bluuebunny/crossref_metadata_2025 huggingface dataset:
Enteral Nutrition in Patients with Inflammatory Bowel Disease: Systematic Review, Meta-Analysis and Meta-Regression
Authors: Comeche Jose Miguel , Caballero Pablo , Gutierrez-Hervas Ana , Garcia-Sanjuan Sofia , Comino Iris , Altavilla Cesare , Tuells Jose
Published: September 2019

Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and characterized by the inflammation of the gastrointestinal tract. One of the possible treatments for this pathology is a change in the type of diet, the enteral nutrition (EN) is one of them. This study is to understand how the use of EN can affect the adult population diagnosed with IBD. We conducted a systematic review, meta-analysis and a meta-regression. On the different databases, (MEDLINE, Scopus, Cochrane, LILACS, Cinhal, WOS) we found 363 registers, the accuracy was 12% (44 registers); After a Full-text review, only 30 research studies were selected for qualitative synthesis and 11 for Meta-analysis and Meta-regression. The variables used were Crohn’s Disease Activity Index (CDAI), C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR). EN has shown to have efficacy for the treatment of Crohn’s Disease and is compatible with other medicines. As for the CDAI or the rates of remission, there were no differences between enteral and parenteral nutrition. Polymeric formulas, have shown better results with respect to the CRP. The long-term treatment could dilute the good CDAI results that are obtained at the start of the EN treatment.
The G119S Acetylcholinesterase (Ace-1) Target Site Mutation Confers Carbamate Resistance in the Major Malaria Vector Anopheles gambiae from Cameroon: A Challenge for the Coming IRS Implementation
Authors: Elanga-Ndille Emmanuel , Nouage Lynda , Ndo Cyrille , Binyang Achille , Assatse Tatiane , Nguiffo-Nguete Daniel , Djonabaye Doumani , Tene-Fossog Billy , Irving Helen , Wondji Charles S.
Published: September 2019

Growing resistance is reported to carbamate insecticides in malaria vectors in Cameroon. However, the contribution of acetylcholinesterase (Ace-1) to this resistance remains uncharacterised. Here, we established that the Ace-1R mutation is driving resistance to carbamates in Anopheles gambiae populations from Cameroon. Insecticide bioassay on field collected mosquitoes from Bankeng, a locality in southern Cameroon, showed high resistance to the carbamates bendiocarb (64.8 ± 3.5 % mortality) and propoxur (55.71 ± 2.9 %) but a full susceptibility to the organophosphate fenithrothion. The TaqMan genotyping of the Ace-1R mutation with field-collected adults revealed the presence of this resistance allele (39%). A significant correlation was observed between the Ace-1R and carbamate resistance at allelic [(bendiocarb; OR = 75.9; P<0.0001) and (propoxur; OR= 1514; P<0.0001)] and genotypic [RR vs SS (bendiocarb; OR = 120.8; P<0.0001) and (propoxur; OR= 3277; P<0.0001) levels. Furthermore, the presence of the mutation was confirmed by sequencing an Ace-1 portion flanking codon 119. The cloning of this fragment revealed a likely duplication of Ace-1 in Cameroon as mosquitoes exhibited at least three distinct haplotypes. Phylogenetic analyses showed that the predominant Ace-1R allele is identical to that from West Africa suggesting a recent introduction of this allele in Central Africa from the West. The spread of this Ace-1R represents a serious challenge to future implementation of IRS-based interventions using carbamates or organophosphates in Cameroon.
Soft-Core Architecture for Odd/Even Order Sampling I/Q Demodulator with Dual-Port Block Memory Considerations
Authors: Mfana Madodana , Hasan Ali N.
Published: September 2019

Soft-Core architecture for Analogue to Digital Converter (ADC) sampling is useful for mixed signal applications. Soft-core architecture for cutting edge odd or even ADC sampling with interface to block RAM memory has not been found. Soft-core architecture as a concept has become popular due to the advantage of customization for different applications as compared to general-core architecture suited for single application. The latest generation of piece wise sampling is odd sampling and was introduced in the second decade of the 20th century. Odd and even order sampling techniques are analogue in nature driven by a tuned (tuned for odd or even) mixer. This paper proposes a third-generation piece wise sampling with soft-core architecture that enables an option to select both odd and even while interfacing to memory mapping. The proposed odd/even has superior SNR performance of 6 dB as compared to existing architecture such as Mod-∆ which recorded worst performance of 18 dB. Advances in soft-core technology have allowed a niche odd/even switching field to be identified and studied, the study has also been extended to include memory architecture.
Long Term Monitoring of Ghana’s Forest Reserves Using Google Earth Engine
Authors: Osei Jeff Dacosta , Andam-Akorful S. A. , Osei jnr Edward Matthew
Published: September 2019

Farm activities continued sand winning operations and the allocation of plots of land to prospective developers in Ghana pose a serious threat to the forest covers and lifespan of the Forest and game reserves. With all the positive add ups to the country from forests, Ghana has lost more than 33.7%(equivalent to 2,500,000 hectares) of its forest, since the early 1990s between 2005 and 2010, the rate of deforestation in Ghana was estimated at 2.19% per annum; the sixth highest deforestation rate globally for that period. This shows how important forest monitoring can be to the forestry commission in Ghana. Despite the frameworks which have been developed to help Ghana to protect and restore its forest resources, inadequate monitoring systems remain a barrier to effective implementation. In this study, Google earth engine was used to map and analyze the structural changes of forest cover using JavaScript to query and compute Landsat, MODIS and NOAA AVHRR satellite imageries of the study area (Ghana) with spatial resolutions 30m, 250m and 7km respectively. A supervised classification was performed on three multi-temporal satellite imageries and a total of six major land use and land cover classes were identified and mapped. By using random Forest-classification technique, from 1985 to 2018 recorded by NOAA AVHRR, forest cover has decreased by 66% and 2000 to 2018 recorded by Landsat and MODIS 61% and 47% respectively. A decrease in the forest has been as a result of anthropogenic activities in Ghana. A change detection analysis was performed on these images and it was noted that Ghana is losing forest reserves in every 5years. Overlay of the reserved forest of the 2000 and the classified map of 2018 shows vegetation changed during 2000-2018 remarkably. Therefore, forest-related institutions like the Forestry Commission can employ and use this monitoring system on Google Earth Engine for processing satellite images particularly Landsat, MODIS and NOAA AVHRR for forest cover monitoring and analysis for fast, efficient and reliable results.
The Power of LC-MS Based Multiomics: Exploring Adipogenic Differentiation of Human Mesenchymal Stem/Stromal Cells
Authors: Rampler Evelyn , Egger Dominik , Schoeny Harald , Rusz Mate , Pacheco Maria Pires , Marino Giada , Kasper Cornelia , Naegele Thomas , Koellensperger Gunda
Published: September 2019

The molecular study of fat cell development in the human body is essential for our understanding of obesity and related diseases. Mesenchymal stem/stromal cells (MSC) are the ideal source to study fat formation as they are the progenitors of adipocytes. In this work, we used human MSCs, received from surgery waste, and differentiate them into fat adipocytes. The combination of several layers of information coming from lipidomics, metabolomics and proteomics enabled comprehensive analysis of the biochemical pathways in adipogenesis. Simultaneous analysis of metabolites, lipids and proteins in cell culture is challenging due to the compound’s chemical difference so that most studies involve separate analysis with unimolecular strategies. In this study, we employed a multimolecular approach using a two–phase extraction to monitor the crosstalk between lipid metabolism and protein-based signaling in a single sample (~105 cells). We developed an innovative analytical workflow including standardization with in-house produced 13C-isotopically labeled compounds, hyphenated high-end mass spectrometry (high-resolution Orbitrap MS) and chromatography (HILIC, RP) for simultaneous untargeted screening and targeted quantification. Metabolite and lipid concentrations ranged over 3-4 orders of magnitude and were detected down to the low fmol (absolute on column) level. Biological validation and data interpretation of the multiomics workflow was performed based on proteomics network reconstruction, metabolic modelling (MetaboAnalyst 4.0) and pathway analysis (OmicsNet). Comparing MSCs and adipocytes, we observed significant regulation of different metabolites and lipids such as triglycerides, gangliosides and carnitine with 113 fully reprogrammed pathways. The observed changes are in accordance with literature findings dealing with adipogenic differentiation of MSC. These results are a proof of principle for the power of multimolecular extraction combined with orthogonal LC-MS assays and network construction. Considering the analytical and biological validation performed in this study, we conclude that the proposed multiomics workflow is ideally suited for comprehensive follow-up studies on adipogenesis and is fit for purpose for different applications.
What is the Best Strategy to Develop Creative Industry in Indonesia?
Authors: Prasnowo Muhammad Adhi , Adriansyah Gusti , Hidayat Khoirul
Published: September 2019

Small and Medium Enterprises (SMEs) have an important role and strategic for economic growth. This is because at the time of the economic crisis in Indonesia, SMEs are the economic sectors which have the most excellent durability. Wedoro Village in Sidoarjo city, Indonesia, is famous for the footwear creative industry especially slippers and shoes. A wide variety of slippers and shoes with different types available. Stores and outlets are widespread across the village. Wedoro region has been known as one of the predecessors of creative industries in the field of footwear. Currently the industrial centres of creative footwear is experiencing a decline in sales compared with its heyday in 2001-2006 years ago. This research aims to design a development strategy of the creative industry centre in Wedoro by using SWOT analysis and grand strategy. The results of this study indicate that the cause of the decline in sales is a flood of Chinese products, rising raw material prices, and the lack of innovation in product design. Hence, creative industry in Indonesia especially in Wedoro Village might need a guidance from the government in developing innovation in product design and marketing. It is therefore expected that the existence of a creative industry in Wedoro can grow and create occupations especially for local residents and also increase the revenue of the Sidoarjo city.
Response of Anther Donor Genotypes (F1) from Indica x Indica Crosses to Rice Anther Culture
Authors: Dewi Iswari Saraswati , Putri Nuha Hera , Purwoko Bambang Sapta
Published: September 2019

Anther culture is one of the in vitro techniques that can be used to accelerate the obtainment of purelines in the form of dihaploid (DH) plants resulted from androgenesis. The objectives of this research were to study response of anther donor genotypes in rice anther culture of F1 populations derived from indica x indica crosses and obtain spontaneous DH lines to be used further for variety development program. Anther donor plant used for the experiment consisted of four kinds of F1 populations derived from single crosses, i.e. IR85/I-5, BioR-81/I-5, Bio-R81/O18, and BioR-82/O-18. The result indicated that kindy of all F1 plants showed similar response to callus induction, but significatly different responses to plant regeneration. Genotypes of anther donor plants (F1) significantly affected the percentage of calli producing green plantlet, but not significantly affected the percentage of calli producing albino plantlet. Anther culturability of anther donor plants (F1) was relatively high, ranged from 2.0 to 7.0%. A total of 73 first generation of spontaneous DH lines (38.8%) from the grew out green plantlets was obtained from this study. The resulted DH lines are readily available to be selected and be used in rice cultivar development program.
Promoting parent child relationships and preventing violence via home visiting: A pre-post cluster randomised trial among Rwandan families linked to social protection programs
Authors: Betancourt Theresa S. , Jensen Sarah K.G. , Barnhart Dale A. , Brennan Robert T. , Murray Shauna M. , Yousafzai Aisha K. , Farrar Jordan , Godfroid Kalisa , Bazubagira Stephanie M. , Rawlings Laura B. , Wilson Briana , Sezibera Vincent , Kamurase Alex
Published: September 2019

Background: Sugira Muryango ​ (SM) is an early child development and violence-prevention home-visiting program delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty who receive SM in combination with government-provided social protection demonstrate greater responsive and positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC).Methods: Sugira Muryango (SM) was delivered to families with children aged 6–36 months living in extreme poverty. We assessed changes in outcomes in intervention and UC control families using structured surveys and observation. Analyses were intent to treat using mixed models.Results: Families receiving SM improved significantly on responsive caregiving using the Home Observation for Measurement of the Environment (Cohen’s d= 0.78; p< 0.001) and the Observation of Mother-Child Interaction (Cohen’s d= 0.29; p< 0.001) and showed decreased violent discipline (OR:0.34: 95% CI: 0.22, 0.51) compared with UC. Children in families receiving SM also had a 0.44 higher increase in food groups consumed in the past 24 hours (Cohen’s d= 0.34, p< 0.001), increased care seeking for diarrhoea (OR=2.2, 95% CI: 1.5, 3.1) and fever (OR: 3.3, 95% CI: 2.3, 4.8), and improved hygiene behaviours such as proper treatment of water (OR: 3.6; 95% CI: 2.4, 5.5) compared with UC. SM was also associated with a decreased intimate partner violence (OR=0.67, 95% CI: 0.33, 1.3) and caregiver depression and anxiety (OR=0.9, 95% 0.58, 1.4).Conclusions: Sugira Muryango led to improvements in family functioning and caregiver behaviours linked to child development and health.
The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy
Authors: Zhu Jingli , Wang Xue-ting , Gong Jing , Sun Hai-bin , Zhao Xiao-qing , Gao Wei
Published: September 2019

Background Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery.Methods A total of 150 patients were randomized into control (C), levobupivacaine (L) and levobupivacaine plus morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded.Results Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores.Conclusions Transversus abdominis plane block plus rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery.
Danish Evaluation of Your Heart Forecast (DANY) - Study Protocol for a Randomised Controlled Trial on an Interactive Risk-communication Tool aimed at improving High Blood Pressure Patients’ adherence.
Authors: Jensen Anders Elkær , Søndergaard Jens , Kjær Niels Kristian , Jackson Rod , Nielsen Jesper Bo
Published: September 2019

Background

To improve communication of risk messages, they must be communicated in a way that is understandable and relevant to the patient. Communicating risk of cardio-vascular-disease is a complex and individualised task, since the risk itself is a combination of multiple personal risk factors. Raised blood pressure is but one of these risk factors. In Denmark, one third of hypertensive patients are adequately treated, with regards to national guidelines. One reason for this meagre status is low treatment adherence, and tools with documented effects for increasing patient adherence are limited.

Our objective is to evaluate the effect of a personalised, interactive and dynamic risk-assessment and risk-communication tool: “Your Heart Forecast” on blood pressure control, primary non-compliance, health literacy and patient empowerment.Methods

Cluster-randomised controlled trial in general practice. Effect measures are adherence, blood pressure, lipid levels and empowerment at inclusion and after 6 and 12 months. To identify other benefits or possible adverse effects of the intervention, qualitative interviews will be conducted with a subgroup of patients. Discussion

The investigators will explore effects of Your Heart Forecast on patients’ health literacy, adherence, empowerment and blood pressure control. The DANish evaluation of Your heart forecast (DANY) project will be the first to rigorously evaluate effects of YHF in Denmark and to link adherence of hypertensive patients exposed to Your Heart Forecast with the national databases of prescriptions and health services provided.
Monitoring in practice – How are UK academic clinical trials monitored? A survey
Authors: Love Sharon , Yorke-Edwards Victoria , Lensen Sarah , Sydes Matthew R
Published: September 2019

Background

Despite the FDA and EMA encouraging the use of risk-based monitoring for trials in 2013, there remains a lack of evidence-based guidelines on how to monitor. We surveyed the academic United Kingdom Clinical Research Collaboration (UKCRC) registered clinical trials units (CTUs) to find out their policy on monitoring of phase III randomised CTIMP trials.

Methods

An online survey of monitoring policy with sections on the CTU, central monitoring and on-site monitoring was sent to all 50 UKCRC registered CTUs in November 2018. Descriptive data analysis and tabulations are reported using the total number answering each question.

Results

43/50 (86%) of CTUs responded with 38 conducting phase III randomised CTIMP trials. Of these 38 CTUs, 34 finished the survey. Most CTUs (36/37, 97%) use a central monitoring process to guide, target or supplement site visits. More than half (19/36, 53%) of CTUs do not use an automated monitoring report when centrally monitoring trials and all units use trial team knowledge to make a final decision on whether an on-site visit is required. 31/34 (91%) CTUs used triggers to decide whether or not to conduct an on-site monitoring visit. On-site, a mixture of Source Data Verification and checking of processes was carried out. The CTUs overwhelmingly (27/34, 79%) selected optimising central monitoring as their most pressing concern.

Conclusion

The survey showed a wide variation in Phase III randomised CTIMP trial monitoring practices by academic clinical trials units within a single research-active country. We urgently need to develop evidence-based regulator agreed guidance for CTUs on best practice for both central and on-site monitoring and to develop tools for all CTUs to use.
The prevalence and risk factors associated with hypertension subtypes among ethnic Dai adults in rural China
Authors: Zhong Hua , Dong Yulong , Tao Yijin , Pan Chen-Wei , Peng Yunzhu , Cai HongYan , Li Jun , Wang Yanmei , Wang Huawei , Sheng Xun , Wang Feng , Chen Lixing
Published: September 2019

Objective
Hypertension is an important risk factor for cardiovascular disease. The purpose of this survey was to determine the prevalence of hypertension subtypes and the risk factors associated with hypertension subtypes among ethnic Dai adults in rural China.
Methods
A population-based survey was carried out with 2150 rural inhabitants aged 50 years or older. The definition of hypertension was a systolic blood pressure (SBP) ≥140 mmHg and/or a diastolic blood pressure (DBP) ≥90 mmHg, or a current treatment plan with an antihypertensive medication. Hypertension included the following subtypes: systolic–diastolic hypertension (SDH), isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH). All participants were interviewed, had physical examinations performed, and had blood pressure measurements taken. Multivariate logistic regression analysis was applied to analyse the risk factors for hypertension.
Results
The prevalence of HBP was 43.2% (95% CI: 41.1-45.3). The subtype-specific prevalence of hypertension was 16.5% (95% CI: 14.9-18.0) for SDH, 24.2% (95% CI: 22.4-26.0) for ISH and 2.5% (95% CI: 1.9-3.2) for IDH. Among hypertensive participants, 37.9% were SDH, 56.8% were ISH and 5.8% were IDH. Older age is a risk factor for HBP and ISH. Obesity, smoking, drinking and history of hypertension are risk factors for HBP, SDH, ISH and IDH (OR>1). Of the hypertensive participants, the awareness of hypertension in our study was 25.0% for HBP, 34.7% for SDH, 20.0% for ISH and 9.3% for IDH. The rates of treatment and control were 23.8% and 6.9% for HBP, 26.8% and 7.9% for SDH, 23.1% and 6.3% for ISH and 11.1% and 5.6% for IDH, respectively.
Conclusions
Among Dai people in rural China, the prevalence of hypertension is high, and the awareness, treatment and control of hypertension is low. ISH is the most frequent kind of high blood pressure in rural elderly people. With the ageing population in China, ISH remains an important public health problem and a challenging issue for practising physicians in rural China. Public health strategies should regularly provide more information about hypertension to both the local physicians and the general population. To reduce cardiovascular events, a combination of drugs and lifestyle changes are strongly recommended.
Survival status and predictors of undesirable treatment outcome of children with severe acute malnutrition admitted to Yekatit 12 hospital medical college from 2013-2016, Addis Ababa, Ethiopia: a retrospective cohort study.
Authors: Negussie Absalat Serawit , Tadesse Amare Worku
Published: September 2019

Background Globally, in 2015, malnutrition contributes to 45% of all child deaths. These early child deaths are due to conditions that could be prevented or treated with access to simple and affordable interventions. Hence, this study intends to provide a quantitative summary of treatment outcomes and to identify factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM) admitted to Yekatit 12 hospital from the year 2013 to 2016.Methods A retrospective cohort of 304 children aged 6-59 months old with complicated SAM admitted to Yekatit 12 teaching hospital from 2013- 2016 were studied. Data on nutritional status, socio-demographic factors and admission medical condition were extracted. Data were analyzed using SPSS version 20. Kaplan-Meier was employed to estimate the recovery rates of the children treated for SAM and Cox regression was used to control for confounding.Result From overall (n = 304) under-five children with SAM, 133 (51.4%) were males and 126 were (48.6%) females. Marasmus was the most common type of severe acute malnutrition 132(51%). The recovery, death and defaulter rate were 70.4%, 12.2% and 8.2% respectively. The main predictors of undesirable outcome were HIV antibody positive children (AHR=3.208; 95% CI: [1.045-9.846]) and sepsis (AHR= 7.677, 95% CI: [2.320-25.404])Conclusion The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation and the main predictors of death in children receiving in-patient treatment for SAM were HIV and sepsis. Intervention to reduce death should focus on institutional care.
Factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey
Authors: Sunuwar Dev Ram , Singh Devendra Raj , Pradhan Pranil Man Singh
Published: September 2019

Background
Double and triple burden of malnutrition is defined by the coexistence of overweight/obese mother and undernourished child and coexistence of overweight/obese mother and undernourished and anemic child at the same household level respectively. The aims of this study were to explore the coexistence of overweight/obesity among mothers and undernourished and anemia among children and associated factors among the mother-child pairs in the same household.
Methods
A total sample of 5018 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements, hemoglobin level of the children and their mothers were taken. The bivariate and multivariate logistic regression were performed to observe the factors associated with the double and triple burden of malnutrition. To assess the outcome, we created the categories such as the double and triple burden of malnutrition where the overweight/obese mother and undernourished (stunted or wasted or underweight) child and overweight/obese mother and undernourished (stunted or wasted or underweight) child and anemic child respectively.
Results
Prevalence of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) was 6.59(5.13-8.84)% and 7(5.42-8.99)% respectively at the same household. In the adjusted multivariate logistic regression, mothers with short stature (AOR=3.94, 95% CI: 1.94-8.00), from the richest wealth status (AOR=2.59, 95% CI= 1.27-5.28), age groups of 26-49 years (AOR=2.38, 95% CI: 1.18-4.77), attended at least a secondary level of education (AOR=1.93, 95% CI: 1.01-3.69) were more likely to have the double burden of malnutrition. Similarly, mothers who had short stature (AOR=4.48, 95% CI: 2.19-9.16), the richest wealth status (AOR=2.46, 95% CI= 1.19-5.08) and age groups of 26-49 years (AOR=2.27, 95% CI: 1.16-4.44) were more likely to suffer from the triple burden of malnutrition.
Conclusions
Our study concludes with the prevalence of double and triple burden of malnutrition existence among mothers and children in Nepal. Mothers having short stature and from the richest family are more prone to double and triple burden of malnutrition. Integration of maternal health promotion and nutrition education program would be a good strategy to prevent mother overweight/obesity and stunting among children under five years of age in Nepal.
Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia
Authors: Borzie Korpo , Jasper Noah , Southall David , MacDonald Rhona , Kola Adeyemo Abass , Dolo Obed , Magnus Asinya , Watson Diane , Casement Maire , Dahn Bernice , Jallah Wilhelmina
Published: September 2019

Background: In low-resource settings with few health workers, the Fetal Heart Rate (FHR) in women in labour can be inadequately monitored contributing to poor outcomes. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia with extremely limited health workforces, to assess the feasibility of educating women in labour to monitor their FHR and alert their attending midwife of any changes which might indicate fetal distress.
Methods and Interventions: Over 15 months, 474 women admitted in labour without obstetric complications were approached. After informed consent, 461 agreed (97%) and 13 refused. Those consented were trained to monitor the FHR using a sonicaid for approximately one minute immediately after the end of every uterine contraction and inform her midwife of changes. If relevant changes were confirmed, standard clinical interventions for possible fetal distress (lateral tilt and intravenous fluids and glucose) and, when appropriate, accelerated delivery by vacuum or Caesarean section were undertaken. Participants provided views on their monitoring experience; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.
Results: 461 out of 474 women gave consent, of whom 426 (92%) completed the monitoring themselves. 386 (97%) of 400 who gave comments, reported positive experiences and 14 reported only negative experiences. 28 participants identified FHR changes, confirmed in 26 cases. Meconium stained liquor accompanied FHR changes in 18 of these 26 (69%). 13 of these 26 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes. One (birth weight 1.3 Kg) could not be resuscitated. There were no intrapartum stillbirths or maternal deaths in participants.
Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience positive and empowering. The absence of intrapartum stillbirths and low number of poor neonatal outcomes are promising but warrant further research.
Major obstetric haemorrhage in Metro East, Cape Town, South Africa: a population-based cohort study using the Maternal Near Miss approach
Authors: Heitkamp Anke , Aronson Simcha Lot , Akker Thomas van den , Vollmer Linda , Gebhardt Stefan , Roosmalen Jos van , de Vries Johanna I , Theron Gerhard
Published: September 2019

Background Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in the whole of Africa. We aimed to assess population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome. Methods Women with major obstetric haemorrhage who met WHO Maternal Near-Miss criteria or died in Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks’ gestation or occurring up to 42 days after birth and leading to hysterectomy or blood transfusion of ≥5 units of Packed Red Blood Cells or hypovolemic shock. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death. Results Incidence of major obstetric haemorrhage was 3/1000 births, and incidence of massive transfusion 4/10.000 births in Metro East region (32.862 birth in the studied time period). Leading causes were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). Median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14] Conclusions Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.
Indigenous rice of Northeast India harbor rich genetic diversity as measured by SSR markers and Zn/Fe content
Authors: Surname Vanlalsanga No , Singh Sagolshem Priyokumar , Singh Yengkhom Tunginba
Published: September 2019

Background

Rice (Oryza sativa L.) is one of the most important crops of the world and a major staple food for half of the World’s human population. The Northeastern (NE) region of India lies in the Indo-Burma biodiversity hotspot and about 45% of the total flora of the country is found in the region. Local rice cultivars from different states of NE India were analyzed for genetic diversity and population structure using microsatellite markers, and their zinc and iron content.

Results

A total of 149 bands were detected using twenty-two microsatellite markers comprising both random and trait-linked markers, showing 100% polymorphism and high value of expected heterozygosity (0.6311) and the polymorphism information content (0.5895). Nali Dhan cultivar of Arunachal Pradesh possessed the highest genetic diversity (0.3545) among studied populations while Moirangphou Khonganbi of Manipur exhibited the lowest genetic diversity (0.0343). The model-based population structure revealed that all the studied 65 rice cultivars were grouped into two clusters. Cluster I was represented by 36 cultivars and cluster II by 29 cultivars. Badalsali cultivar of Assam possessed the highest Zn content (75.8 μg/g) and Kapongla from Manipur possessed the lowest (17.98 μg/g). The highest and the lowest Fe content was found in Fazu (215.62 μg/g) and Idaw (11.42 μg/g) of Mizoram.

Conclusion

The result suggested rice cultivars of NE India possessing high genetic diversity (Nali Dhan), high Zn (Badalsali) and Fe (Fazu) content can be useful as a source of germplasm for future rice improvement programs.
Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test
Authors: Friederichs Hendrik , Birkenstein Roman , Becker Jan C. , Marschall Bernhard , Weissenstein Anne
Published: September 2019

Background

Responsibility for helping patients understand potential health benefits and risks falls largely to general practitioners (GPs), especially for screening tests. The Berlin Numeracy Test (BNT) specifically measures risk literacy, meaning the range of statistical numeracy associated with accurate interpretation of information about risks. This study explored the association between the level of risk literacy and clinical experience, and risk literacy’s impact on evaluating the predictive value of screening tests.

Methods

The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0–4 points). For the GPs an additional case scenario on mammography screening was given as a simple measure of performance in applying numeracy skills.

Results

Despite having an average of 25.9 years clinical experience, GPs scored no better than did medical students on risk literacy (GPs: 2.33 points, 95% CI 2.08–2.59; students: 2.34, 95% CI 2.07–2.61; P = .983). Of all GPs, 71.6% (n = 58) came to the opposite conclusion of the real predictive value.

Conclusions

In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and in consequence do not fully understand numeric estimates of probability of routine screening procedures.
Are there any Connections between Adrenal Myelolipoma and Hypertension?
Authors: Lin Lede , Gong Lina , Sun Wenjin , Cheng Liang , Li Hong , Wang Kunjie , Zhu Yuchun
Published: September 2019

Background. Adrenal myelolipoma (AML) is a non-functional benign neoplasm from adrenal cortex, composed of mature fat and hematopoietic tissue. Usually, patients have no symptoms. However, some present with hypertension and blood pressure normalizes after surgery, indicating some connections between AML and hypertension.
Methods . This is a retrospective cohort study of 372 patients diagnosed with AML from September 2008 to December 2018 collected in Urology Department of West China Hospital, Chengdu, Sichuan, China. We collected clinical records of patients before surgery and partial patients were done with hormone examination. Postoperative follow-up was also done for those with hypertension and whether patients needed to take antihypertensive drugs and postoperative blood pressure were recorded. We aim to explore the characteristics of both AML patients with hypertension and remission of hypertension in 1 year after surgery.
Results. There were 372 AML patients included in the study, 159 males and 213 females, aged 49.77±11.64 years old. Among them, 118 patients presented with hypertension. The percentage of hypertension in each subgroup increased with age. Sixty patients were followed up for 1 to 9 years, with a median follow-up of 52 months. The course of hypertension in the remission group was shorter than that in the non-remission group (P=0.020), and tumor lateralization was significantly different between two groups (P=0.005).
Conclusion. Nearly one third of AML patients suffered from hypertension in our study and there do exist some potential links between AML and hypertension.
Quantitative Bone SPECT/CT: High Specificity for Identification of Prostate Cancer Bone Metastases
Authors: Tabotta Flavian , Jre Mario , Schaefer Niklaus , Becce Fabio , Geldhof Christine , Prior John O. , Nicod-Lalonde Marie
Published: September 2019

Purpose: Bone scintigraphy with 99mTc-labeled diphosphonates can identify prostate cancer bone metastases with high sensitivity, but relatively low specificity, because benign conditions such as osteoarthritis can also trigger osteoblastic reactions. We aimed to investigate the diagnostic performance of 99mTc-2,3-dicarboxy propane-1,1-diphosphonate (99mTc-DPD) uptake quantification by single-photon emission computed tomography coupled with computed tomography (SPECT/CT) for distinguishing prostate cancer bone metastases from spinal and pelvic osteoarthritic lesions.
Methods: We retrospectively assessed 26 bone scans from 26 patients with known prostate cancer bone metastases and 13 control patients with benign spinal and pelvic osteoarthritic changes without known neoplastic disease. Quantitative SPECT/CT (xSPECT, Siemens Symbia Intevo, Erlangen, Germany) was performed and standardized uptake values (SUVs) were quantified with measurements of SUVmax and SUVmean (g/mL) in all bone metastases for the prostate cancer group and in lumbar and pelvic osteoarthritic changes for the control group. We used receiver operating characteristics (ROC) curves to determine the optimum SUVmax cutoff value to distinguish between bone metastases and benign spinal and pelvic lesions.
Results: In total, 264 prostate cancer bone metastases were analyzed, showing a mean SUVmax and SUVmean of 34.6±24.6 and 20.8±14.7 g/mL, respectively. In 24 spinal and pelvic osteoarthritic lesions, mean SUVmax and SUVmean were 14.2±3.8 and 8.9±2.2 g/mL, respectively. SUVmax and SUVmean were both significantly different between the bone metastases and osteoarthritic groups (p≤0.0001). Using a SUVmax cutoff of 19.5 g/mL for prostate cancer bone metastases in the spine and pelvis, sensitivity, specificity, positive and negative predictive values were 87%, 92%, 99% and 49%, respectively.
Conclusion: This study showed significant differences in quantitative 99mTc-DPD uptake on bone SPECT/CT between prostate cancer bone metastases and spinal and pelvic osteoarthritic changes, with higher SUVmax and SUVmean in metastases. Using a SUVmax cutoff of 19.5 g/mL, high specificity and positive predictive value for metastases identification in the spine and pelvis were found, thus increasing accuracy of bone scintigraphy.
Point-of-care tests for hepatitis B are associated with a higher linkage to care and lower cost compared to venepuncture sampling during outreach screenings in an Asian migrant population
Authors: Ho Erwin , Michielsen Peter , Damme Pierre Van , Ieven Margareta , Veldhuijzen Irene , Vanwolleghem Thomas
Published: September 2019

Background

This study compares venepuncture versus point-of-care (POC) HBsAg tests on screening cost and linkage to care in prospective outreach screenings in an Asian population in 3 major cities in Belgium between 10/2014 and 5/2018.

Methods

Two community outreach screening programs were organised between 10/2014 and 5/2018. The first screening program used venepuncture and serologic testing for HBsAg. In the second program, HBsAg was tested in finger stick blood POC tests. Positive results were confirmed during outpatient visits with serologic testing. Linkage to care was defined as having received specialist care follow-up with at least 1 abdominal ultrasound within 3 months of screening.

Results

For 575 participating individuals, 571 valid results were obtained, 456 with venepuncture and 115 using POC testing. Overall HBsAg seroprevalence was 6.8%. Linkage to care was higher when using POC testing compared to venepuncture (86% or n=6/7 versus 34% or n=11/32; p= 0.020). The POC screening program was economically more attractive with a total cost of € 1,461.8 or € 12.7 per person screened compared to € 24,819 or € 54.0 per person screened when using venepuncture testing. Results and an appointment for specialist care follow-up were given onsite with POC testing, while with venepuncture testing; results were sent within 20-45 days.

Conclusion

In an Asian migrant population in Belgium with a HBsAg seroprevalence of 6.8%, HBV screening based on POC tests resulted in lower costs per person screened (76.5% lower), and higher linkage to care (2.5 times).
Capacity and patient flow planning in post-term pregnancy outpatient clinics: a computer simulation modelling study
Authors: Viana Joe , Simonsen Tone B , Faraas Hildegunn E , Schmidt Nina , Dahl Fredrik A , Flo Kari
Published: September 2019

Background The demand for a large Norwegian hospital’s post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital’s catchment area and to clinical guidelines. Planning the clinic is further complicated due to the high did not attend rates as a result of women giving birth. The aim of this study was to develop a tool that supports clinic management to better understand and improve capacity and patient flow planning.Methods A hybrid agent based discrete event simulation model of the clinic was used to evaluate alternative configurations to gain insight into clinic planning and to support decision making. Clinic configurations consisted of six factors: X0: Arrivals. X1: Arrival pattern. X2: Order of midwife and doctor consultations. X3: Number of midwives. X4: Number of doctors. X5: Number of cardiotocography (CTGs) machines. A full factorial experimental design of the six factors generated 608 configurations.Results Each configuration was evaluated using the following measures: Y1: Arrivals. Y2: Time last woman checks out. Y3: Women’s length of stay (LoS). Y4: Clinic overrun time. Y5: Midwife waiting time (WT). Y6: Doctor WT. Y7: CTG connection WT. Optimisation was used to maximise X0 with respect to the 32 combinations of X1-X5. Configuration 0a, the base case Y1 = 7 women and Y3 = 102.97 [0.21] mins. Changing the arrival pattern (X1) and the order of the midwife and doctor consultations (X2) configuration 0d, where X3, X4, X5 = 0a, Y1 = 8 woman and Y3 86.06 [0.10] mins.Conclusions From the clinic’s perspective, the changes in catchment area and clinical guidelines led to increased demand. The simulation model demonstrated flexible pathways in the order of midwife/doctor and appointment scheduling increases flow substantially, reducing LoS. Equipment appeared more of a bottleneck than personnel, as one additional CTG machine has the same effect as an extra midwife and an extra doctor, and the WT for CTG connection is a key contributor to LoS. A more general finding is that a simulation model can be used to identify bottlenecks, and efficient ways of restructuring an outpatient clinic.
Recipient and Instructor perspectives of an adapted exercise-based fall prevention program for older adults with vision impairment: a qualitative study nested within a randomised controlled trial
Authors: Dillon Lisa , Clemson Lindy , Nguyen Helen , Jakobsen Kirsten B , Martin Jodi , Tinsley Frances , Keay Lisa
Published: September 2019

Background

People with vision impairment are at an increased risk of falls compared with their sighted peers, but have very little access to existing community fall prevention programs. The Lifestyle-integrated Functional Exercise (LiFE) program can prevent falls in older people and may be suitable for adults aged ≥50 with vision impairment.

Methods

The LiFE program was adapted for older adults with vision impairment (v-LiFE) and delivered by Orientation and Mobility Specialists (Instructors), who are experienced with individualised programs for people with vision impairment. Perspectives of older adults with vision impairment (recipients) receiving the v-LiFE program and their Instructors were explored through semi-structured interviews.

Results

Of 73 trained Instructors, 51(70%) delivered at least one session to a total of 240 older adults with vision impairment between March 2017 and May 2019. Of these, 11/51(22%) Instructors and 154/172(90%) of invited recipients (until thematic saturation was reached) were interviewed. Six key themes were identified relating to recipient (delivery aptitude; social norms; habit formation) and Instructor (individualised adaptation; complimentary to scope of practice; challenges to delivery) perspectives. Instructors considered delivering v-LiFE as an extension of their scope of work.

Conclusions

Older adults with vision impairment demonstrated positive attitudes towards the program, but younger or more physically fit recipients considered the program too easy for them. The perspectives of recipients and instructors indicate that the v-LiFE program delivered within existing services may fill the gap for a fall prevention program for people with vision impairment.
Impact of liver damage and blood-borne variables on pulmonary hemodynamic responses to hypoxia and hyperoxia in anesthetized rats
Authors: Sepehrinezhad Ali , Dehghanian Amirreza , Rafati Ali , Ketabchi Farzaneh
Published: September 2019

Background : Liver disorders may lead to a wide spectrum of pulmonary complications from hepatopulmonary syndrome to portopulmonary hypertension. In this study, we aimed to investigate the effect of severity of liver dysfunctions on blood-borne variables, and pulmonary hemodynamic during repeated ventilation of animals with hypoxic and hyperoxic gases.
Methods: Female Sprague Dawley rats were divided into four groups of Sham, common bile duct ligation (CBDL), portal vein ligation (PPVL), and combination of them (CBDL+ PPVL). Twenty-eight days later, right ventricular systolic pressure (RVSP) and systemic blood pressure were recorded in anesthetized animals. Besides, we assessed blood parameters in parallel with liver histology.
Results: Data of liver histology and enzymes indicated a larger liver damage in the CBDL+PPVL group as compared with the other groups. Moreover, low platelet level was only observed in the CBDL+PPVL group. Besides, the enhancement of serum estradiol in the CBDL+PPVL group was less pronounced than that in the CBDL group. The baseline RVSP in the CBDL groups were significantly higher than those in the Sham and PPVL groups, and in the CBDL+PPVL group was higher than the ones in the other groups. Hypoxic pulmonary vasoconstriction (HPV) were eliminated in both CBDL groups, whereas, it was recovered in the PPVL group.
Conclusion: In this study, we presented, for the first time, ligations of both CBDL and PPVL as a possible animal model for POPH. High RVSP in this model may be linked to ROS production, serum estradiol level, low platelet level or a combination of them.