bluuebunny/crossref_metadata_2025 huggingface dataset:
A new molecular method for the rapid subtyping of bovine herpesvirus 1 field isolates
Authors: Maidana Silvina S. , Miño Samuel , Apostolo Romina M. , De Stefano Gabriel A. , Romera Sonia A.
Published: February 2020

Bovine herpesvirus 1 (BoHV-1) causes several clinical syndromes in cattle worldwide. There are 3 subtypes of BoHV-1: 1.1, 1.2a, and 1.2b. Several molecular methods are commonly used in the detection and characterization of BoHV-1. Among them, restriction endonuclease analysis (REA) and single-nucleotide polymorphism (SNP) analysis of the complete viral genome allow classification of BoHV-1 into different subtypes. However, developing countries need simpler and cheaper screening assays for routine testing. We designed a standard multiplex PCR followed by a REA assay allowing straightforward subclassification of all BoHV-1 isolates tested into 1.1, 1.2a, and 1.2b subtypes based on the analysis of fragment length polymorphism. Our standard multiplex PCR-REA was used to analyze 33 field strains of BoHV-1 isolated from various tissues. The assay confirmed the subtype identified previously by REA. In addition, non-polymorphic or undigested fragments were sequenced in order to confirm the mutation affecting the RE HindIII site. Our PCR-REA method is an affordable and rapid test that will subtype all BoHV-1 strains.
Institutions: Everywhere But Not Everything
Authors: Ocasio William , Gai Shelby L.
Published: February 2020

Recent critiques by Alvesson, Hallett, and Spicer have characterized neo-institutional theory (NIT) specifically as confronting a mid-life crisis and institutional theory (IT) more generally as uninhibited. While offering valid points, these critiques lack a fundamental understanding of how organizational institutionalism (OI) has become distinct from NIT. In contrast to NIT’s master hypothesis of isomorphism and focus on structural determinism, OI has made remarkable progress in explaining institutional variation and change. Notably, like organization theory more generally, OI is not a coherent theory, but rather a big tent community with its own set of internal differences, and at times confusing concepts. Rather than abandoning the concept of institutions, we suggest continued progress in OI requires greater clarification. Institutions are everywhere, but not everything, so it is important for researchers to specify which institutions are being studied, distinguish between institutions and culture, and ascertain the relationship between institutions and organizations.
A Review on Acrylamide in Food: Occurrence, Toxicity, and Mitigation Strategies
Authors: Rifai Lubna , Saleh Fatima A.
Published: February 2020

Acrylamide (AA) is a food contaminant present in a wide range of frequently consumed foods, which makes human exposure to this toxicant unfortunately unavoidable. However, efforts to reduce the formation of AA in food have resulted in some success. This review aims to summarize the occurrence of AA and the potential mitigation strategies of its formation in foods. Formation of AA in foods is mainly linked to Maillard reaction, which is the first feasible route that can be manipulated to reduce AA formation. Furthermore, manipulating processing conditions such as time and temperature of the heating process, and including certain preheating treatments such as soaking and blanching, can further reduce AA formation. Due to the high exposure to AA, recognition of its toxic effect is necessary, especially in developing countries where awareness about AA health risks is still very low. Therefore, this review also focuses on the different toxic effects of AA exposure, including neurotoxicity, genotoxicity, carcinogenicity, reproductive toxicity, hepatotoxicity, and immunotoxicity.
Overhead of using spare nodes
Authors: Hori Atsushi , Yoshinaga Kazumi , Herault Thomas , Bouteiller Aurélien , Bosilca George , Ishikawa Yutaka
Published: February 2020

With the increasing fault rate on high-end supercomputers, the topic of fault tolerance has been gathering attention. To cope with this situation, various fault-tolerance techniques are under investigation; these include user-level, algorithm-based fault-tolerance techniques and parallel execution environments that enable jobs to continue following node failure. Even with these techniques, some programs with static load balancing, such as stencil computation, may underperform after a failure recovery. Even when spare nodes are present, they are not always substituted for failed nodes in an effective way. This article considers the questions of how spare nodes should be allocated, how to substitute them for faulty nodes, and how much the communication performance is affected by such a substitution. The third question stems from the modification of the rank mapping by node substitutions, which can incur additional message collisions. In a stencil computation, rank mapping is done in a straightforward way on a Cartesian network without incurring any message collisions. However, once a substitution has occurred, the optimal node-rank mapping may be destroyed. Therefore, these questions must be answered in a way that minimizes the degradation of communication performance. In this article, several spare node allocation and failed node substitution methods will be proposed, analyzed, and compared in terms of communication performance following the substitution. The proposed substitution methods are named sliding methods. The sliding methods are analyzed by using our developed simulation program and evaluated by using the K computer, Blue Gene/Q (BG/Q), and TSUBAME 2.5. It will be shown that when failures occur, the stencil communication performance on the K and BG/Q can be slowed around 10 times depending on the number of node failures. The barrier performance on the K can be cut in half. On BG/Q, barrier performance can be slowed by a factor of 10. Further, it will also be shown that almost no such communication performance degradation can be seen on TSUBAME 2.5. This is because TSUBAME 2.5 has an Infiniband network connected with a FatTree topology, while the K computer and BG/Q have dedicated Cartesian networks. Thus, the communication performance degradation depends on network characteristics.
The Connection and Disconnection Between Microbiome and Metabolome: A Critical Appraisal in Clinical Research
Authors: Misra Biswapriya B.
Published: February 2020

Big data-driven omics research has led to a steep rise in investigations involving two of the most functional omes, the metabolome and microbiome. The former is touted as the closest to the phenotype, and the latter is implicated in general well-being and a plethora of human diseases. Although some research publications have integrated the concepts of the two domains, most focus their analyses on evidence solely originating from one or the other. With a growing interest in connecting the microbiome and metabolome in the context of disease, researchers must also appreciate the disconnect between the two domains. In the present review, drawing examples from the current literature, tools, and resources, I discuss the connections between the microbiome and metabolome and highlight challenges and opportunities in linking them together for the basic, translational, clinical, and nursing research communities.
Stakeholder views on publication bias in health services research
Authors: Williams Iestyn , Ayorinde Abimbola A , Mannion Russell , Skrybant Magdalena , Song Fujian , Lilford Richard J , Chen Yen-Fu
Published: February 2020

Objectives

While the presence of publication bias in clinical research is well documented, little is known about its role in the reporting of health services research. This paper explores stakeholder perceptions and experiences with regard to the role of publication and related biases in quantitative research relating to the quality, accessibility and organization of health services.

Methods

We present findings from semi-structured interviews with those responsible for the funding, publishing and/or conduct of quantitative health services research, primarily in the UK. Additional data collection includes interviews with health care decision makers as ‘end users’ of health services research, and a focus group with patient and service user representatives. The final sample comprised 24 interviews and eight focus group participants.

Results

Many study participants felt unable to say with any degree of certainty whether publication bias represents a significant problem in quantitative health services research. Participants drew broad contrasts between externally funded and peer reviewed research on the one hand, and end user funded quality improvement projects on the other, with the latter perceived as more vulnerable to selective publication and author over-claiming. Multiple study objectives, and a general acceptance of ‘mess and noise’ in the data and its interpretation was seen to reduce the importance attached to replicable estimates of effect sizes in health services research. The relative absence of external scrutiny, either from manufacturers of interventions or health system decision makers, added to this general sense of ‘low stakes’ of health services research. As a result, while many participants advocated study pre-registration and using protocols to pre-identify outcomes, others saw this as an unwarranted imposition.

Conclusions

This study finds that incentives towards publication and related bias are likely to be present, but not to the same degree as in clinical research. In health services research, these were seen as being offset by other forms of ‘novelty’ bias in the reporting and publishing of research findings.
Smart mobility, age and data justice
Authors: Sourbati Maria , Behrendt Frauke
Published: February 2020

This article examines converging trends in ageing, digitalisation and datafication in the context of mobility and transport. While mobility data are increasingly captured by (public) transport and mobility as a service (MaaS) providers, Internet of Things (IoT) vehicles, apps and so on, the increasing entanglement of mobility and datafication happens unevenly, for example, in relation to age. This is particularly significant in the light of the rise of data-driven policy-making, and its potential impacts on mobility provision for older people. The article highlights new questions for public policy around data gaps and social inclusion and examines them through a UK case study. The results show that old age and mobility is an area with significant gaps in the data available to policy makers. A key recommendation is for commissioning bodies to develop a strategic approach to structured data gathering and analysis that addresses issues of exclusion from smart public service infrastructure.
Mitral Valve Repair Techniques With Neochords: When Sizing Matters
Authors: Di Bacco Lorenzo , Miceli Antonio , Glauber Mattia
Published: February 2020

Mitral valve (MV) repair procedures have evolved over time and multiple approaches have been proposed also for the repair with neochords implantation. This article compiles the currently available approaches for implanting and sizing neochords, to restore a proper coaptation of the MV leaflets and a good systo-dyastolic movement. The described techniques are aimed at standardizing chordal measurement, in order to reduce variability in chordal length. The placement of annuloplasty ring before chordae implantation should be avoided. Regardless of the technique chosen, it is important that the implanted chordae do not interfere with normal native chordae, to avoid the risk that neochordae may heal together or get damaged. This article aims to give an overview of the most common sizing techniques available.
Comparisons Across Dimensions, People, and Time: On the Primacy of Social Comparison in Self-Evaluations
Authors: Zell Ethan , Strickhouser Jason E.
Published: February 2020

People often consider how their performance in one domain compares to their performance in other domains, the performance of other people, and their past performance (i.e., dimensional, social, and temporal comparison). The present research is the first to test whether social comparisons have a significantly larger effect on self-evaluations than dimensional and temporal comparisons. Study 1 participants received downward versus upward dimensional, social, and temporal comparison feedback ( N = 393). Study 2 participants received downward versus upward comparison feedback for one type and lateral comparisons for the other two types ( N = 281). Dimensional and social comparison significantly influenced self-evaluations and affective reactions in both studies. As anticipated, however, social comparison had a significantly larger effect on self-evaluations and affective reactions than either dimensional or temporal comparison. These data provide novel, causal evidence for the primacy of social comparison when people receive three feedback types.
Heart failure is a common complication after acute myocardial infarction in patients with diabetes: A nationwide study in the SWEDEHEART registry
Authors: Ritsinger Viveca , Nyström Thomas , Saleh Nawsad , Lagerqvist Bo , Norhammar Anna
Published: February 2020

Background

Several glucose lowering drugs with preventive effects on heart failure and death have entered the market, however, still used in low proportions after acute myocardial infarction. We explored the complication rates of heart failure and death after acute myocardial infarction in patients with and without diabetes.

Methods

All patients (N = 73,959) with acute myocardial infarction admitted for coronary angiography included in the SWEDEHEART registry during the years 2012–2017 were followed for heart failure (until 31 December 2017) and mortality (until 30 June 2018); mean follow-up time 1223 (SD ± 623) days.

Results

Mean age was 69 years (SD ± 12), 69% were male and 24% had diabetes. Heart failure occurred more often in diabetes (22% vs. 12% if no diabetes), especially if previous MI (33% vs. 23%). Patients with diabetes had increased risk of HF regardless of previous myocardial infarction (MI); with previous MI adjusted hazard ratio 2.09 (95% confidence interval 1.96–2.20) and without MI 1.52 (1.44–1.61) respectively when non-diabetes patients with first MI served as reference. In patients with no previous heart failure or MI and discharged with left ventricular ejection fraction ≥50% the risk of heart failure was particularly high in those with diabetes (1.56; 1.39–1.76) when compared with those without. Similar findings were seen for death and combined event (heart failure and death).

Conclusions

Heart failure is a common complication after acute myocardial infarction in diabetes, increasing the risk by 50–60% regardless of previous heart failure or MI. This risk is present even with normal reported left ventricular ejection fraction, indicating the existence of a large diabetes population at heart failure risk after acute myocardial infarction.
Marx, Anderson and the Critique of Indian Political Economy and the Caste System
Authors: Sampath Rajesh
Published: February 2020

This article will deconstruct the assumptions of the famous British Western Marxist, Anderson (2012) , and his recent critique of the Indian political economy in his controversial The Indian Ideology. Anderson’s work is a blistering critique of the origins of the post-British colonial Indian political-economy, society and culture. The paper examines different critical responses to Anderson’s work by Indian intellectuals in light of our re-interpretation of Marx and Engel’s classic, The German Ideology. Our aim is to critically appropriate the salience of Ambedkar’s ideas today in treating contemporary modalities of social exclusion, the continued practice of caste discrimination and political and constitutional responses to caste inequality. The paper argues for the development of new philosophical tools beyond the twentieth century Western Marxist frameworks, which informs the work of current thinkers like Anderson, to extend in new directions Ambedkar’s initial impulses in the South Asian critique of caste.
An open-source framework for regional earthquake loss estimation using the city-scale nonlinear time history analysis
Authors: Lu Xinzheng , McKenna Frank , Cheng Qingle , Xu Zhen , Zeng Xiang , Mahin Stephen A
Published: February 2020

Regional seismic damage simulation of buildings provides decision-makers with important information for earthquake disaster prevention and mitigation. Utilizing nonlinear time history analysis using multiple-degree-of-freedom (MDOF) models for buildings, and the next-generation performance-based earthquake engineering, an open-source general-purpose scientific workflow for seismic damage simulation and loss prediction of urban buildings (referred to as SimCenter Workflow) is presented in this study. To introduce the SimCenter Workflow process in detail and demonstrate its advantages, a seismic damage simulation and loss prediction for 1.8 million buildings in the San Francisco Bay Area were performed using the SimCenter Workflow. The open nature and modularization of the SimCenter Workflow facilitate its extensibility and make it practical for researchers to apply to seismic damage simulations in other regions.
Earthquake hazard and public policy in California
Authors: Reitherman Robert
Published: February 2020

A posthumously published speech by Karl V. Steinbrugge to the Commonwealth Club of California in 1973.
Structural, chemical, and multi-scale mechanical characterization of waste windmill palm fiber (Trachycarpus fortunei)
Authors: Li Jing , Zhang Xuexia , Zhu Jiawei , Yu Yan , Wang Hankun
Published: February 2020

This study investigated the structural, chemical, and multi-scale mechanical properties of windmill palm (Trachycarpus fortunei) leaf sheath fiber, which were frequently wasted. Significant variation was observed in fiber diameter and cross-sectional morphology among different layers in a single leaf sheath, whereas the chemical composition, relative crystallinity index, and the microfibrillar angle (MFA) of palm fibers were almost the same among different layers. Windmill palm fibers had low cellulose contents (34.70–35.5%), low relative crystallinity index (45.7–49.2%), and high MFA (38.8°–29.4°), resulting in low strength and modulus, but high failure strain under tensile load. The tensile fracture surface of windmill palm fibers was assessed through SEM studies and its ductile fracture was confirmed, which can potentially enhance the toughness of composites when used as reinforcement material. Nanoindentation was carried out among different leaf sheath layers, and the results showed the modulus and hardness values of windmill palm fibers are in the same range as other plant fibers. The experimental results may help guide selection of suitable reinforcing fibers for use in composites in different applications.
Cohort retrospective study: the neutrophil to lymphocyte ratio as an independent predictor of outcomes at the presentation of the multi-trauma patient
Authors: Soulaiman Soulaiman Elias , Dopa Dalal , Raad Al-Batool T. , Hasan Walaa , Ibrahim Niyazi , Hasan Al-Ykzan , Sulaiman Hussam Aldin , Darwich Moufid
Published: February 2020

Background

Although the association of neutrophil to lymphocyte ratio (NLR) with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. Recent studies suggest that the NLR has a predictive value of mortality in trauma patients during various times of admission. This study aimed to determine the prognostic impact of NLR at the presentation in critically ill trauma patients.

Methods

A retrospective cohort study of adult trauma patients between July 2017 and November 2017 in Tishreen Hospital. All patients who had arrived at the emergency department with multi-trauma injury within the age category (14–80 years) were included in this analysis. The prophetical capability of NLR on mortality was assessed by the receiver operative characteristics (ROC) curve. To identify the impact of the NLR on survival, a separate log-rank test was used. Multivariable Cox proportional hazard modeling was used to identify independent predictors of mortality.

Results

Throughout the time of the study, 566 patients met the inclusion criteria. Of these, 98.8% were male, 75.8% sustained penetrating trauma, and median age [IQR25–IQR75] was 26 [23–32]. Ninety-seven patients (17.1%) had major trauma, with an Injury Severity Score (ISS) ≥ 15. Using the ROC curve analyses hospitalization day 1, optimal NLR cutoff values of 4.00 were calculated by maximizing the Youden index. Kaplan-Meier curves revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality (p = 0.020, log-rank test). The Cox regression model demonstrated significant collinearity among the predictive variables (all VIF results < 2). Only ISS > 15 has a significant statistical relation with elevated NLR on day 1 (p = 0.010).

Conclusions

Elevated NLR on day 1 has high predictive power for overall survival during the first 30 days after trauma, but it was not independent of other factors.
Transcriptome analysis reveals insight into molecular hydrogen-induced cadmium tolerance in alfalfa: the prominent role of sulfur and (homo)glutathione metabolism
Authors: Cui Weiti , Yao Ping , Pan Jincheng , Dai Chen , Cao Hong , Chen Zhiyu , Zhang Shiting , Xu Sheng , Shen Wenbiao
Published: February 2020

Background

Hydrogen gas (H2) is hypothesised to play a role in plants that are coping with stresses by regulating signal transduction and gene expression. Although the beneficial role of H2 in plant tolerance to cadmium (Cd) has been investigated previously, the corresponding mechanism has not been elucidated. In this report, the transcriptomes of alfalfa seedling roots under Cd and/or hydrogen-rich water (HRW) treatment were first analysed. Then, the sulfur metabolism pathways were focused on and further investigated by pharmacological and genetic approaches.

Results

A total of 1968 differentially expressed genes (DEGs) in alfalfa seedling roots under Cd and/or HRW treatment were identified by RNA-Seq. The DEGs were classified into many clusters, including glutathione (GSH) metabolism, oxidative stress, and ATP-binding cassette (ABC) transporters. The results validated by RT-qPCR showed that the levels of relevant genes involved in sulfur metabolism were enhanced by HRW under Cd treatment, especially the genes involved in (homo)glutathione metabolism. Additional experiments carried out with a glutathione synthesis inhibitor and Arabidopsis thaliana cad2–1 mutant plants suggested the prominent role of glutathione in HRW-induced Cd tolerance. These results were in accordance with the effects of HRW on the contents of (homo)glutathione and (homo)phytochelatins and in alleviating oxidative stress under Cd stress. In addition, the HRW-induced alleviation of Cd toxicity might also be caused by a decrease in available Cd in seedling roots, achieved through ABC transporter-mediated secretion.

Conclusions

Taken together, the results of our study indicate that H2 regulated the expression of genes relevant to sulfur and glutathione metabolism and enhanced glutathione metabolism which resulted in Cd tolerance by activating antioxidation and Cd chelation. These results may help to elucidate the mechanism governing H2-induced Cd tolerance in alfalfa.
Wound infection with Vibrio harveyi following a traumatic leg amputation after a motorboat propeller injury in Mallorca, Spain: a case report and review of literature
Authors: Brehm Thomas Theo , Berneking Laura , Rohde Holger , Chistner Martin , Schlickewei Carsten , Sena Martins Meike , Schmiedel Stefan
Published: February 2020

Background

Vibrio spp. are aquatic bacteria that are ubiquitous in warm estuarine and marine environments, of which 12 species are currently known to cause infections in humans. So far, only five human infections with V. harveyi have been reported.

Case presentation

A 26-year old patient was transferred to our center by inter-hospital air transfer from Mallorca, Spain. Seven days before, he had suffered a complete amputation injury of his left lower leg combined with an open, multi-fragment, distal femur fracture after he had been struck by the propeller of a passing motorboat while snorkeling in the Mediterranean Sea. On admission he was febrile; laboratory studies showed markedly elevated inflammatory parameters and antibiotic treatment with ampicillin/sulbactam was initiated. Physical examination showed a tender and erythematous amputation stump, so surgical revision was performed and confirmed a putrid infection with necrosis of the subcutaneous tissue and the muscles. Tissue cultures subsequently grew V. harveyi with a minimal inhibitory concentration (MIC) of 16 mg/L for ampicillin, and antibiotic treatment was switched to ceftriaxone and ciprofloxacin. Throughout the following days, the patient repeatedly had to undergo surgical debridement but eventually the infection could be controlled, and he was discharged.

Conclusions

We report the first human infection with V. harveyi acquired in Spain and the second infection acquired in the Mediterranean Sea. This case suggests that physicians and microbiologists should be aware of the possibility of wound infections caused by Vibrio spp. acquired in the ocean environment, especially during hot summer months. Since Vibrio spp. preferentially grow at water temperatures above 18 °C, global warming is responsible for an abundance of these bacteria in coastal waters. This will likely lead to a worldwide increase in reports of Vibrio-associated diseases in the future.
A case-control study on the risk factors for hemorrhagic fever with renal syndrome
Authors: Wang Xiaochen , Shen Wenqi , Qin Yuanfang , Ying Liang , Li Haipeng , Lu Jiankui , Lu Jing , Zhang Nan , Li Zhifeng , Zhou Weizhong , Tang Fenyang , Zhu Fengcai , Hu Jianli , Bao Changjun
Published: February 2020

Background

Hemorrhagic fever with renal syndrome (HFRS) is an endemic communicable disease in China, accounting for 90% of total reported cases worldwide. In this study, the authors want to investigate the risk factors for HFRS in recent years to provide the prevention and control advices.

Methods

A community-based, 1:2 matched case-control study was carried out to investigate the risk factors for HFRS. Cases were defined as laboratory-confirmed cases that tested positive for hantavirus-specific IgM antibodies. Two neighbourhood controls of each case were selected by sex, age and occupation. Standardized questionnaires were used to collect information and identify the risk factors for HFRS.

Results

Eighty-six matched pairs were investigated in the study. The median age of the cases was 55.0 years, 72.09% were male, and 73.26% were farmers. In the multivariate logistic regression analysis, cleaning spare room at home (OR = 3.310, 95%CI 1.335–8.210) was found to be risk factor for infection; storing food and crops properly (OR = 0.279 95%CI 0.097–0.804) provided protection from infection.

Conclusion

Storing food and crops properly seemed to be protective factor, which was important for HFRS prevention and control. More attention should be paid to promote comprehensive health education and behaviour change among high-risk populations in the HFRS endemic area.
Designing a multifaceted telehealth intervention for a rural population using a model for developing complex interventions in nursing
Authors: Davis Stephen M. , Jones Amanda , Jaynes Margaret E. , Woodrum Kori N. , Canaday Marcus , Allen Lindsay , Mallow Jennifer A.
Published: February 2020

Background

Telehealth interventions offer an evidenced-based approach to providing cost-effective care, education, and timely communication at a distance. Yet, despite its widespread use, telehealth has not reached full potential, especially in rural areas, due to the complex process of designing and implementing telehealth programs. The objective of this paper is to explore the use of a theory-based approach, the Model for Developing Complex Interventions in Nursing, to design a pilot telehealth intervention program for a rural population with multiple chronic conditions.

Methods

In order to develop a robust, evidenced based intervention that suits the needs of the community, stakeholders, and healthcare agencies involved, a design team comprised of state representatives, telehealth experts, and patient advocates was convened. Each design team meeting was guided by major model constructs (i.e., problem identification, defining the target population and objectives, measurement theory selection, building and planning the intervention protocol). Overarching the process was a review of the literature to ensure that the developed intervention was congruent with evidence-based practice and underlying the entire process was scope of practice considerations.

Results

Ten design team meetings were held over a six-month period. An adaptive pilot intervention targeting home and community-based Medicaid Waiver Program participants in a rural environment with a primary objective of preventing re-institutionalizations was developed and accepted for implementation. To promote intervention effectiveness, asynchronous (i.e., remote patient monitoring) and synchronous (i.e., nursing assessment of pain and mental health and care coordination) telehealth approaches were selected to address the multiple comorbidities of the target population. An economic evaluation plan was developed and included in the pilot program to assess intervention cost efficiency.

Conclusions

The Model for Developing Complex Interventions in Nursing provided a simple, structured process for designing a multifaceted telehealth intervention to minimize re-institutionalization of participants with multiple chronic conditions. This structured process may promote efficient development of other complex telehealth interventions in time and resource constrained settings. This paper provides detailed examples of how the model was operationalized.
Defining sustainability in practice: views from implementing real-world innovations in health care
Authors: Urquhart Robin , Kendell Cynthia , Cornelissen Evelyn , Madden Laura L. , Powell Byron J. , Kissmann Glenn , Richmond Sarah A. , Willis Cameron , Bender Jackie L.
Published: February 2020

Background

One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability actually means. Several reviews have helped synthesize and clarify how researchers conceptualize and operationalize sustainability. In this study, we sought to identify how individuals who implement and/or sustain evidence-informed innovations in health care define sustainability.

Methods

We conducted in-depth, semi-structured interviews with implementation leaders and relevant staff involved in the implementation of evidence-based innovations relevant to cancer survivorship care (n = 27). An inductive approach, using constant comparative analysis, was used for analysis of interview transcripts and field notes.

Results

Participants described sustainability as an ongoing and dynamic process that incorporates three key concepts and four important conditions. The key concepts were: (1) continued capacity to deliver the innovation, (2) continued delivery of the innovation, and (3) continued receipt of benefits. The key conditions related to (2) and (3), and included: (2a) innovations must continue in the absence of the champion or person/team who introduced it and (3a) adaptation is critical to ensuring relevancy and fit, and thus to delivering the intended benefits.

Conclusions

Participants provided a nuanced view of sustainability, with both continued delivery and continued benefits only relevant under certain conditions. The findings reveal the interconnected elements of what sustainability means in practice, providing a unique and important perspective to the academic literature.
Cell engraftment, vascularization, and inflammation after treatment of equine distal limb wounds with endothelial colony forming cells encapsulated within hydrogel microspheres
Authors: Winter Randolph L. , Tian Yuan , Caldwell Fred J. , Seeto Wen J. , Koehler Jey W. , Pascoe David A. , Fan Shirley , Gaillard Phillippe , Lipke Elizabeth A. , Wooldridge Anne A.
Published: February 2020

Background

Endothelial colony forming cells (ECFCs) may be useful therapeutically in conditions with poor blood supply, such as distal limb wounds in the horse. Encapsulation of ECFCs into injectable hydrogel microspheres may ensure cell survival and cell localization to improve neovascularization and healing. Autologous ECFCs were isolated from 6 horses, labeled with quantum nanodots (QD), and a subset were encapsulated in poly(ethylene) glycol fibrinogen microspheres (PEG-Fb MS). Full-thickness dermal wounds were created on each distal limb and injected with empty PEG-Fb MS, serum, ECFCs, or ECFCs encapsulated into PEG- Fb MS (ECFC/MS). Analysis included wound surface area (WSA), granulation tissue scoring (GS), thermography, collagen density staining, and immunohistochemical staining for endothelial and inflammatory cells. The purpose of this study was to track cell location and evaluate wound vascularization and inflammatory response after injection of ECFC/MS or naked ECFCs in equine distal limb wounds.

Results

ECFCs were found near and within newly formed blood vessels up to 3 weeks after injection. ECFC and ECFC/MS groups had the greatest blood vessel quantity at week 1 in the wound periphery. Wounds treated with ECFCs and ECFC/MS had the lowest density of neutrophils and macrophages at week 4. There were no significant effects of ECFC or ECFC/MS treatment on other measured parameters.

Conclusions

Injection of microsphere encapsulated ECFCs was practical for clinical use and well-tolerated. The positive ECFC treatment effects on blood vessel density and wound inflammation warrant further investigation.
Molecular surveillance of Pfcrt and k13 propeller polymorphisms of imported Plasmodium falciparum cases to Zhejiang Province, China between 2016 and 2018
Authors: Wang Xiaoxiao , Ruan Wei , Zhou Shuisen , Huang Fang , Lu Qiaoyi , Feng Xinyu , Yan He
Published: February 2020

Background

Resistance to anti-malarial drugs hinders malaria elimination. Monitoring the molecular markers of drug resistance helps improve malaria treatment policies. This study aimed to assess the distribution of molecular markers of imported Plasmodium falciparum infections.

Methods

In total, 485 P. falciparum cases imported from Africa, Southeast Asia, and Oceania into Zhejiang province, China, from 2016 to 2018 were investigated. Most were imported from Africa, and only a few cases originated in Asia and Oceania. Blood samples were collected from each patient. Plasmodium falciparum chloroquine resistance transporter (Pfcrt) at residues 72–76 and Kelch13-propeller (k13) were determined by nested PCR and DNA sequence.

Results

Wild-type Pfcrt at residues 72–76 was predominant (72.61%), but mutant and mixed alleles were also detected, of which CVIET (22.72%) was the most common. Mutant Pfcrt haplotypes were more frequent in patients from West Africa (26.92%), North Africa (25%), and Central Africa (21.93%). The number of cases of P. falciparum infections was small in Southeast Asia and Oceania, and these cases involved Pfcrt mutant type. For the k13 propeller gene, 26 samples presented 19 different point mutations, including eight nonsynonymous mutations (P441S, D464E, K503E, R561H, A578S, R622I, V650F, N694K). In addition, R561H, one of the validated SNPs in k13, was detected in one patient from Myanmar and one patient from Rwanda. A578S, although common in Africa, was found in only one patient from Cameroon. R622I was detected in one sample from Mozambique and one sample from Somalia. The genetic diversity of k13 was low in most regions of Africa and purifying selection was suggested by Tajima’s D test.

Conclusions

The frequency and spatial distributions of Pfcrt and k13 mutations associated with drug resistance were determined. Wild-type Pfcrt was dominant in Africa. Among k13 mutations correlated with delayed parasite clearance, only the R561H mutation was found in one case from Rwanda in Africa. Both Pfcrt and k13 mutations were detected in patients from Southeast Asia and Oceania. These findings provide insights into the molecular epidemiological profile of drug resistance markers in the study region.
CLEC14A deficiency exacerbates neuronal loss by increasing blood-brain barrier permeability and inflammation
Authors: Kim Yeomyeong , Lee Sungwoon , Zhang Haiying , Lee Sunghye , Kim Hyejeong , Kim Yeaji , Won Moo-Ho , Kim Young-Myeong , Kwon Young-Guen
Published: February 2020

Background

Ischemic stroke is a main cause of mortality. Blood-brain barrier (BBB) breakdown appears to play a critical role in inflammation in patients with ischemic stroke and acceleration of brain injury. The BBB has a protective function and is composed of endothelial cells, pericytes, and astrocytes. In ischemic stroke treatments, regulation of vascular endothelial growth factor (VEGF)-A and vascular endothelial growth factor receptor (VEGFR)-2 is a crucial target despite adverse effects. Our previous study found that loss of C-type lectin family 14 member A (CLEC14A) activated VEGF-A/VEGFR-2 signaling in developmental and tumoral angiogenesis. Here, we evaluate the effects of BBB impairment caused by CLEC14A deficiency in ischemia-reperfusion injury.

Methods

In vitro fluorescein isothiocyanate (FITC)-dextran permeability, transendothelial electrical resistance (TEER) assay, and immunostaining were used to evaluate endothelial integrity. BBB permeability was assessed using Evans blue dye and FITC-dextran injection in Clec14a−/− (CLEC14A-KO) mice and wild-type mice. Middle cerebral artery occlusion surgery and behavioral assessments were performed to evaluate the neurologic damage. The change of tight junctional proteins, adhesion molecules, pro-inflammatory cytokines, and microglial were confirmed by immunofluorescence staining, Western blotting, and quantitative reverse transcription polymerase chain reaction of brain samples.

Results

In endothelial cells, knockdown of CLEC14A increased FITC-dextran permeability and decreased transendothelial electrical resistance; the severity of this effect increased with VEGF treatment. Immunofluorescence staining revealed that tight junctional proteins were attenuated in the CLEC14A knockdown endothelial cells. Consistent with the in vitro results, CLEC14A-KO mice that were injected with Evans blue dye had cerebral vascular leakage at postnatal day 8; wild-type mice had no leakage. We used a middle cerebral artery occlusion model and found that CLEC14A-KO mice had severe infarcted brain and neurological deficits with upregulated VEGFR-2 expression. FITC-dextran leakage was present in CLEC14A-KO mice after ischemia-reperfusion, and the numbers of tight junctional molecules were significantly decreased. Loss of CLEC14A increased the pro-inflammatory response through adhesion molecule expression, and glial cells were activated.

Conclusions

These results suggest that activation of VEGFR-2 in CLEC14A-KO mice aggravates ischemic stroke by exacerbating cerebral vascular leakage and increasing neuronal inflammation after ischemia-reperfusion injury.
Development assistance for health and the Middle East and North Africa
Authors: Zhao Yingxi , Micah Angela E. , Gloyd Stephen , Dieleman Joseph L.
Published: February 2020

Background

Donor countries in the Middle East and North Africa (MENA) including Saudi Arabia, Kuwait and United Arab Emirates (UAE) have been among the largest donors in the world. However, little is known about their contributions for health. In this study, we addressed this gap by estimating the amount of development assistance for health (DAH) contributed by MENA country donors from 2000 to 2017.

Methods

We tracked DAH provided and received by the MENA region leveraging publicly available development assistance data in the Development Assistance Committee (DAC) database of the Organisation for Economic Co-operation and Development (OECD), government agency reports and financial statements from key international development agencies. We generated estimates of DAH provided by the three largest donor countries in the MENA region (UAE, Kuwait, Saudi Arabia) and compared contributions to their relative gross domestic product (GDP) and government spending; We captured DAH contributions by other MENA country governments (Egypt, Iran, Qatar, Turkey, etc.) disbursed through multilateral agencies. Additionally, we compared DAH contributed from and provided to the MENA region.

Results

In 2017, DAH contributed by the MENA region reached $514.8 million. While UAE ($220.1 million, 43.2%), Saudi Arabia ($177.3 million, 34.8%) and Kuwait ($59.8 million, 11.6%) as sources contributed the majority of DAH in 2017, 58.5% of total DAH from MENA was disbursed through their bilateral agencies, 12.0% through the World Health Organization (WHO) and 3.3% through other United Nations agencies. 44.8% of DAH contributions from MENA was directed to health system strengthening/sector-wide approaches. Relative to their GDP and government spending, DAH level fluctuated across 2000 to 2017 but UAE and Saudi Arabia indicated increasing trends. While considering all MENA countries as recipients, only 10.5% of DAH received by MENA countries were from MENA donors in 2017.

Conclusion

MENA country donors especially UAE, Saudi Arabia and Kuwait have been providing substantial amount of DAH, channeled through their bilateral agencies, WHO and other multilateral agencies, with a prioritized focus on health system strengthening. DAH from the MENA region has been increasing for the past decade and could lend itself to important contributions for the region and the globe.
Clinical features of hepatocellular carcinoma with hepatitis B virus among patients on Nucleos(t) ide analog therapy
Authors: Liu Li
Published: February 2020

Background

The clinical manifestation of hepatocellular carcinoma (HCC) with hepatitis B virus (HBV) varies significantly between patients treated with or without nucleos(t) ide analog (NUC) therapy. To have a better understanding of HCC with HBV, we compared the clinical features of patients with HCC receiving or not receiving NUC therapy.

Methods

We retrospectively reviewed the medical records of 76 patients with HBV-caused HCC who received treatment at the Hunan Provincial Peoples’ Hospital starting from January 1, 2008 to December 31, 2017. They were categorized into two groups, namely, NUC group and non-NUC group, based on whether they had received NUC therapy or not.

Results

The percentage of liver pain (36.36% vs. 79.07%; p < 0.05) and appetite loss (30.30% vs. 70.27%; p < 0.05) in the NUC group was lower than that in the non-NUC group. We observed a similar trend for the percentage of undetectable HBV-DNA (11.63% vs. 63.64%; p < 0.05) and normal ALT (25.58% vs. 75.76%; p < 0.05) between non-NUC and NUC groups. There were no significant differences between the two groups with respect to TBiL (p = 0.370) and ALB (p = 0.475). The same trend was observed for the proportion of HBeAg negative (p = 0.719) and AFP ≤ 14.65 ng/mL (p = 0.199) in both groups. Single tumor nodule was more common in the NUC group compared to the non-NUC group (66.67% vs. 6.98%; p < 0.05). An opposite trend was observed for portal vein invasion (18.18% vs. 79.07%; p < 0.05) and metastasis (0% vs. 44.19%; p < 0.05).

Conclusions

Nucleos(t) ide analog therapy exerts a significant impact on the clinical and radiological characteristics of hepatocellular carcinoma with HBV. Patients receiving nucleos(t) ide analog therapy were found to have milder symptoms and fewer radiographic findings.
Applying trauma systems concepts to humanitarian battlefield care: a qualitative analysis of the Mosul trauma pathway
Authors: Garber Kent , Kushner Adam L. , Wren Sherry M. , Wise Paul H. , Spiegel Paul B.
Published: February 2020

Background

Trauma systems have been shown to save lives in military and civilian settings, but their use by humanitarians in conflict settings has been more limited. During the Battle of Mosul (October 2016–July 2017), trauma care for injured civilians was provided through a novel approach in which humanitarian actors were organized into a trauma pathway involving echelons of care, a key component of military trauma systems. A better understanding of this approach may help inform trauma care delivery in future humanitarian responses in conflicts.

Methodology

A qualitative study design was used to examine the Mosul civilian trauma response. From August–December 2017, in-depth semi-structured interviews were conducted with stakeholders (n = 54) representing nearly two dozen organizations that directly participated in or had first-hand knowledge of the response. Source document reviews were also conducted. Responses were analyzed in accordance with a published framework on civilian battlefield trauma systems, focusing on whether the response functioned as an integrated trauma system. Opportunities for improvement were identified.

Results

The Mosul civilian trauma pathway was implemented as a chain of care for civilian casualties with three successive echelons (trauma stabilization points, field hospitals, and referral hospitals). Coordinated by the World Health Organization, it comprised a variety of actors, including non-governmental organizations, civilian institutions, and at least one private medical company. Stakeholders generally felt that this approach improved access to trauma care for civilians injured near the frontlines compared to what would have been available. Several trauma systems elements such as transportation, data collection, field coordination, and post-operative rehabilitative care might have been further developed to support a more integrated system.

Conclusions

The Mosul trauma pathway evolved to address critical gaps in trauma care during the Battle of Mosul. It adapted the concept of echelons of care from western military practice to push humanitarian actors closer to the frontlines and improve access to care for injured civilians. Although efforts were made to incorporate some of the integrative components (e.g. evidence-based pre-hospital care, transportation, and data collection) that have enabled recent achievements by military trauma systems, many of these proved difficult to implement in the Mosul context. Further discussion and research are needed to determine how trauma systems insights can be adapted in future humanitarian responses given resource, logistical, and security constraints, as well as to clarify the responsibilities of various actors.
Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary stricture: a case report
Authors: Sah Dhruba Narayan , Bhandari Ramesh Singh
Published: February 2020

Background

Benign biliary stricture is an infrequent condition and the majority occur following cholecystectomy. This case report highlights the occurrence of such a stricture 11 years after cholecystectomy without development of biliary cirrhosis.

Case presentation

Our patient was a 55-year-old Nepalese woman who presented to our hospital with cholangitis of 1-month duration and a history of cholecystectomy 11 years ago. A diagnosis of benign biliary stricture without features of biliary cirrhosis was made, and the patient was successfully managed with a multidisciplinary approach.

Conclusion

Benign biliary stricture can present even decades after cholecystectomy. Roux-en-Y hepaticojejunostomy is the treatment of choice, and a long-term favorable outcome can be expected.