bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Flipped Classroom Model: A Case Study from Oman
Authors: Pandow Bilal Ahmad , Inan Nihan Kutahnecioglu , S. Ananda
Published: March 2020

The flipped learning approach over the years has gained importance, especially in higher educational establishments that primarily focus on more personalized learning for the students. In this context, the current study evaluates a flipped learning approach which was implemented by a higher education institution from the Middle East region as a pilot project and analyses the impact of the flipped approach on the student performance from the educators’ perspective. The study focuses on different aspects like the impact of the flipped approach on student performance in a different type of assessments, the impact of the flipped approach on academic performance, learning and development, and academic support activities. Also, this article analyses whether flipped learning reduces the plagiarism cases, impact on student attendance, student participation in extracurricular activities, impact on student’s knowledge, influence on student collaboration, effect on improvement in the ability to solve problems and impact of this approach on helping students to take the responsibility of their learning and become self-learners. This study empirically identified the learning outcomes from a flipped class and provides recommendations for the educators and higher education institutions for successful implementation of the flipped learning approach.
Training With Lighter Baseballs Increases Velocity Without Increasing the Injury Risk
Authors: Erickson Brandon J. , Atlee Thomas R. , Chalmers Peter N. , Bassora Rocco , Inzerillo Christopher , Beharrie Andrew , Romeo Anthony A.
Published: March 2020

Background:

Pitch velocity has become an increasingly popular metric by which pitchers are graded and compared. Training programs that utilize weighted balls have been effective in increasing velocity but at the cost of an increased injury risk. No studies have evaluated training with lighter baseballs with regard to increasing pitch velocity and the injury risk.

Purpose/Hypothesis:

The purpose of this study was to determine whether a training program utilizing lighter baseballs could increase fastball velocity without increasing the injury risk to participants. We hypothesized that a training program with lighter baseballs would increase fastball velocity but not increase the injury risk.

Study Design:

Case series; Level of evidence, 4.

Methods:

All baseball pitchers who participated in a 15-week program at a single location, with the same coaches, and aimed to improve pitching mechanics and increase velocity were included. The training program was broken down into 3 phases, and each participant went through the same program. Lighter baseballs (3 and 4 oz) and standard baseballs (5 oz) were utilized as part of the training program. Weighted (heavier) balls were not used. Velocity was measured at 4 time points throughout the program with the pitcher throwing 5 fastballs using a standard 5-oz ball at maximum velocity (sessions 3, 10, 17, and 25). Injuries for all players were recorded throughout the entire program.

Results:

A total of 44 male pitchers aged 10 to 17 years (mean age, 14.7 ± 1.8 years) completed the training program and were available for analysis. No pitcher sustained a shoulder or elbow injury during the course of the training program. Fastball velocity increased by a mean of 4.8 mph (95% CI, 4.0-5.6 mph) ( P < .001). Overall, 43 of 44 players (98%) had an increase in fastball velocity over the course of the program.

Conclusion:

A 15-week pitching training program with lighter baseballs significantly improved pitching velocity without causing any injuries, specifically to the shoulder or elbow. Lighter baseballs should be considered as an alternative to weighted baseballs when attempting to increase a pitcher’s velocity.
A statistical shape grammar approach to analysing and generating design instances of Murcutt’s domestic architecture
Authors: Lee Ju Hyun , Ostwald Michael J , Gu Ning
Published: March 2020

This paper develops a statistical approach to measuring and guiding grammatical applications using a descriptive shape grammar, ‘Murcutt Grammar’. Normalised Distance ( ND) is proposed to identify the level of disparity of each design instance. Alternative design instances are generated using rule transition paths that illustrate the transition sequences of the grammar application (transition probability). The results demonstrate that this approach is significant for the way it clearly generates design instances with their grammatical levels of disparity, as well as for generating more appropriate design instances in the language. This shape grammar approach is applicable to design research more generally in the field of architecture.
CARASIL with coronary artery disease and distinct cerebral microhemorrhage: A case report and literature review
Authors: Müller Sebastian J , Khadhraoui Eya , Allam Ibrahim , Argyriou Loukas , Hehr Ute , Liman Jan , Hasenfuß Gerd , Bähr Mathias , Riedel Christian H , Koch Jan C
Published: March 2020

Cerebral Autosomal Recessive Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CARASIL, Maeda syndrome) is an extremely rare autosomal-recessive genetic disorder with a serious arteriopathy causing subcortical infarcts and leukoencephalopathy. In less than 20 cases, a genetic mutation was proven. Patients suffer from alopecia, disc herniations, and spondylosis. Between the age of 30 and 40, the patients typically develop severe cerebral infarcts. Clinical symptoms, genetic study, magnetic resonance imaging (MRI), and coronary angiography of a patient with proven CARASIL are presented. The patient showed the typical phenotype with cerebral small-vessel disease, cerebral infarcts, spondylosis, and abnormal hair loss. Additionally, distinct cerebral microhemorrhage and a severe coronary artery disease (CAD) were found, which have not been reported before for CARASIL. Mutation screening revealed the presence of a homozygous c.1022G > T substitution in the HTRA1 gene. Evidence from other publications supports a pathogenetic link between the HTRA1 mutation and CAD as a new feature of CARASIL. This is the first report about CARASIL with a concomitant severe CAD. Thus, in patients with CARASIL, other vessel diseases should also be considered.
A DOE approach to optimize the strength properties of concrete incorporated with different ratios of PVA fibre and nano-Fe2O3
Authors: Cibilakshmi G , Jegan J
Published: March 2020

The purpose of this research is to optimize the fresh and strength properties of concrete with various incorporation ratios of polyvinyl alcohol (PVA) fibre and nano-Fe2O3 by design of experiment approach. Central composite design of response surface methodology was used to acquire the optimal composition of process variables, and the influence of process variable on the fresh and strength properties of concrete was also verified. A total of five responses ( Y Slump, f ck,7, f ck,28, f t,7 and f t,28) were considered in this study, and the factors and the level of each response was 2 and 3, respectively. Regression models for Y Slump, f ck,7, f ck,28, f t,7 and f t,28 were tested; the statistical significance of each process variable was assessed through analysis of variance and Pareto chart, and the obtained models were expressed in the form of second-order polynomial equation. The test results revealed that incorporation of PVA and high-reactive nano-Fe2O3 improved the strength of the concrete; however, the higher level incorporation exhibited unpronounced effect on the strength enhancement. The incorporation of nano-Fe2O3 enhanced the compressive strength to the maximum of 7.44%. The high-reactive nano-Fe2O3 accelerated the hydration process of concrete and enhanced the particle packing density of the concrete by filling the micropores. However, the higher incorporation of nano-Fe2O3 leached out the surplus silica from the concrete and reduced the strength enhancement of the cement composite matrix. The regression analysis results revealed that the most significant and contribution factor for f ck,7 and f ck,28 is the linear term nano-Fe2O3 ( X 2), 99.81% contribution, and for f t,7 and f t,28 is the linear term PVA ( X 1), 75.75% contribution. Pareto chart and surface plot analysis also revealed the same as above. The optimal proportion of design variables against f ck,7, f ck,28, f t,7 and f t,28 were obtained and the percentage of error of the confirmation tests for Y Slump, f ck,7, f ck,28, f t,7 and f t,28 were less than 3%.
The safety of isoniazid tuberculosis preventive treatment in pregnant and postpartum women: systematic review and meta-analysis
Authors: Hamada Yohhei , Figueroa Carmen , Martín-Sánchez Mario , Falzon Dennis , Kanchar Avinash
Published: March 2020

Background

The World Health Organization (WHO) recommends tuberculosis (TB) preventive treatment for high-risk groups. Isoniazid preventive therapy (IPT) has been used globally for this purpose for many years, including in pregnancy. This review assessed current knowledge about the safety of IPT in pregnancy.

Methods

We searched PubMed, Embase, CENTRAL, Global Health Library and HIV and TB-related conference abstracts, until May 15, 2019, for randomised controlled trials (RCTs) and non-randomised studies (NRS) where IPT was administered to pregnant women. Outcomes of interest were: 1) maternal outcomes, including permanent drug discontinuation due to adverse drug reactions, any grade 3 or 4 drug-related toxic effects, death from any cause and hepatotoxicity; and 2) pregnancy outcomes, includingin uterofetal death, neonatal death or stillbirth, preterm delivery/prematurity, intrauterine growth restriction, low birth weight and congenital anomalies. Meta-analyses were conducted using a random-effects model.

Results

After screening 1342 citations, nine studies (of 34 to 51 942 participants) met inclusion criteria. We found an increased likelihood of hepatotoxicity among pregnant women given IPT (risk ratio 1.64, 95% CI 0.78–3.44) compared with no IPT exposure in one RCT. Four studies reported on pregnancy outcomes comparing IPT exposure to no exposure among pregnant women with HIV. In one RCT, adverse pregnancy outcomes were associated with IPT exposure during pregnancy (odds ratio (OR) 1.51, 95% CI 1.09–2.10), but three NRS showed a protective effect.

Conclusions

We found inconsistent associations between IPT and adverse pregnancy outcomes. Considering the grave consequences of active TB in pregnancy, current evidence does not support systematic deferral of IPT until postpartum. Research on safety is needed.
Effects of aging on the quality of roasted sesame-like flavor Daqu
Authors: Fan Guangsen , Fu Zhilei , Teng Chao , Liu Pengxiao , Wu Qiuhua , Rahman Md Khondakar Raziur , Li Xiuting
Published: March 2020

Background

Daqu, the saccharification, fermentation, and aroma-producing agents for Baijiu brewing, is prepared using a complex process. Aging is important for improving the quality of Daqu, but its impact has rarely been studied. This study investigated changes in the physicochemical properties, flavor compounds, and microbial communities during aging of Daqu with a roasted sesame-like flavor.

Results

The physicochemical properties changed continuously during aging to provide a high esterifying activity. Aging removed unpleasant flavor compounds and helped to stabilize the flavor compounds in mature Daqu. A high-throughput sequencing approach was used to analyze the changing composition of the microbial communities during aging. Aging helped to modify the microbial population to produce better Baijiu by eliminating low-abundance microbial communities and optimizing the proportion of predominant microbial communities. Nine genera of prokaryotic microbes formed the core microbiota in Daqu after aging. Regarding eukaryotic microbes, Zygomycota, the predominant community, increased in the first 2 months, then decreased in the third month of aging, while Ascomycota, the subdominant community, showed the opposite behavior. Absidia, Trichocomaceae_norank and Rhizopus were the predominant genera in the mature Daqu.

Conclusions

Significant correlations between microbiota and physicochemical properties or flavor compounds were observed, indicating that optimizing microbial communities is essential for aging Daqu. This study provides detailed information on aging during Daqu preparation.
On estimating the time to statistical cure
Authors: Jakobsen Lasse H. , Andersson Therese M.-L. , Biccler Jorne L. , Poulsen Laurids Ø. , Severinsen Marianne T. , El-Galaly Tarec C. , Bøgsted Martin
Published: March 2020

Background

The mortality risk among cancer patients measured from the time of diagnosis is often elevated in comparison to the general population. However, for some cancer types, the patient mortality risk will over time reach the same level as the general population mortality risk. The time point at which the mortality risk reaches the same level as the general population is called the cure point and is of great interest to patients, clinicians, and health care planners. In previous studies, estimation of the cure point has been handled in an ad hoc fashion, often without considerations about margins of clinical relevance.

Methods

We review existing methods for estimating the cure point and discuss new clinically relevant measures for quantifying the mortality difference between cancer patients and the general population, which can be used for cure point estimation. The performance of the methods is assessed in a simulation study and the methods are illustrated on survival data from Danish colon cancer patients.

Results

The simulations revealed that the bias of the estimated cure point depends on the measure chosen for quantifying the excess mortality, the chosen margin of clinical relevance, and the applied estimation procedure. These choices are interdependent as the choice of mortality measure depends both on the ability to define a margin of clinical relevance and the ability to accurately compute the mortality measure. The analysis of cancer survival data demonstrates the importance of considering the confidence interval of the estimated cure point, as these may be wide in some scenarios limiting the applicability of the estimated cure point.

Conclusions

Although cure points are appealing in a clinical context and has widespread applicability, estimation remains a difficult task. The estimation relies on a number of choices, each associated with pitfalls that the practitioner should be aware of.
Oral cavity swabbing for diagnosis of group a Streptococcus: a prospective study
Authors: Adler Limor , Parizade Miriam , Koren Gideon , Yehoshua Ilan
Published: March 2020

Background

Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture, molecular test or a rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the study is to compare cultures from the tonsils or posterior pharyngeal wall (throat) with cultures from the oral cavity (mouth).

Methods

A prospective study conducted in ambulatory care. Eleven family physicians collected 2 swabs (throat and mouth) from 200 consecutive patients who complaint about throat pain. Inclusion criteria were throat pain and Centor Criteria > 2. Exclusion criteria were tonsillectomy and age (< 3 or > 65 years old). Participants were later divided into two groups – pediatrics (3–18 years old) and adults (19–65 year old). Sensitivity and specificity of mouth culture were calculated, with throat culture considered the reference gold standard.

Results

Between November 2017 and March 2019, 200 swabs were collected (101 adults and 99 children). In the adult group sensitivity of mouth culture was 72.1% (95% Confidence Interval [CI] 59.9–82.3%) and specificity was 100% (95% CI 92.7–89.4%-100%). In the pediatric group sensitivity of mouth culture was 78.3% (95% CI 65.8–87.9%) and specificity was 100% (95% CI 92.5–100%).

Conclusion

Our study demonstrated higher sensitivity of mouth culture for GAS than previously published. This finding suggests that areas of the oral cavity that were considered as unacceptable sites for culture of GAS pharyngitis may be considered as acceptable swabbing sites.

Trial registration

Trial registration: ClinicalTrials.gov, ID NCT03137823. Registered 3 May 2017.
Knowledge and skills required to perform point-of-care ultrasonography in family practice – a modified Delphi study among family physicians in Slovenia
Authors: Homar Vesna , Gale Zala Kumse , Lainscak Mitja , Svab Igor
Published: March 2020

Background

More and more family physicians (FPs) are using point-of-care ultrasonography (POCUS) in Europe. Still, there is no general consensus about the specific knowledge and skills that a FP should acquire in order to effectively perform POCUS. The objective of this study was to identify indications for the use of POCUS among FPs, explore the barriers of its use and provide an expert opinion of FPs on knowledge and skills required to effectively implement POCUS in family practice.

Methods

A modified two-round Delphi study was carried out among FPs using POCUS in Slovenia.

Results

21 FPs were invited to participate in the study. A total of 13 FPs (62%) responded the round-one questionnaire and 10 (48%) completed the round-two questionnaire. Results show a large variability of indications for the use of POCUS in family practice, the most common being acute abdominal conditions, lung ultrasonography and eyeballing echocardiography. In contrast, the results show little variability in barriers for the use of POCUS, the most common being lack of time, inaccessibility of specific training programmes and financial issues. There is a strong consensus on the knowledge and skills needed to perform POCUS. Panellists agreed on a learning medical knowledge, technical skills and expressed a need for individual consultations and tutorship options.

Conclusion

This study proves that although POCUS is used in family practice for a wide variety of indications with a significant number of barriers, there is a strong consensus on what a FP needs to know to effectively perform POCUS.
Correction to: Study protocol for a randomized control trial to investigate the effectiveness of an 8-week mindfulness-integrated cognitive behavior therapy (MiCBT) transdiagnostic group intervention for primary care patients
Authors: Francis Sarah , Shawyer Frances , Cayoun Bruno , Enticott Joanne , Meadows Graham
Published: March 2020

After publication of our article [1] the authors have notified us that one of the names has been incorrectly spelled.
Dating SOS: a systematic and theory-based development of a web-based tailored intervention to prevent dating violence among Brazilian youth
Authors: Murta Sheila Giardini , Parada Priscila de Oliveira , da Silva Meneses Sara , Medeiros João Victor Venâncio , Balbino Amanda , Rodrigues Marina Caricatti , Miura Marco Akira , dos Santos Thiago André Araújo , de Vries Hein
Published: March 2020

Background

Dating violence has an alarming prevalence among Brazilian adolescents. School-based preventive programs have been implemented, but remain isolated initiatives with low reach. Health communication strategies based on innovative technologies with a high potential of diffusion are urgent. This study aimed to develop a computer-tailored intervention to prevent victimization and perpetration of dating violence among Brazilian youth.

Methods

The intervention, called Dating SOS (SOS Namoro), is based on the I-Change Model and attachment theory and is a comprehensive preventive program targeted to young people with a current partner. The intervention design included the stages of needs assessment; definition of objectives of change; development of the library of messages; elaboration of a questionnaire for tailoring feedbacks according to the relevant variables; integration of the content in the software Tailor Builder; pre-testing; and usability and efficacy evaluation planning. Dating SOS is composed of four online sessions. The first session gives a tailored orientation on attachment style and risk perception of violence. The second session addresses knowledge on conflict management, positive and negative social models of intimate relationships and an action plan to improve everyday interactions. The third session covers social norms, self-efficacy and an action plan to cope with conflicts. The fourth session discusses attitudes, social support and an action plan to protect from violence. Improvements on the interface and tailoring refinement was done after pre-testing to improve attractiveness and decrease risk of iatrogenic effects.

Discussion

The principal merit of the present study resides in the development of an innovative strategy based on the qualified use of the internet for education surrounding romantic relationships and the prevention of dating violence among adolescent and young Brazilians, a hitherto unaddressed need in the field. The intervention usability and efficacy should be investigated in further studies.

Trial registration

Brazilian Registry of Clinical Trials. RBR-9frj8q. Prospectively registered on July 25, 2019. http://www.ensaiosclinicos.gov.br/rg/RBR-9frj8q/
Managing mental health: why we need to redress the balance between healthcare spending and social spending
Authors: Park Daniel S. , Han Jing , Torabi Mahmoud , Forget Evelyn L.
Published: March 2020

Background

Mental health outcomes vary widely among high-income countries, although mental health problems represent an increasing proportion of the burden of disease for all countries. This has led to increased demand for healthcare services, but mental health outcomes may also be particularly sensitive to the availability of social services. This paper examines the variation in the absolute and relative amounts that high-income countries spend on healthcare and social services to determine whether increased expenditure on social services relative to healthcare expenditure might be associated with better mental health outcomes.

Methods

This paper estimates the association between patterns of government spending and population mental health, as measured by the death rate resulting from mental and behavioural disorders, across member countries of the Organisation for Economic Cooperation and Development (OECD). We use country-level repeated measures multivariable modelling for the period from 1995 to 2016 with region and time effects, adjusted for total spending and demographic and economic characteristics. Healthcare spending includes all curative services, long-term care, ancillary services, medical goods, preventative care and administration whilst social spending consists of all transfer payments made to individuals and families as part of the welfare state.

Results

We find that a higher ratio of social to healthcare expenditure is associated with significantly better mental health outcomes for OECD populations, as measured by the death rate resulting from mental and behavioural disorders. We also find that there is no statistically significant association between healthcare spending and population mental health when we do not control for social spending.

Conclusion

This study suggests that OECD countries can have a significant impact on population mental health by investing a greater proportion of total expenditure in social services.
Information-Motivation-Behavioral Skills model of consistent condom use among transgender women in Shenyang, China
Authors: Wang Huwen , Chang Ruijie , Shen Qiuming , Tsamlag Lhakpa , Zhang Shuxian , Shi Yue , Ma Tiecheng , Wang Zixin , She Rui , Lau Joseph T. F. , Wang Ying , Cai Yong
Published: March 2020

Background

The Information-Motivation-Behavioral Skills (IMB) model has received consistent empirical support in the context of HIV prevention among various key populations, but not yet among transgender women (TGW). None effective interventions has been carried out among TGW so far to control their high prevalence of unprotected anal intercourse. The intent of the current study is to examine the application of the IMB model to clarifying the association between condom use correlates and condom use frequency among TGW in China.

Methods

Using snowball sampling, we recruited 198 self-identified TGW in Shenyang, China from April 2017 to July 2017. Participants were required to complete a questionnaire assessing their background characteristics and IMB model constructs. Structural equation modeling (SEM) was conducted to demonstrate the utility of the IMB model.

Results

The consistent condom use (CCU) rate was 47.0%. Results of SEM indicated that HIV-preventive motivation (comprising condom use attitude and subjective norms; β = 0.823, P <  0.001) and behavioral skills (including condom use skills and self-efficacy; β = 0.979, P = 0.004) were related to more frequent condom use, whereas HIV knowledge was unrelated to condom use (β = 0.052, P = 0.540).

Conclusions

The low CCU rate suggested that TGW in China were at high risk of HIV infection and transmission and a key intervention population. HIV-preventive interventions for this population should focus on enhancing motivation and strengthening behavioral skills to increase condom use frequency and reduce HIV infection.
Factors associated with low handgrip strength in older people: data of the Study of Chronic Diseases (Edoc-I)
Authors: de Araújo Amaral Cledir , Amaral Thatiana Lameira Maciel , Monteiro Gina Torres Rego , de Vasconcellos Maurício Teixeira Leite , Portela Margareth Crisóstomo
Published: March 2020

Background

Handgrip strength (HGS) is an important health biomarker whose low scores have been shown to be associated with the morbimortality. This study aimed to analyze the factors associated with low HGS in older people in Rio Branco, Acre, Brazil.

Methods

The study was carried out with data from the Study of Chronic Diseases (EDOC-I) – Older People, a cross-sectional household PAPI probability sample survey performed with 1016 people aged over 60 residing in Rio Branco in 2014. The low HGS was defined by the 20th percentile of the maximum HGS by sex and age group. Associations between variables of health status (psychological and physical) and low HGS, by sex, were estimated using logistic regression, expressed by adjusted ORs (aOR).

Results

Older individuals had lower median HGS than younger individuals (− 6.0 kg among men and − 2.6 kg among women). Women aged over 80 had, on average, the lower quintile of HGS compared to women of the previous age groups. Factors independently associated with low HGS in men and women, respectively, were low weigh in body mass index [(aOR = 2.80; 95%CI: 1.19, 6.61) and (aOR = 2.61; 95%CI: 1.46, 4.66)], anemia [(aOR = 4.15; 95%CI: 2.09, 8.21) and (aOR = 1.80; 95%CI: 1.06, 3.06)] and diabetes as a risk factor in men (aOR 1.95; 95%CI: 1.00, 3.81). There was a higher chance of low HGS in men with partners (aOR = 2.44; 95%CI: 1.32, 4.51), smokers or former smokers (aOR = 3.25; 95%CI: 1.25, 8.44), with current self-assessment of health worse than the 12 previous months (aOR = 2.21; 95%CI: 1.14, 4.30) and dependence in activities of daily living (aOR = 2.92; 95%CI: 1.35, 6.30). Only among women, there was an increased chance of low HGS associated with altered waist-to-hip ratio (aOR = 1.79; 95%CI: 1.02, 3.12), insomnia (aOR = 1.83; 95%CI: 1.10, 3.03) and physical activity from displacement/occupation (aOR = 1.75; 95%CI: 1.08, 2.84).

Conclusion

Factors associated with low HGS are not the same between sexes, and the inclusion of HGS as a component of health assessment seems to be a promising strategy for disease prevention and health promotion.
Gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice: a 24-week randomized controlled trial
Authors: Parkinson C. R. , Milleman K. R. , Milleman J. L.
Published: March 2020

Background

Plaque-induced gingivitis can be prevented and treated with regular effective oral hygiene, principally via mechanical cleaning with regular toothbrushing. To complement the mechanical plaque removal, antimicrobial ingredients can be incorporated into dentifrices to inhibit the growth of plaque. This study aimed to evaluate and compare gingivitis and the proportion of subjects moving between gingivitis severity (< 10, > 10 < 30, > 30% bleeding sites), and plaque reduction, following twice daily use of an experimental non-aqueous 0.454% weight/weight (w/w) stannous fluoride (SnF2) dentifrice, compared to a negative control dentifrice over 12 and 24 weeks.

Method

This was a single-center, examiner-blinded, randomized, stratified, two-treatment arm, parallel group, 24-week clinical study in healthy adult volunteers with moderate gingivitis. At baseline, after abstaining from toothbrushing overnight, subjects underwent MGI (modified gingival index), BI (bleeding index) and PI (plaque index) assessments. Eligible subjects, who met the inclusion/exclusion criteria, were stratified based on gender and baseline mean MGI score (Low ≤2.00 /High > 2.00) and randomized to treatment. Following randomization, subjects underwent a thorough dental prophylaxis and flossing. After 12 and 24 weeks of twice daily brushing with their allocated treatment, subjects returned to the site (with overnight plaque, having abstained from oral hygiene procedures for 8 h prior to visit) for MGI, BI and PI assessments. Treatment effect was evaluated by comparing the MGI, BI and PI scores.

Results

One hundred and twenty-nine subjects were screened; 98 subjects were randomized and 90 subjects completed the study. Statistically significant differences between treatments, in favour of the 0.454% stannous fluoride dentifrice were observed, compared to the negative control dentifrice, for all outcome measures (MGI, BI, bleeding sites and PI at weeks 12 and 24p < 0.0001). At 24 weeks, 71% of subjects in the 0.453% SnF2treatment group demonstrated < 10% of bleeding sites.

Conclusion

A dentifrice containing 0.454% w/w SnF2was shown to be superior to a standard dentifrice in controlling gingivitis and supra-gingival plaque, over a 24-week period. Over two thirds of subjects in the 0.454% SnF2treatment group demonstrated a level of bleeding sites potentially representative of “clinical periodontal health” (< 10%) following a dental prophylaxis and 24 weeks of product use.

Trial registration

This study was retrospectively registered at ClinicalTrials.gov, on 11th Oct. 2019 (NCT04123665).
Prevalence of Mycoplasma genitalium infection in women with bacterial vaginosis
Authors: Nye Melinda B. , Harris Ayla B. , Pherson Amanda J. , Cartwright Charles P.
Published: March 2020

Background

Bacterial vaginosis (BV) is a common condition in reproductive-age women and is known to be positively associated with risk of acquisition of sexually transmitted infections (STI) such as chlamydia and gonorrhea. Mycoplasma genitalium is an emerging STI that has been linked to increased risk of pelvic inflammatory disease, adverse pregnancy outcomes and infertility. In the present study we sought to examine whether women diagnosed with symptomatic BV were at increased risk of having concurrent infection with Mycoplasma genitalium.

Methods

We used a novel PCR-based assay (ResistancePlus MG; SpeeDx Pty. Ltd., Sydney, Australia) to determine the prevalence of Mycoplasma genitalium infection and 23S rRNA macrolide-resistance mediating mutations (MRMM) in a cohort of 1532 women presenting with symptoms of vaginitis.

Results

M. genitalium was detected in 4.0% (62/1532) of samples with 37.1% (23/62) harboring MRMMs. The prevalence of M. genitalium infection in subjects with BV was significantly higher than in subjects with non-BV vaginitis (7.0% v 3.6%; OR = 1.97 (95% CI: 1.14–3.39).

Conclusions

Prevalence of M. genitalium infection is associated with BV in women with symptomatic vaginitis. Improved management of BV is needed as a component of STI prevention strategies.
Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis
Authors: Zhang Gemin , Zhang Jie , Wang Bowen , Zhu Xionglin , Wang Qiang , Qiu Shiming
Published: March 2020

Background

Since December 2019, 2019 novel coronavirus pneumonia emerged in Wuhan city and rapidly spread throughout China and even the world. We sought to analyse the clinical characteristics and laboratory findings of some cases with 2019 novel coronavirus pneumonia .

Methods

In this retrospective study, we extracted the data on 95 patients with laboratory-confirmed 2019 novel coronavirus pneumonia in Wuhan Xinzhou District People’s Hospital from January 16th to February 25th, 2020. Cases were confirmed by real-time RT-PCR and abnormal radiologic findings. Outcomes were followed up until March 2th, 2020.

Results

Higher temperature, blood leukocyte count, neutrophil count, neutrophil percentage, C-reactive protein level, D-dimer level, alanine aminotransferase activity, aspartate aminotransferase activity, α - hydroxybutyrate dehydrogenase activity, lactate dehydrogenase activity and creatine kinase activity were related to severe 2019 novel coronavirus pneumonia and composite endpoint, and so were lower lymphocyte count, lymphocyte percentage and total protein level. Age below 40 or above 60 years old, male, higher Creatinine level, and lower platelet count also seemed related to severe 2019 novel coronavirus pneumonia and composite endpoint, however the P values were greater than 0.05, which mean under the same condition studies of larger samples are needed in the future.

Conclusion

Multiple factors were related to severe 2019 novel coronavirus pneumonia and composite endpoint, and more related studies are needed in the future.
Using gridded population and quadtree sampling units to support survey sample design in low-income settings
Authors: Qader Sarchil Hama , Lefebvre Veronique , Tatem Andrew J. , Pape Utz , Jochem Warren , Himelein Kristen , Ninneman Amy , Wolburg Philip , Nunez-Chaim Gonzalo , Bengtsson Linus , Bird Tomas
Published: March 2020

Background

Household surveys are the main source of demographic, health and socio-economic data in low- and middle-income countries (LMICs). To conduct such a survey, census population information mapped into enumeration areas (EAs) typically serves a sampling frame from which to generate a random sample. However, the use of census information to generate this sample frame can be problematic as in many LMIC contexts, such data are often outdated or incomplete, potentially introducing coverage issues into the sample frame. Increasingly, where census data are outdated or unavailable, modelled population datasets in the gridded form are being used to create household survey sampling frames.

Methods

Previously this process was done by either sampling from a set of the uniform grid cells (UGC) which are then manually subdivided to achieve the desired population size, or by sampling very small grid cells then aggregating cells into larger units to achieve a minimum population per survey cluster. The former approach is time and resource-intensive as well as results in substantial heterogeneity in the output sampling units, while the latter can complicate the calculation of unbiased sampling weights. Using the context of Somalia, which has not had a full census since 1987, we implemented a quadtree algorithm for the first time to create a population sampling frame. The approach uses gridded population estimates and it is based on the idea of a quadtree decomposition in which an area successively subdivided into four equal size quadrants, until the content of each quadrant is homogenous.

Results

The quadtree approach used here produced much more homogeneous sampling units than the UGC (1 × 1 km and 3 × 3 km) approach. At the national and pre-war regional scale, the standard deviation and coefficient of variation, as indications of homogeneity, were calculated for the output sampling units using quadtree and UGC 1 × 1 km and 3 × 3 km approaches to create the sampling frame and the results showed outstanding performance for quadtree approach.

Conclusion

Our approach reduces the manual burden of manually subdividing UGC into highly populated areas, while allowing for correct calculation of sampling weights. The algorithm produces a relatively homogenous population counts within the sampling units, reducing the variation in the weights and improving the precision of the resulting estimates. Furthermore, a protocol of creating approximately equal-sized blocks and using tablets for randomized selection of a household in each block mitigated potential selection bias by enumerators. The approach shows labour, time and cost-saving and points to the potential use in wider contexts.
Introduction and methods of the evidence-based guidelines for the diagnosis and management of autism spectrum disorder by the Italian National Institute of Health
Authors:   on behalf of the Italian National Institute of Health guideline working group on Autism Spectrum Disorder, Morgano Gian Paolo , Fulceri Francesca , Nardocci Franco , Barbui Corrado , Ostuzzi Giovanni , Papola Davide , Fatta Laura Maria , Fauci Alice Josephine , Coclite Daniela , Napoletano Antonello , De Crescenzo Franco , D’Alò Gian Loreto , Amato Laura , Cinquini Michela , Iannone Primiano , Schünemann Holger Jens , Scattoni Maria Luisa
Published: March 2020

Background

Autism Spectrum Disorder (ASD) is a neuro-developmental disorder that affects communication and behavior with a prevalence of approximately 1% worldwide. Health outcomes of interventions for ASD are largely Participant Reported Outcomes (PROs). Specific guidelines can help support the best care for people with ASD to optimize these health outcomes but they have to adhere to standards for their development to be trustworthy.

Objective

The goal of this article is to describe the new methodological standards of the Italian National Institute of Health and novel aspects of this guideline development process. This article will serve as a reference standard for future guideline development in the Italian setting.

Methods

We applied the new standards of the Italian National Institute of Health to the two guidelines on diagnosis and management of children/adolescents and adults with ASD, with a focus on the scoping, panel composition, management of conflict of interest, generation and prioritization of research questions, early stakeholders’ involvement, and PROs. Recommendations are based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision frameworks.

Results

Following a public application process, the ISS established two multidisciplinary panels including people with ASD and/or their caregivers. Seventy-nine research questions were identified as potentially relevant for the guideline on children and adolescents with ASD and 31 for the one on adults with ASD. Questions deemed to have the highest priority were selected for inclusion in the guidelines. Other stakeholders valued their early involvement in the process which will largely focus on PROs. The panels then successfully piloted the development of recommendations using the methodological standards and process set by the ISS with a focus on PROs.

Conclusions

In this article, we describe the development of practice guidelines that focus on PROs for the diagnosis and management of ASD based on novel methods for question prioritization and stakeholder involvement. The recommendations allow for the adoption or adaptation to international settings.
XIAOPI formula inhibits the pre-metastatic niche formation in breast cancer via suppressing TAMs/CXCL1 signaling
Authors: Zheng Yifeng , Wang Neng , Wang Shengqi , Yang Bowen , Situ Honglin , Zhong Lidan , Lin Yi , Wang Zhiyu
Published: March 2020

Background

Recent findings suggested that premetastatic niche (PMN) is a prerequisite in mediating cancer metastasis. Previously we demonstrated that XIAOPI formula could inhibit breast cancer lung metastasis via inhibiting tumor associated macrophages (TAMs)-secreted CXCL1. Herein, we aimed to explore the effects of XIAOPI formula on preventing breast cancer PMN formation and its underlying molecular mechanisms.

Methods

CXCL1 expression of TAMs was detected by qPCR and Western blotting assay. The influences of XIAOPI formula on the proliferation of TAMs and 4 T1 in the co-culture system were tested by CCK8 or EdU staining. Transwell experiment was applied to determine the effects of XIAOPI formula on the invasion ability of HSPCs and 4 T1. Breast cancer xenografts were built by inoculating 4 T1 cells into the mammary pads of Balb/c mice and lung metastasis was monitored by luciferase imaging. Immune fluorescence assay was used to test the epithelial-mesenchymal transition process and PMN formation in the lung tissues. The effects of XIAOPI formula on TAMs phenotype, hematopoietic stem/progenitor cells (HSPCs) and myeloid-derived suppressor cells (MDSCs) were determined by flow cytometry.

Results

It was found that XIAOPI formula could inhibit the proliferation and polarization of M2 phenotype macrophages, and reduce CXCL1 expression in a dose-dependent manner. However, M1 phenotype macrophages were not significantly affected by XIAOPI formula. TAMs/CXCL1 signaling was subsequently found to stimulate the recruitment of c-Kit+/Sca-1+ HSPCs and their differentiation into CD11b+/Gr-1+ MDSCs, which were symbolic events accounting for PMN formation. Moreover, XIAOPI formula was effective in inhibiting HSPCs activation and suppressing the proliferation and metastasis of breast cancer cells 4 T1 induced by HSPCs and TAMs co-culture system, implying that XIAOPI was effective in preventing PMN formation in vitro. Breast cancer xenograft experiments further demonstrated that XIAOPI formula could inhibit breast cancer PMN formation and subsequent lung metastasis in vivo. The populations of HSPCs in the bone marrow and MDSCs in the lung tissues were all remarkably declined by XIAOPI formula treatment. However, the inhibitory effects of XIAOPI formula could be relieved by CXCL1 overexpression in the TAMs.

Conclusions

Taken together, our study provided preclinical evidence supporting the application of XIAOPI formula in preventing breast cancer PMN formation, and highlighted TAMs/CXCL1 as a potential therapeutic strategy for PMN targeting therapy.

Graphical abstract
Review of the reverse innovation series in globalization and health – where are we and what else is needed?
Authors: Harris Matthew , Dadwal Viva , Syed Shams B.
Published: March 2020

Following advances in industrial strategy and organizational behaviour, as well as post-development debates in international relations, Globalization and Health launched the Reverse Innovation series in 2012, in order to forge an agenda to promote not just the innovativeness of low-income country health systems but to recognize current and advocate for future strengthened knowledge flow between the global south and global north. It was considered to be a timely antidote to a knowledge flow that has traditionally been characterised by unidirectionality of innovation and expertise. Since then, the series provides a repository of research, theory, commentary and debate through which a collective community of practice in Reverse Innovation might emerge and provide an evidence base to promote, support and mainstream this type of knowledge flow. In this Commentary, we review the series as a whole, explore what has been learnt and what needs to come next in terms of empirical research, business models, processes and theoretical contributions to inform reverse innovation.
Immune microenvironment in ductal carcinoma in situ: a comparison with invasive carcinoma of the breast
Authors: Kim Milim , Chung Yul Ri , Kim Hyun Jeong , Woo Ji Won , Ahn Soomin , Park So Yeon
Published: March 2020

Background

The immune microenvironment in ductal carcinoma in situ (DCIS) and its significance are not well established. This study was conducted to evaluate the immune microenvironment of DCIS including the composition of tumor-infiltrating lymphocyte (TIL) subsets and PD-L1+ immune cells and to compare it with that of invasive breast cancer.

Materials and methods

A total of 671 cases including three different disease groups of pure DCIS, DCIS with microinvasion (DCIS-M), and invasive carcinoma were included in this study. CD4+, CD8+, and FOXP3+ TIL subsets and PD-L1+ immune cells were detected with immunohistochemistry using tissue microarrays and were analyzed in relation to clinicopathologic characteristics and different disease groups.

Results

In pure DCIS, high infiltrations of CD4+, CD8+, and FOXP3+ T cells and the presence of PD-L1+ immune cells were associated with high nuclear grade, comedo-type necrosis, hormone receptor (HR) negativity, and high Ki-67 proliferation index. All immune cell infiltrations were higher in invasive carcinoma than in pure DCIS regardless of the HR status. While CD4+ T cells were more abundant than CD8+ T cells in pure DCIS, CD8+ T cells were dominant in invasive carcinoma, especially in HR-negative tumors. Within individual cases of invasive carcinoma with DCIS component, all immune cell subset infiltration was higher in the invasive component than in the DCIS component; however, CD4+ TIL infiltration did not differ between the two components in HR-negative tumors. Comparing pure DCIS, DCIS-M, and DCIS associated with invasive carcinoma (DCIS-INV), CD4+ TIL infiltration revealed a gradual increase from pure DCIS to DCIS-M and DCIS-INV in the HR-negative group, whereas FOXP3+ TIL infiltration was significantly increased in DCIS-INV than in pure DCIS in the HR-positive group. The high infiltration of FOXP3+ TIL and the presence of PD-L1+ immune cells were associated with tumor recurrence in patients with pure DCIS.

Conclusions

Our study showed that the immune microenvironment differs significantly not only between DCIS and invasive carcinoma but also between pure DCIS, DCIS-M, and DCIS-INV depending on the HR status.
Diverse genetic mechanisms underlie worldwide convergent rice feralization
Authors: Qiu Jie , Jia Lei , Wu Dongya , Weng Xifang , Chen Lijuan , Sun Jian , Chen Meihong , Mao Lingfeng , Jiang Bowen , Ye Chuyu , Turra Guilherme Menegol , Guo Longbiao , Ye Guoyou , Zhu Qian-Hao , Imaizumi Toshiyuki , Song Beng-Kah , Scarabel Laura , Merotto Aldo , Olsen Kenneth M. , Fan Longjiang
Published: March 2020

Background

Worldwide feralization of crop species into agricultural weeds threatens global food security. Weedy rice is a feral form of rice that infests paddies worldwide and aggressively outcompetes cultivated varieties. Despite increasing attention in recent years, a comprehensive understanding of the origins of weedy crop relatives and how a universal feralization process acts at the genomic and molecular level to allow the rapid adaptation to weediness are still yet to be explored.

Results

We use whole-genome sequencing to examine the origin and adaptation of 524 global weedy rice samples representing all major regions of rice cultivation. Weed populations have evolved multiple times from cultivated rice, and a strikingly high proportion of contemporary Asian weed strains can be traced to a few Green Revolution cultivars that were widely grown in the late twentieth century. Latin American weedy rice stands out in having originated through extensive hybridization. Selection scans indicate that most genomic regions underlying weedy adaptations do not overlap with domestication targets of selection, suggesting that feralization occurs largely through changes at loci unrelated to domestication.

Conclusions

This is the first investigation to provide detailed genomic characterizations of weedy rice on a global scale, and the results reveal diverse genetic mechanisms underlying worldwide convergent rice feralization.