bluuebunny/crossref_metadata_2025 huggingface dataset:
Do USMLE steps, and ITE score predict the American Board of Internal Medicine Certifying Exam results?
Authors: Rayamajhi Supratik , Dhakal Prajwal , Wang Ling , Rai Manoj P. , Shrotriya Shiva
Published: March 2020

Background

To evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 CK, USMLE Step 3, and residency third-year in-service training exam (ITE) scores predict the results of American Board of Internal Medicine Certifying Exam (ABIM-CE).

Methods

We performed a retrospective review of USMLE Step 1, USMLE Step 2 CK, USMLE Step 3, third-year residency ITE scores and ABIM-CE results of IM residents at our residency program from 2004 through 2017. Statistical analysis was perfrormed using Pearson correlation coefficient, and logistic regression to assess the relationship between USMLE Step 1, USMLE Step 2CK, USMLE Step 3, 3rd year ITE scores and ABIM-CE results. We used Multivariate logistic regression to predict pass or fail results in ABIM-CE based on USMLE and third-year ITE test scores controlling for other covariates.

Results

Among 114 Internal Medicine MD residents included in the study, 92% (n = 105) passed the ABIM-CE. The OR of passing ABIM-CE was 2.70 (95% CI = 1.38–5.29), 2.31 (95% CI = 1.33–4.01), and 1.63 (95% CI = 0.81–3.29) with a ten-point increase in USMLE Step 1, USMLE Step 2 CK and USMLE Step 3 scores respectively. The OR of ABIM-CE passing chance was 2.96 (95% CI = 0.95–9.20), with a ten-point increase in the average score of the above three exams. A 5 % increase in ITE percentage raised the likelihood of passing ABIM-CE (OR 2.92, 95% CI 1.15–7.38). All residents who failed ABIM-CE had Step 1 scores < 220. Among 31 residents with Step 2 CK score < 220, 20% (n = 6) failed ABIM. Similarly, 9% of residents with USMLE Step 3 score < 220 failed ABIM-CE; all residents who failed had scored < 220. The probability curve predicted that the chance of passing ABIM- CE was around 80% with USMLE scores greater than 200 and increased to almost 100% with USMLE scores of 250 or more.

Conclusion

USMLE Step 1, USMLE Step 2 CK, and third-year ITE scores can predict the chances of passing ABIM-CE. The third-year ITE score has a higher preditive value compared to USMLE Step 1 and USMLE Step 2 scores. USMLE Step 1 scores more predictive of ABIM-CE results compared to USMLE Step 2CK scores. Thus, residency programs can identify internal medicine residents at risk of failing ABIM-CE and formulate interventions at an early stage during residency training. Measures such as enrolling them in question banks or board review courses can be helpful in improving their chances of passing ABIM-CE.
Towards a values framework for integrated health services: an international Delphi study
Authors: Zonneveld Nick , Raab Jörg , Minkman Mirella M. N.
Published: March 2020

Background

In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations. Therefore, this article focuses on these underlying normative aspects of integrated health services. This study investigates the values that underpin integrated health services delivery as a concept, by examining the extent to which an initial literature based set of underlying values underpins integrated care and the relevance of these values on the different levels of integration.

Methods

An international Delphi study with 33 experts from 13 different countries was carried out to examine the initial set of underlying values of integrated health services. In addition, the relevance of the values was assessed on the different levels of integration: personal level, professional level, management level and system level.

Results

The study resulted in a refined set of 18 values of integrated health services developed in three Delphi study rounds. In addition, the results provided insight into the relevance of these values on the personal level (e.g. ‘trustful’), professional level (e.g. ‘collaborative’), management level (e.g. ‘efficient’) and system level (e.g. ‘comprehensive’) of integration. Some of the values score consistent across the different levels of integration while other values score inconsistent across these levels.

Conclusions

The Delphi study resulted in an international normative basis for integrated health services delivery as a concept. The values can be used as ingredients for a values framework and provide a better understanding of the normative aspects of integrated health services delivery. Future research could focus on associated behaviors in practice, the relationship between normative integration and governance, and differences between the value priorities of stakeholder groups.
Utilization of breast cancer screening in Kenya: what are the determinants?
Authors: Antabe Roger , Kansanga Moses , Sano Yujiro , Kyeremeh Emmanuel , Galaa Yvonne
Published: March 2020

Background

Breast cancer accounts for 23% of all cancer cases among women in Kenya. Although breast cancer screening is important, we know little about the factors associated with women’s breast cancer screening utilization in Kenya. Using the Andersen’s behavioural model of health care utilization, we aim to address this void in the literature.

Methods

We draw data on the Kenya Demographic and Health Survey and employ univariate, bivariate, and multivariate analyses.

Results

We find that women’s geographic location, specifically, living in a rural area (OR = 0.89; p < 0.001) and the North Eastern Province is associated with lower odds of women being screened for breast cancer. Moreover, compared to the more educated, richer and insured, women who are less educated, poorer, and uninsured (OR = 0.74; p < 0.001) are less likely to have been screened for breast cancer.

Conclusion

Based on these findings, we recommend place and group-specific education and interventions on increasing breast cancer screening in Kenya.
MiR-33a functions as a tumor suppressor in triple-negative breast cancer by targeting EZH2
Authors: Weihua Zeng , Guorong Zou , Xiaolong Cao , Weizhan Li
Published: March 2020

Background

Increasing reports have confirmed that microRNAs play an important role in breast cancer progression, particularly in triple-negative breast cancer (TNBC). The aim of our study was to investigate the role of miR-33a in TNBC progression.

Methods

PCR assays were performed to detect miR-33a and EZH2 expression in TNBC tissues, adjacent nontumor tissues and cell lines. Western blot, CCK8, Transwell, cell colony formation and EdU cell proliferation, cell cycle analysis and luciferase reporter assays were used to determine the regulation of miR-33a/EZH2 in TNBC progression.

Results

MiR-33a was significantly downregulated in TNBC tissues and cell lines. MiR-33a overexpression in TNBC cells significantly inhibited cell growth and mobility and induced G1 cell cycle arrest. The luciferase reporter assay revealed that EZH2 is a direct target of miR-33a and that it was upregulated in TNBC tissues and cell lines. There was a negative correlation between miR-33a and EZH2 expression in TNBC tissues. EZH2 knockdown exerted similar inhibitory effects, while ectopic expression of EZH2 showed suppressive effects on malignant behaviors induced by miR-33a overexpression in TNBC cells.

Conclusions

These findings revealed that miR-33a is a tumor-suppressive miRNA in TNBC and can inhibit proliferation and mobility and induce G1 cell cycle arrest by directly targeting EZH2.
A geographic identifier assignment algorithm with Bayesian variable selection to identify neighborhood factors associated with emergency department visit disparities for asthma
Authors: Bozigar Matthew , Lawson Andrew , Pearce John , King Kathryn , Svendsen Erik
Published: March 2020

Background

Ecologic health studies often rely on outcomes from health service utilization data that are limited by relatively coarse spatial resolutions and missing geographic information, particularly neighborhood level identifiers. When fine-scale geographic data are missing, the ramifications and strategies for addressing them are not well researched or developed. This study illustrates a novel spatio-temporal framework that combines a geographic identifier assignment (i.e., geographic imputation) algorithm with predictive Bayesian variable selection to identify neighborhood factors associated with disparities in emergency department (ED) visits for asthma.

Methods

ED visit records with missing fine-scale spatial identifiers (~ 20%) were geocoded using information from known, coarser, misaligned spatial units using an innovative geographic identifier assignment algorithm. We then employed systematic variable selection in a spatio-temporal Bayesian hierarchical model (BHM) predictive framework within the NIMBLE package in R. Our novel methodology is illustrated in an ecologic case study aimed at identifying neighborhood-level predictors of asthma ED visits in South Carolina, United States, from 1999 to 2015. The health outcome was annual ED visit counts in small areas (i.e., census tracts) with primary diagnoses of asthma (ICD9 codes 493.XX) among children ages 5 to 19 years.

Results

We maintained 96% of ED visit records for this analysis. When the algorithm used areal proportions as probabilities for assignment, which addressed differential missingness of census tract identifiers in rural areas, variable selection consistently identified significant neighborhood-level predictors of asthma ED visit risk including pharmacy proximity, average household size, and carbon monoxide interactions. Contrasted with common solutions of removing geographically incomplete records or scaling up analyses, our methodology identified critical differences in parameters estimated, predictors selected, and inferences. We posit that the differences were attributable to improved data resolution, resulting in greater power and less bias. Importantly, without this methodology, we would have inaccurately identified predictors of risk for asthma ED visits, particularly in rural areas.

Conclusions

Our approach innovatively addressed several issues in ecologic health studies, including missing small-area geographic information, multiple correlated neighborhood covariates, and multiscale unmeasured confounding factors. Our methodology could be widely applied to other small-area studies, useful to a range of researchers throughout the world.
The interrupted effect of autophagic flux and lysosomal function induced by graphene oxide in p62-dependent apoptosis of F98 cells
Authors: Zhang Chao , Feng Xiaoli , He Longwen , Zhang Yaqing , Shao Longquan
Published: March 2020

Background

Graphene oxide (GO) nanoparticles (NPs) have been widely applied in various fields, especially in biomedical applications. Extensive studies have suggested that GO can pass through the blood–brain barrier (BBB) and induce abnormal autophagy and cytotoxicity in the central nervous system (CNS). However, the effect and specific mechanism of GO on astrocytes, the most abundant cells in the brain still has not been extensively investigated.

Results

In this study, we systematically explored the toxicity and mechanism of GO exposure in the rat astroglioma-derived F98 cell line using molecular biological techniques (immunofluorescence staining, flow cytometry and Western blot) at the subcellular level and the signaling pathway level. Cells exposed to GO exhibited decreased cell viability and increased lactate dehydrogenase (LDH) release in a concentration- and time-dependent manner. GO-induced autophagy was evidenced by transmission electron microscopy (TEM) and immunofluorescence staining. Western blots showed that LC3II/I and p62 were upregulated and PI3K/Akt/mTOR was downregulated. Detection of lysosomal acidity and cathepsin B activity assay indicated the impairment of lysosomal function. Annexin V-FITC-PI detection showed the occurrence of apoptosis after GO exposure. The decrease in mitochondrial membrane potential (MMP) with an accompanying upregulation of cleaved caspase-3 and Bax/Bcl-2 further suggested that endogenous signaling pathways were involved in GO-induced apoptosis.

Conclusion

The exposure of F98 cells to GO can elicit concentration- and time-dependent toxicological effects. Additionally, increased autophagic response can be triggered after GO treatment and that the blocking of autophagy flux plays a vital role in GO cytotoxicity, which was determined to be related to dysfunction of lysosomal degradation. Importantly, the abnormal accumulation of autophagic substrate p62 protein can induce capase-3-mediated apoptosis. Inhibition of abnormal accumulation of autophagic cargo could alleviate the occurrence of GO-induced apoptosis in F98 cells.
Intravenous delivery of enzalutamide based on high drug loading multifunctional graphene oxide nanoparticles for castration-resistant prostate cancer therapy
Authors: Jiang Wenjun , Chen Jiyuan , Gong Chunai , Wang Yuanyuan , Gao Yuan , Yuan Yongfang
Published: March 2020

Background

Enzalutamide (Enz) has shown limited bioavailability via oral administration. Castration-resistant prostate cancer (CRPC) is frequent among patients receiving 18–24 months of androgen deprivation therapy. The nonsteroidal anti-androgen enzalutamide (Enz) used in the treatment of prostate cancer has shown limited bioavailability via oral administration. Therefore, we developed a multifunctional enzalutamide-loaded graphene oxide nanosystem (TP-GQDss/Enz) for CRPC intravenous treatment, with high drug loading efficiency.

Methods

Aminated graphene quantum dots (GQDs) were first cross-linked via disulfide bonds into a graphene quantum dot derivative of approximately 200 nm (GQDss), which was further functionalized with a tumour-targeting peptide and PEG to form TP-GQDss. Enz was loaded into TP-GQDss for in vitro and in vivo study.

Results

The results showed that high drug-loading efficiency was achieved by TP-GQDss via π–π electron interaction. TP-GQDss could be rapidly internalized by CRPC cells via endocytosis. Moreover, Enz in TP-GQDss could inhibit the growth of C4-2B and LNCaP prostate cancer cell lines in vitro. Further, TP-GQDss exhibited an enhanced cancer-targeting ability and alleviated the side effects of Enz in vivo.

Conclusions

The multifunctional nanocarrier constructed here could accomplish controlled Enz release and serve as an intravenous therapy platform for CRPC.
Cross-cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids’ Life Assessment Tool (CHO-KLAT) in Côte d’Ivoire (the Ivory Coast)
Authors: Lambert Catherine , Meité N’ Dogomo , Sanogo Ibrahima , Lobet Sébastien , Hermans Cedric , Henrard Séverine , Blanchette Victor , Young Nancy L.
Published: March 2020

Introduction

Health-related quality of life evaluation is recognized as an important outcome in the assessment of boys with haemophilia. In fact, reliable health-related quality of life data are even more critical in developing countries to advocate for government agencies to develop national haemophilia care programmes. However, validated tools are not yet available in sub-Saharan African countries.

Aims

The purpose of this study was to complete the cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids’ Life Assessment Tool version2.0 (CHO-KLAT2.0) in Côte d’Ivoire.

Methods

The process included four steps: a linguistic adaptation, cognitive debriefing interviews with children and their parents, a validity assessment with the Pediatric Quality of Life Inventory (PedsQL) as a comparator, and a test-retest reliability assessment.

Results

The initial Ivoirian version of the CHO-KLAT2.0 was developed through a linguistic adaptation performed in close collaboration with members of the local medical team and haemophilia community. Cognitive debriefings were completed with five boys and their parents, with the final Ivoirian version of the CHO-KLAT2.0 developed in September 2017. The validation process included 37 boys with haemophilia (mean age: 11.4 years; 34 with severe and three with moderate forms of haemophilia, all treated on demand) and their parents. Among the child-reported population (n = 20), we observed a mean CHO-KLAT2.0 score of 51.3 ± 9.2; there was a moderate correlation between the CHO-KLAT2.0 and PedsQL scores (r = 0.581; p = 0.007) and an inverse correlation of the CHO-KLAT2.0 and PedsQL scores with the global rating of the degree to which the boys were bothered by their haemophilia. The mean parent proxy CHO-KLAT2.0 score (n = 17) was 53.5 ± 9.8. Among the parents, we found no significant correlation between the Ivoirian CHO-KLAT2.0 and PedsQL scores or between the parent-reported scores and the parent global ratings of bother. The test-retest intraclass correlation coefficient was 0.879 (95% CI: 0.673; 0.954) for the child-reported questionnaires and 0.880 (95% CI: 0.694; 0.955) for the proxy-reported questionnaires.

Conclusions

A cross-culturally adapted and validated version of the CHO-KLAT2.0 for Côte d’Ivoire is now available that enables baseline values to be obtained and intervention outcomes (namely, prophylaxis) to be measured in Ivoirian boys with haemophilia.
Explaining breastfeeding experiences and assessing factors affecting breastfeeding self-efficacy in mothers of premature infants: a mixed method study protocol
Authors: Asadi Gholamreza , Aslani Armin , Nayebinia Anvar-Sadat , Fathnezhad-Kazemi Azita
Published: March 2020

Background

Breastfeeding has a great effect on health promotion and disease prevention in premature infants. However, various factors affect the success of breastfeeding process in mothers. The present study aims to: a) explain breastfeeding experiences; b) assess the factors affecting breastfeeding self-efficacy; and c) present a guideline for promoting breastfeeding in mothers of premature infants.

Methods

This mixed-methods study with a sequential explanatory design consisted of three phases. The first phase is qualitative study to explore the breastfeeding experiences in mothers of premature infants. In this phase, the subjects will be selected through purposive sampling; moreover, in-depth individual interviewing will be used for data collection. Finally, the conventional content analysis approach will be employed for data analysis. The second phase is quantitative and will be used a cross-sectional approach to assess the association of the social determinants of health with breastfeeding self-efficacy in mothers of premature infants. In this phase, the multistage cluster sampling method will be used to select 360 subjects who will be visited healthcare centers in Tabriz, Iran. The third phase focused on developing strategies to increase the ability of mothers to breastfeed their premature infants, using the qualitative and quantitative results of previous phases, a review of the related literature, and the nominal group technique will be performed among experts.

Discussion

The present research is the first study that investigated the experiences of breastfeeding and factors influencing breastfeeding self-efficacy in mothers of premature infants. For the purposes of the study, the mixed methods approach will be used which aimed to develop strategies for the improvement of healthcare services in this regard. It is worth noting that there is no strategic guideline in Iran’s healthcare system for the improvement of breastfeeding, especially regarding mothers of premature infants. Therefore, it is hoped that the strategy proposed in the current study can lead to improvements in this regard.

Ethical code

IR.TBZMED.REC.1398.100.
SpikeSegNet-a deep learning approach utilizing encoder-decoder network with hourglass for spike segmentation and counting in wheat plant from visual imaging
Authors: Misra Tanuj , Arora Alka , Marwaha Sudeep , Chinnusamy Viswanathan , Rao Atmakuri Ramakrishna , Jain Rajni , Sahoo Rabi Narayan , Ray Mrinmoy , Kumar Sudhir , Raju Dhandapani , Jha Ranjeet Ranjan , Nigam Aditya , Goel Swati
Published: March 2020

Background

High throughput non-destructive phenotyping is emerging as a significant approach for phenotyping germplasm and breeding populations for the identification of superior donors, elite lines, and QTLs. Detection and counting of spikes, the grain bearing organs of wheat, is critical for phenomics of a large set of germplasm and breeding lines in controlled and field conditions. It is also required for precision agriculture where the application of nitrogen, water, and other inputs at this critical stage is necessary. Further, counting of spikes is an important measure to determine yield. Digital image analysis and machine learning techniques play an essential role in non-destructive plant phenotyping analysis.

Results

In this study, an approach based on computer vision, particularly object detection, to recognize and count the number of spikes of the wheat plant from the digital images is proposed. For spike identification, a novel deep-learning network, SpikeSegNet, has been developed by combining two proposed feature networks: Local Patch extraction Network (LPNet) and Global Mask refinement Network (GMRNet). In LPNet, the contextual and spatial features are learned at the local patch level. The output of LPNet is a segmented mask image, which is further refined at the global level using GMRNet. Visual (RGB) images of 200 wheat plants were captured using LemnaTec imaging system installed at Nanaji Deshmukh Plant Phenomics Centre, ICAR-IARI, New Delhi. The precision, accuracy, and robustness (F1score) of the proposed approach for spike segmentation are found to be 99.93%, 99.91%, and 99.91%, respectively. For counting the number of spikes, “analyse particles”—function of imageJ was applied on the output image of the proposed SpikeSegNet model. For spike counting, the average precision, accuracy, and robustness are 99%, 95%, and 97%, respectively. SpikeSegNet approach is tested for robustness with illuminated image dataset, and no significant difference is observed in the segmentation performance.

Conclusion

In this study, a new approach called as SpikeSegNet has been proposed based on combined digital image analysis and deep learning techniques. A dedicated deep learning approach has been developed to identify and count spikes in the wheat plants. The performance of the approach demonstrates that SpikeSegNet is an effective and robust approach for spike detection and counting. As detection and counting of wheat spikes are closely related to the crop yield, and the proposed approach is also non-destructive, it is a significant step forward in the area of non-destructive and high-throughput phenotyping of wheat.
Correction to: Impact of early intravenous amiodarone administration on neurological outcome in refractory ventricular fibrillation: retrospective analysis of prospectively collected prehospital data
Authors: Lee Dong Keon , Kim Yu Jin , Kim Giwoon , Lee Choung Ah. , Moon Hyung Jun , Oh Jaehoon , Yang Hae Chul , Choi Han Joo , Oh Young Taeck , Park Seung Min
Published: March 2020

Following the publication of the original article [1], the authors unfortunately became aware of some typesetting and resolution problems in Figs. 1 and 2.
PfSWIB, a potential chromatin regulator for var gene regulation and parasite development in Plasmodium falciparum
Authors: Wang Wei-Feng , Zhang Yi-Long
Published: March 2020

Background

Various transcription factors are involved in the process of mutually exclusive expression and clonal variation of thePlasmodiummultigene (var) family. Recent studies revealed that aP. falciparumSWI/SNF-related matrix-associated actin-dependent regulator of chromatin (PfSWIB) might trigger stage-specific programmed cell death (PCD), and was not only crucial for the survival and development of parasite, but also had profound effects on the parasite by interacting with other unknown proteins. However, it remains unclear whetherPfSIWBis involved in transcriptional regulation of this virulence gene and its functional properties.

Methods

A conditional knockdown system “PfSWIB-FKBP-LID” was introduced to the parasite clone 3D7, and an integrated parasite line “PfSWIB-HA-FKBP-LID” was obtained by drug cycling and clone screening. Growth curve analysis (GCA) was performed to investigate the growth and development of different parasite lines during 96 hin vitroculturing, by assessing parasitemia. Finally, we performed qPCR assays to detectvargene expression profiling in various comparison groups, as well as the mutually exclusive expression pattern of thevargenes within a single 48 h life-cycle ofP. falciparumin different parasite lines. In addition, RNA-seq was applied to analyze thevargene expression in different lines.

Results

GCA revealed that conditional knockdown ofPfSWIBcould interfere with the growth and development ofP. falciparum. The parasitemia ofPfSWIB∆showed a significant decline at 96 h duringin vitroculture compared with thePfSWIBand 3D7 lines (P < 0.0001). qPCR and RNA-seq analysis confirmed that depletion ofPfSWIBnot only silencesupsA,upsCand partialupsB vargenes, as well as removes the silencing of partialupsB vargenes at the ring stage inPfSWIB∆line, but also leads to aberrant expression ofupsAand partialupsB/upsC vargenes at the mature stage ofP. falciparum, during a single 48-h life-cycle.

Conclusions

We demonstrated thatPfSWIBwas involved in the process of clonal variation invargene expression, and crucial for the survival and development ofPlasmodiumparasite. These findings could provide better understanding of the mechanism and function ofPfSWIBcontributing to the pathogenesis in malaria parasites.
Knowledge of prevention of mother to child transmission of HIV among women of reproductive age group and associated factors at Mecha district, Northwest Ethiopia
Authors: Liyeh Tewachew Muche , Cherkose Endeshaw Admasu , Limenih Miteku Andualem , Yimer Tigist Seid , Tebeje Hailemariam Demewozu
Published: March 2020

Objective

This study was aimed to asses knowledge of prevention of mother to child transmission of HIV among reproductive age women and associated factors at Mecha district, North West Ethiopia. A community based cross sectional study was conducted among 853 reproductive age women from July 1- 30/2016 in Mecha district. By multistage sampling technique data were collected through pre-tested questionnaire. The collected data was entered in Epi Data 3.1 and analyzed with SPSS version 20. Bivariate and multivariable logistic regression model were used.

Result

About 22.4% of the respondents were knowledgeable on prevention of mother to child transmission (PMTCT) of HIV. Having knowledge on PMTCT of HIV was significantly associated with urban residence (AOR = 2.486, 95% CI 1.160–5.328), education level of secondary and above (AOR = 5.445, 95% CI 2.698–10.986), those having history of antenatal care followup (AOR = 4.430, 95% CI 1.471–13.340), those with history of institutional delivery (AOR = 4.766, 95%CI 2.004–11.334), those having comprehensive knowledge on HIV/AIDS (AOR = 1.697, 95%CI 1.011–2.846), women who were knowledgeable about mother to child transmission of HIV (AOR = 2.203, 95% CI 1.37–3.54), and women who held discussions with their husband regarding HIV/AIDS, (AOR = 2.700, 95% CI 1.658–4.396).
CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy
Authors: Bégin P. , Chan E. S. , Kim H. , Wagner M. , Cellier M. S. , Favron-Godbout C. , Abrams E. M. , Ben-Shoshan M. , Cameron S. B. , Carr S. , Fischer D. , Haynes A. , Kapur S. , Primeau M. N. , Upton J. , Vander Leek T. K. , Goetghebeur M. M.
Published: March 2020

Background

Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice.

Objective

To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management.

Materials and methods

Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations.

Results

The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients’ needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations.

Conclusions

This innovative CPG methodology was guided by patients’ perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need.
A general stability result for second order stochastic quasilinear evolution equations with memory
Authors: Yang Hui , Fang Shiyue , Liang Fei , Li Min
Published: March 2020

The goal of this paper is to discuss an initial boundary value problem for the stochastic quasilinear viscoelastic evolution equation with memory driven by additive noise. We prove the existence of global solution and asymptotic stability of the solution using some properties of the convex functions. Moreover, our result is established without imposing restrictive assumptions on the behavior of the relaxation function at infinity.
Effects of dietary hemp seed oil to sows on fatty acid profiles, nutritional and immune status of piglets
Authors: Vodolazska D. , Lauridsen C.
Published: March 2020

Background

The oil from industrial hemp seeds (Cannabis sativa) is an ideal source of stearidonic acid, which is a precursor fatty acid for the long-chained n-3 polyunsaturated fatty acids. These fatty acids are important for neonatal development, health and immunity. Hemp seed oil has been investigated for the influence on human health, but research on the impact in pig nutrition is scarce. The aim of our research was to study the effect of dietary hemp seed oil relative to soybean oil to lactating sows on the transfer of fatty acids to the off-spring and the effect on piglets’ immune and nutritional status.

Results

The fatty acid composition of the hemp seed and the soybean oil influenced the fatty acid composition of sow plasma, colostrum and mature milk. The highest proportion of C18:3n-3, C18:4n-3 and C20:4n-6 was obtained in mature milk fat of sows fed 5% hemp seed oil diet when compared to the other dietary fat sources (5% soybean oil or a 50:50 mix of hemp and soybean oil at 5%). The effect of dietary oil supplementation to sows was reflected in the plasma fatty acids profile of piglets. Notably the proportion of C20:5n-3 and C22:5n-3 was the highest in plasma of piglets suckling sows fed hemp seed oil-containing diets, whereas no C18:4n-3 could be detected hence indicating conversion of α-linolenic acid (ALA) and stearidonic acid (SDA) to the longer chained n-3 polyunsaturated fatty acids. Dietary fat source also influenced number of born piglets, their weight gain during first week, plasma concentration of glucose and IgG, and haematological profile.

Conclusions

The hemp seed oil resulted in direct maternal supply with n-3 long-chain polyunsaturated fatty acids (LCPUFA), especially ALA and SDA, and piglets were able to convert these fatty acids obtained via the sow milk intake to C20:5n-3 and C22:5n-3. Furthermore, some interesting effects of the 5% hemp seed oil was obtained with regard to piglet initial body weight gain and glucose, which could be of interest for further research, i.e., the capability of hemp seed oil to benefit piglets during early life.
Population dynamics, pathogen detection and insecticide resistance of mosquito and sand fly in refugee camps, Greece
Authors: Fotakis Emmanouil Alexandros , Giantsis Ioannis Apostolou , Castells Sierra Javier , Tanti Filianna , Balaska Sofia , Mavridis Konstantinos , Kourtidis Sofoklis , Vontas John , Chaskopoulou Alexandra
Published: March 2020

Background

As of 2015 thousands of refugees are being hosted in temporary refugee camps in Greece. Displaced populations, travelling and living under poor conditions with limited access to healthcare are at a high risk of exposure to vector borne disease (VBD). This study sought to evaluate the risk for VBD transmission within refugee camps in Greece by analyzing the mosquito and sand fly populations present, in light of designing effective and efficient context specific vector and disease control programs.

Methods

A vector/pathogen surveillance network targeting mosquitoes and sand flies was deployed in four temporary refugee camps in Greece. Sample collections were conducted bi-weekly during June–September 2017 with the use of Centers for Disease Control (CDC) light traps and oviposition traps. Using conventional and molecular diagnostic tools we investigated the mosquito/sand fly species composition, population dynamics, pathogen infection rates, and insecticide resistance status in the major vector species.

Results

Important disease vectors including Anopheles sacharovi, Culex pipiens, Aedes albopictus and the Leishmania vectors Phlebotomus neglectus, P. perfiliewi and P. tobbi were recorded in the study refugee camps. No mosquito pathogens (Plasmodium parasites, flaviviruses) were detected in the analysed samples yet high sand fly Leishmania infection rates are reported. Culex pipiens mosquitoes displayed relatively high knock down resistance (kdr) mutation allelic frequencies (ranging from 41.0 to 63.3%) while kdr mutations were also detected in Ae. albopictus populations, but not in Anopheles and sand fly specimens. No diflubenzuron (DFB) mutations were detected in any of the mosquito species analysed.

Conclusions

Important disease vectors and pathogens in vectors (Leishmania spp.) were recorded in the refugee camps indicating a situational risk factor for disease transmission. The Cx. pipiens and Ae. albopictus kdr mutation frequencies recorded pose a potential threat against the effectiveness of pyrethroid insecticides in these settings. In contrast, pyrethroids appear suitable for the control of Anopheles mosquitoes and sand flies and DFB for Cx. pipiens and Ae. albopictus larvicide applications. Targeted actions ensuring adequate living conditions and the establishment of integrated vector-borne disease surveillance programs in refugee settlements are essential for protecting refugee populations against VBDs.
A comparison on visual prediction models for MAMO (multi activity-multi object) recognition using deep learning
Authors: Padmaja Budi , Myneni Madhu Bala , Krishna Rao Patro Epili
Published: March 2020

Multi activity-multi object recognition (MAMO) is a challenging task in visual systems for monitoring, recognizing and alerting in various public places, such as universities, hospitals and airports. While both academic and commercial researchers are aiming towards automatic tracking of human activities in intelligent video surveillance using deep learning frameworks. This is required for many real time applications to detect unusual/suspicious activities like tracking of suspicious behaviour in crime events etc. The primary purpose of this paper is to render a multi class activity prediction in individuals as well as groups from video sequences by using the state-of-the-art object detector You Look only Once (YOLOv3). By optimum utilization of the geographical information of cameras and YOLO object detection framework, a Deep Landmark model recognize a simple to complex human actions on gray scale to RGB image frames of video sequences. This model is tested and compared with various benchmark datasets and found to be the most precise model for detecting human activities in video streams. Upon analysing the experimental results, it has been observed that the proposed method shows superior performance as well as high accuracy.
Effects of a regenerating matrix on the survival of birds in tropical forest fragments
Authors: Wolfe Jared D. , Stouffer Philip C. , Bierregaard Richard O. , Luther David A. , Lovejoy Thomas E.
Published: March 2020

Background

Vast areas of lowland neotropical forest have regenerated after initially being cleared for agricultural purposes. The ecological value of regenerating second growth to forest-dwelling birds may largely depend on the age of the forest, associated vegetative structure, and when it is capable of sustaining avian demographics similar to those found in pristine forest.

Methods

To determine the influence of second growth age on bird demography, we estimated the annual survival of six central Amazonian bird species residing in pristine forest, a single 100 and a single 10 ha forest fragment, taking into consideration age of the surrounding matrix (i.e. regenerating forest adjacent to each fragment) as an explanatory variable.

Results

Study species exhibited three responses: arboreal, flocking and ant-following insectivores (Willisornis poecilinotus, Thamnomanes ardesiacus and Pithys albifrons) showed declines in survival associated with fragmentation followed by an increase in survival after 5 years of matrix regeneration. Conversely, Percnostola rufifrons, a gap-specialist, showed elevated survival in response to fragmentation followed by a decline after 5 years of regeneration. Lastly, facultative flocking and frugivore species (Glyphorynchus spirurus and Dixiphia pipra, respectively) showed no response to adjacent clearing and subsequent regeneration.

Conclusions

Our results in association with previous studies confirm that the value of regenerating forest surrounding habitat patches is dependent on two factors: ecological guild of the species in question and second growth age. Given the rapid increase in survival following succession, we suggest that the ecological value of young tropical forest should not be based solely on a contemporary snapshot, but rather, on the future value of mature second growth as well.
Bone plate repositioned over the antrostomy after sinus floor elevation: an experimental study in sheep
Authors: Perini Alessandro , Ferrante Giada , Sivolella Stefano , Velez Joaquín Urbizo , Bengazi Franco , Botticelli Daniele
Published: March 2020

The objective of this study was to compare the healing of the augmented sinus at which the antrostomy was covered with a membrane or the repositioned bone plate.

Eight sheep underwent bilateral maxillary sinus floor augmentation. The control site was covered with a resorbable membrane, while at the experimental site the bone plate was repositioned, and both were secured with cyanoacrylate. Animals were euthanised after 4 months and histomorphometric analysis was performed.

A large amount of the graft appeared to be partially interpenetrated by the newly formed bone. Statistical analysis demonstrated different percentages of the new bone and bone interpenetrated to the graft between test and control site in the close-to-window area respectively 22.1 ± 12.6 vs 7.5 ± 4.5 (P= 0.028) and 66.1 ± 14.7 vs 44.2 ± 15.1 (P= 0.046). Other areas showed no difference in the bone and graft amount. More bone was found at the edges of the antrostomy in the experimental site, without statistical significance. In the centre of the antrostomy, the replaced bony window appeared bonded to the newly formed bone. No remnants and no biological response to cyanoacrylate were observed.

The repositioning of the bony window after sinus floor elevation in sheep led to a larger amount of newly formed bone in the close-to-window zone of the grafted area. The bony window appeared partially bonded to the new bone. Newly formed bone was found interpenetrating the graft granules.
Laparoscopic surgery for two patients with strangulated transomental hernias
Authors: Fujimoto Yuka , Ohya Yuki , Hayashida Shintaro , Iizaka Masayoshi , Maeda Yuto , Kumamoto Sayahito , Tsuji Akira , Shibata Hidekatsu , Kuramoto Kunitaka , Hayashi Hironori , Nakahara Osamu , Tomiyasu Shinjiro , Inomata Yukihiro
Published: March 2020

Background

Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability.

Case presentation

The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6.

Conclusion

Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.
Grade IV traumatic pancreatic injury with primary duodenum malignant lymphoma following pancreatoduodenectomy: a case report
Authors: Ono Kosuke , Abe Tomoyuki , Amano Hironobu , Yonehara Shuji , Kobayashi Tsuyoshi , Nakahara Masahiro , Ohdan Hideki , Noriyuki Toshio
Published: March 2020

Background

Traumatic pancreatic injury with a main pancreatic duct injury has a high incidence of mortality and requires a prompt and appropriate treatment. However, the best approach, and treatment options, which may be limited, remains controversial especially for the elderly patients. Herein, we present a case of traumatic pancreatic injury in an elderly patient for whom pancreatoduodenectomy was safe and effective.

Case presentation

An 87-year-old man was diagnosed with a traumatic pancreatic injury with a main pancreatic duct injury. In addition, the horizontal segment of the duodenum was largely eradicated. There were no comorbidities, and his vital signs were stable. A pancreatoduodenectomy was performed. The postoperative course was uneventful, and he was discharged. Pathological examination revealed a primary follicular lymphoma of the duodenum.

Conclusions

This case demonstrated that pancreatoduodenectomy could be performed safely for a severe pancreatic injury in an elderly patient. However, special attention should be paid to select the optimal surgical procedure. Further, this was a rare case, as initially a primary follicular lymphoma of the duodenum was suspected as a duodenal injury coexisting with a traumatic pancreatic injury because of the increased duodenal thickness.
Vitamin D status among postmenopausal osteoporotic women: a hospital based cross-sectional study from Northern Sri Lanka
Authors: Suganthan Navaneethakrishnan , Kumanan Thirunavukarasu , Kesavan Vithegi , Aravinthan Mahalingam , Rajeshkannan Nadarajah
Published: March 2020

Background

Vitamin D deficiency is common among post-menopausal women and it is important to treat vitamin D deficiency to prevent falls and fractures in patients with osteoporosis. Few studies examined the prevalence of vitamin D deficiency in general population of Sri Lanka but no studies to date done among post-menopausal women with osteoporosis in Sri Lanka. This is the first study in Sri Lanka of such kind conducted to evaluate the serum vitamin D levels among postmenopausal women.

Methods

Cross-sectional study was conducted at the Endocrine Unit, Teaching Hospital Jaffna from January to December 2018. During this period 105 postmenopausal women who registered for bone density assessment were recruited to the study. Data collection was done by investigators and blood sample was taken from each participant by registered nurses and total 25-Hydroxy Vitamin D level (25(OH)-Vit D) was measured by competitive immunoassay with enhanced chemiluminiscence technique, levels were categorized and analysis was done using SPSS 26.

Results

Mean age of 105 postmenopausal women was 67.7 with minimum 33 and maximum 84 years. Mean total 25(OH)-Vit D was 27.5 (range11.7–52.5 ng/mL). 25(OH)-Vit D levels were adequate in only 36.2% (95%CI: 27–45), 44% had insufficient levels and deficiency was present in 19% (95%CI: 12–27) of postmenopausal women. Among total study participants 20% were vegetarian, 53, 76.2 and 64.8% were consuming milk, fish and egg respectively and 71.4% reported adequate level of sun exposure (> 30 min/day). Commonly reported vitamin D deficiency symptoms include paraesthesia (57.1%), bone-pain (55.2%), easy fatigability (54.3%), malaise (51.4%), muscle cramps (43.8%) and proximal myopathy (40.0%). Nevertheless, comparison of musculoskeletal symptoms between group with sufficient level and group with insufficient and deficient level showed no significant difference (P > 0.05). Among 71 participants (66.7%) who completed bone density assessment, 38% (95%CI: 27–49) showed osteoporosis. Vertebral Z score showed a significant correlation with 25(OH)-Vit D level (r-0.252, P-0.03).

Conclusion

Prevalence of vitamin D deficiency is relatively high among the post-menopausal women with a provisional diagnosis of osteoporosis. It is essential to consider vitamin D supplementation when initiating treatment for osteoporosis. Hence, Vitamin D testing is desirable in decision making to treat or not to treat.