organisational level.
Knowledge of PEP and PrEP Among People Living with HIV/aids in Brazil
Authors: Sousa Laelson Rochelle Milanês , Elias Henrique Ciabotti , Fernandes Nilo Martinez , Gir Elucir , Reis Renata Karina
Published: August 2020

Background:The objective was to analyze the factors associated with knowledge of PrEP and PEP among people living with HIV/aids in Brazil. Cross-sectional analytical study carried out among people living with HIV/aids treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil.Methods:Logistic regression analysis was used to assess the influence of independent variables on dependent variables: having knowledge about PrEP and PEP. Of the 397 participants, 140 (35.26%) were heterosexual women, aged 40 to 49 years (36.27%).Results: Participants with less than 11 years of study (adjusted odds: 0.2903; 95% CI: 0.1340-0.6007); who did not have a low viral load or did not know how to report viral load (adjusted odds: 0.2931; 95% CI: 0.0961-0.8398) and those with casual partners (adjusted odds: 0.2931; 95% CI: 0.0961- 0.8398) were less likely to have knowledge about the PrEP. MSM (adjusted odds: 2.8788; 95% CI: 1.5912-5.3092) and those who used alcohol during sexual intercourse (adjusted odds: 1.7305; 95% CI: 1.0656-2.8248) were more likely to have knowledge about the PEP.Conclusions: Awareness about PrEP and PEP should be widely disseminated by health promoting institutions in order to expand knowledge of these two methods.
New Family of Ionic Supersalts with Covalent-like Directionality and Unconventional Multiferroicity
Authors: Gao Yaxin , Wu Menghao , Jena Puru
Published: August 2020

Ionic crystals composed of elemental ions such as NaCl are centro-symmetric and, thus, non-polar due to directionless ionic bonding interactions. To develop polar materials, the directionality feature of covalent bonding is necessary. Here, we propose a novel way where ionically bonded crystals can develop polarity by changing their building blocks from elemental ions to cluster-ions. Superalkalis and superhalogens are clusters which mimic the chemistry of alkali and halogen atoms. Equally important, unlike the elemental ions, the geometries of these superions are not spherical. Endowed with these unique features, ionic supersalts form anisotropic polar structures with ionic bonding, yet covalent-like directionality, akin to sp3 hybridized systems. Using density functional theory and extensive structure searches, we predict a series of stable supersalts, PnH4MX4 (Pn = N, P; M = B, Al, Fe; X = Cl, Br) composed of superalkali PnH4 and superhalogen MX4 ions with unprecedented properties: (1) ferroelectricity with ultra-long ion displacements (~ 3 Å); (2) ferroelasticity with ultra-large reversible strain (> 40%); and (3) both with ultra-low switching barriers (about 6 to 13 meV/atom). These values are inconceivable in traditional ferroelectric/ferroelastic materials owing to their brittle covalent nature. Coupling of ferroelectricity with ferroelasticity can further enable strain-controlled polarization as well as electrically-controlled strain. In particular, PnH4FeX4 exhibits triferroic coupling of ferroelectricity, ferroelasticity, and antiferromagnetism where the spin directions can be altered via either ferroelastic or 90-degree ferroelectric switching. These ionic supersalts can be synthesized using facile solution-processed fabrication by exothermic reactions, MPn + 4HX→PnH4MX4 or PnH4X + MX3→PnH4MX4, which may open a new chapter in multiferroics.
Understanding Demand for, and Feasibility of, Centre-based Child-care for Poor Urban Households: A Mixed Methods Study in Dhaka, Bangladesh.
Authors: Elsey Helen , Fieroze Fariza , Shawon Riffat , Nasreen Shammi , Hicks Joseph Paul , Das Mahua , Huque Rumana , Hirano Izumi , Wallace Hilary , Mashreky Saidur
Published: August 2020

Background: Centre-based child-care has potential to provide multiple health and development benefits to children, families and societies. With rapid urbanisation, increasing numbers of low-income women work with reduced support from extended family, leaving a child-care vacuum in many low- and middle-income countries. We aimed to understand perceptions of, and demand for, centre-based child-care in Dhaka, Bangladesh among poor, urban households, and test the feasibility of delivering sustainable centre-based child-care. Methods: We used sequential mixed methods including a household survey (n=222) and qualitative interviews with care-givers (n=16), community leaders (n=5) and policy-makers (n=5). We co-produced and piloted a centre-based child-care model over ten-months, documenting implementation. A co-design focus group with mothers, parents’ meetings, and qualitative interviews with child-care centre users (n=5), non-users (n=3), ex-users (n=3) and staff (2) were used to refine the model and identify implementation issues. Results: We found 24% (95% CI: 16%,37%) of care-givers reported turning-down paid work due to lack of child-care and 84% (95% CI:74%, 91%) reported wishing to use centre-based child-care and were willing to pay up to 283 Takka (~$3.30) per month. Adjusted odds of reported need for child-care among slum households were 3.8 times those of non-slum households (95% CI: 1.4, 10). Implementation highlighted that poor households needed free child-care with food provided, presenting feasibility challenges. Meta-inference across quantitative and qualitative findings identified the impact of urban environment on child-care through long working hours, low social capital and fears for child safety. These influences interacted with religious and social norms resulting in caution in using centre-based child-care despite evident need.Conclusion: sustainable provision of centre-based care that focuses on early childhood development requires subsidy and careful design sensitive to the working lives of poor families, particularly women and must respond to the dynamics of the urban environment and community values.
Evaluating performance of health care facilities at meeting HIV-indicator reporting requirements in Kenya: An application of K-means clustering algorithm
Authors: Gesicho Milka , Babic Ankica , Were Martin
Published: August 2020

Introduction: The ability to report complete, accurate and timely data by HIV care providers and other entities is a key aspect in monitoring trends in HIV prevention, treatment and care, hence contributing to its eradication. In many low-middle-income-countries (LMICs), aggregate HIV data reporting is done through the District Health Information Software 2 (DHIS2). Nevertheless, despite a long-standing requirement to report HIV indicator data to DHIS2 in LMICs, few rigorous evaluations exist to evaluate adequacy of health facility reporting at meeting completeness and timeliness requirements over time. In this study, we report on a comprehensive assessment of the reporting status for HIV indicators, from the time of DHIS2 implementation, using Kenya as a case example.Methods: A retrospective observational study was conducted to assess reporting performance of health facilities providing any of the HIV services in all 47 counties in Kenya between 2011 to 2018. Using data extracted from DHIS2, K-means clustering algorithm was used to identify homogeneous groups of health facilities based on their performance in meeting timeliness and completeness reporting requirements for each of the six programmatic areas. Average silhouette coefficient was used in measuring the quality of the selected clusters.Results: Based on percentage average facility reporting completeness and timeliness, four homogeneous groups of facilities were identified namely: best performers, average performers, poor performers and outlier performers. Apart from blood safety reports, a distinct pattern was observed in five of the remaining reports, with the proportion of best performing facilities increasing and the proportion of poor performing facilities decreasing over time. However, between 2016 and 2018, the proportion of best performers declined in some of the programmatic areas. Over the study period, no distinct pattern or trend in proportion changes was observed among facilities in the average and outlier groups.Conclusion: The identified clusters revealed general improvements in reporting performance in the various reporting areas over time, but with noticeable decrease in some areas between 2016 and 2018. This signifies the need for continuous performance monitoring with possible integration of machine learning and visualization approaches into national HIV reporting systems.
A Systematic Review and Meta-Analysis of Nab-Paclitaxel Mono-Chemotherapy for Metastatic Breast Cancer.
Authors: Lu Haili , Zha Siluo , Zhang Wei , Wang Qiang , Jiang Daozhen , Xu Xinyun , Zheng Xiangmin , Qiu Ming , Shan Chengxiang
Published: August 2020

Background: Various clinical trials and real-life studies have tried to explore the value of nab-paclitaxel mono-chemotherapy for metastatic breast cancer (MBC). The safety and efficacy of nab-paclitaxel needs to be systematically evaluated. Methods : Electronic searches for prospective clinical trials containing nab-paclitaxel monotherapy for MBC were performed. Requisite data were extracted, integrated and analyzed from the included studies according to different purposes using systematic review and meta-analysis.Results: 22 studies with 3287 MBC patients were included. 1685 MBC patients received nab-paclitaxel as first-line therapy, 640 patients as further-line therapy, and 962 patients as mixed-line therapy. 1966 MBC patients (60.40%) received nab-paclitaxel weekly, while 1190 patients (36.56%) received nab-paclitaxel triweekly and 99 patients (3.04%) biweekly. The overall incidence of all grades neutropenia, leukopenia, peripheral sensory neuropathy, and fatigue was 52% (95% CI, 38%-66%), 58% (95% CI, 43%-73%), 58% (95% CI, 48%-68%), and 49% (95% CI, 41%-56%) respectively. The overall response rate (ORR) was 40% (95% CI, 35%-45%) and the clinical benefit rate (CBR) was 66% (95% CI, 59%-73%) following nab-paclitaxel monotherapy. The median progression free survival (PFS) was 7.64 months (95% CI, 6.89-8.40 months) and the median overall survival (OS) was 24.51 months (95% CI, 21.25-27.78 months). According to the meta-regression analysis, grade 3/4 neutropenia occurred less frequently in Her-2 negative patients compared with all population (P=0.046). Patients who received first-line nab-paclitaxel monotherapy showed higher ORR (P=0.006) and longer PFS (P=0.045). Patients who received further-line therapy was demonstrated to have shorter median OS versus first- and mixed-line therapy. Efficacy outcomes were not affected by the administration schedule. However, patients appeared to have more superior ORR (P=0.044) and longer PFS (P=0.03) along with the increasing dosage of nab-paclitaxel under the same schedule. Conclusions: Both weekly and triweekly nab-paclitaxel mono-chemotherapy were proved to be effective for MBC with generally reasonable toxicity profiles. Higher ORR, longer PFS and OS would be achieved in patients treated with nab-paclitaxel as first line. Increasing nab-paclitaxel dosage would result in better tumor control (higher ORR and PFS). Changing nab-paclitaxel schedule had no benefit on ameliorating the overall survival.