bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of day period on labour safety at maintenance and repair of catenary facilities
Authors:   Ural state university of railway transport (USURT), Pazukha Alexander Alexandrovich
Published: October 2020

The paper investigates an influence of day period on labour safety of workers that are engaged at maintenance and repair of catenary facilities. It also considers electric traumatism occasions that took place on catenary for the period of 2012– 2019. The author has carried out a verification of significance of difference between values of electric traumatism frequency coefficient in daylight time and in the period of evening civil twilight, along with in dark time and in the period of evening civil twilight. For the selection of principles of comparison of average values he has calculated variance of the considered values and with the use of Fisher criterion has carried out an assessment of the significance of difference of these variances. The author has also considered lighting systems that are used during execution of works in dark day period on railway catenary facilities. As a result, further directions of research on influence of day period on labour safety of employees of the JSC Russian Railways are determined.
Problems of development of traction drives with brushless traction motors for passenger electric locomotives
Authors:   Russian University of Transport (RUT-MIIT), Kosmodamianskiy Andrey Sergeevich , Vorobyev Vladimir Ivanovich ,   Bryansk State Technical University (BSTU), Kapustin Mikhail Yuryevich ,   Russian University of Transport (RUT-MIIT), Izmerov Oleg Vasilyevich ,   Bryansk State Technical University (BSTU), Shevchenko Dmitriy Nikolaevich ,   Russian University of Transport (RUT-MIIT), Samotkanov Alexander Vasilyevich ,   Russian University of Transport (RUT-MIIT)
Published: October 2020

The paper considers a problem of creation of new traction drives with brushless electric traction motors (ETM) for passenger locomotives. Analysis of drive designs revealed that the increase of power of induction motors through the increase of rotation frequency leads to the contradiction between requirements for the design reliability, on the one hand, and requirements for technological simplicity, on the other hand. In order to solve the contradiction it is necessary to use ETM designs that have enhanced torque and minimal dimensions in axial direction. It is established that ETM with disk rotor (axial magnetic flux) satisfy such requirements. The authors proposed an aggregate scheme of support-frame traction drives that include ETM with disk rotor, which allows significantly increasing the adaptability to manufacture and repairability of drive at preservation of reliability. As a result, the authors made a conclusion about the reasonability of conducting research and development work on creation of locomotive ETM with axial magnetic flux. The authors have submitted an application for a patent on the proposed design of traction drive.
Pantograph cooling system mathematical model during motion of the railway electric transport
Authors:   Omsk State Transport University (OSTU), Tomilov Valeriy Viktorovich , Utepbergenova Sandugash Myrzabekovna ,   Omsk State Transport University (OSTU), Sidorov Oleg Alexeevich ,   Omsk State Transport University (OSTU)
Published: October 2020

Uneven heating of the pantograph slide is the reason for limiting the pantograph removal of the maximum permissible long-term current from the contact network. The highest heating point is observed in the center of the pantograph head relative to the path axis, which can be taken into account when developing a pantograph slide cooling device. Existing models of the thermal state of the pantograph slide do not describe the transient modes of distributed heating of a closed-type structure (euro pantograph head) as a result of the impact of a contact wire in the plan when moving a rolling stock. Existing methods for calculating the heating of the pantograph slide require the use of special programs for the development of its three-dimensional model and significant power of electronic computers. The paper presents a mathematical model euro pantograph head standard design and are equipped with passive cooling system the center through the frame device of the confuser type, which can calculate the load characteristics of the pantograph slide, to evaluate the reduction of uneven heating of its design and to determine the maximal permissible continuous current of the pantograph.
Requirements to assessment of reliability of supporting constructions for bearing and contact wires
Authors:   Ural state university of railway transport (USURT), Kovalev Alexey Anatolyevich , Okunev Alexander Vladimirovich ,   Ural state university of railway transport (USURT), Mikava Alexander Vanoevich ,   Ural state university of railway transport (USURT), Krapivin Nikita Vasilyevich ,   Ural state university of railway transport (USURT)
Published: October 2020

Increased requirements are set to catenary suspension of electrified railways on all stages of life cycle. Big influence on its correct operation is rendered by supporting constructions. The paper presents an analysis of operation of supporting constructions such as catenary poles, cantilevers and pull-offs. As a result, the authors proved the necessity to apply a special method for calculation of reliability parameters, which will allow creating an accurate system of catenary section maintenance.
COLETA SELETIVA COMO FERRAMENTA DE EDUCAÇÃO AMBIENTAL DE JOVENS EDUCANDOS DO MUNICÍPIO DE MACAPÁ-AP
Authors: Marques Monte Verde Olivaldo , Figueiredo Pinto Ricardo
Published: October 2020

Na sociedade contemporânea, a temática ambiental está presente de diversas formas, sobretudo no que diz respeito aos aspectos relacionados à proteção do meio ambiente, à sua governança e ao desenvolvimento sustentável, neste foco, na educação ambiental cabe o papel de formar cidadãos para uma reflexão crítica, em termos ambientais e sociais, e também formar pessoas capazes de promover transformações na sua maneira de pensar, de agir, de tomar decisões, descartando a ideia individualista e principiando a sociedade, o agir coletivo, por meio de ações socioambientais, intervindo no ambiente local e buscando o resultado planetário, educando o indivíduo para sua própria sustentabilidade e consequentemente, a do planeta. Objetivo: Analisar como cada educando compreende o meio ambiente, a reciclagem, resíduos sólidos e como está inserido a essas questões em sua realidade. Métodos: Se trata de um estudo transversal; foi aplicado um questionário estruturado qualitativo com 22 questões sobre meio ambiente a 321 (±46,02) alunos, com idade média de 13,5 anos, de 9 escolas públicas de Macapá-AP. Conclusão: A Educação Ambiental deve ser veiculada com seriedade nas escolas, e, muitos educadores estão empenhados neste compromisso de desenvolver propostas sobre esta temática. Porém, ainda há uma carência de recursos e orientações para colocá-las em prática, atingir metas e objetivos concretos para um efetivo desenvolvimento social. Afinal, cabe à escola trabalhar conceitos que conscientizem e mobilizem a sociedade em geral, para a mudança de hábitos e atitudes referentes ao meio ambiente.
Comparison growth of Candida albicans in alternative media and semi-synthetic on fisheries cerumen in bastiong karance Ternate City
Authors: Nurdin Erpi
Published: October 2020

Otomycosis is an inflammatory process in the ear canal caused by a fungal infection. The activity of fishermen on the high seas at night or during the day is often at risk of contracting fungal diseases, because their workplaces are in the open air and in wet and humid areas favored by fungi. Work as a fisherman also makes them often exposed to direct sunlight so that the body's temperature rises, the body will produce sweat and cause the ear wax to be disturbed. Semi-synthetic media such as PDAs have sufficient carbohydrate content so that they are good for fungal growth. This media is pretty much needed in fungal breeding both in the laboratory and in agriculture. But the price of this media is quite expensive besides that not all chemical shops provide it, while the needs of PDA media are increasing so that another alternative is needed to replace the fungal culture media. This research is instrumental with a cross sectional approach and aims to find out the level of significance of the differences in the growth of Candida albicans against alternative media for agar dextrose agar and semi-synthetic Potato Dextrose agar (PDA). The sampling technique was non-random with a purposive sampling design of 46 people. The sample was then isolated on a semi-synthetic PDA media and alternative media to see differences in the growth of Candida albicans. Based on the research that has been carried out, it is concluded that there are 38 samples of respondents detected positively Candida albicans on semi-synthetic media (PDA) and alternative media, and based on the results of data processing obtained p value 0,000 <0.05 which indicates that there are very significant differences in growth Candida albicans between semi-synthetic media (PDA) and alternative media.Keyword : Candida albicans, Alternative Media, Potato Dextrose Agar.
Haemophilus paraphrophilus brain abscess in a 9-year-old boy: Case report and literature review
Authors: ZRIKEM Hind , AIT SAID Loubna , ZAHLANE Kawtar
Published: October 2020

Human diseases due to A. paraphrophilus aren’t usual. The following case report describes the first isolated case of A. paraphrophilus brain abscess in our laboratory. A 9-year-old boy presented to pediatric emergencies for frontal headache, vomiting, blurred vision and left hemiparesis. Radiological diagnosis consists with a frontal abscess. Gram staining of purulent samples showed abundant neutrophils with gram negative bacilli. Culture was made on blood agar, chocolate agar, Chapman’s agar and incubated in 5% CO2 at 37°C for 24 hours. Positive culture was detected only on chocolate agar. It was monomicrobial with small yellowish non-hemolytic colonies. Gram stain of colonies showed pleomorphic gram-negative coccobacilli. The strain required V factor for growth. The isolated strain was sensitive to all antibiotics tested.  The interest of this case is that it shows the emergence of A. paraphrophilus as a causative agent of brain abscesses on pediatric population without associated congenital heart disease. It may also help identifying risk factors of these infections and how to prevent them.
Prevalence and Risk Factors Associated with HIV Infection among Pregnant Women in Odisha State, India
Authors: Santhakumar Aridoss , Mathiyazhakan Malathi , Jaganathasamy Nagaraj , Ganesh Balsubramanian , Manikandan N , Padmapriya VM , Monika Angel , David Joseph K , Kumar Arvind , Arumugam Elangovan
Published: October 2020

Background and Objectives: The purpose of this study was to analyze trends in HIV prevalence and risk factors associated with HIV infection among pregnant women attending antenatal clinics in Odisha State, India.

Methods: Data were from the HIV Sentinel Surveillance (HSS) among pregnant women, a descriptive cross-sectional study using consecutive sampling method and conducted in India. Data and samples were collected from pregnant women attending select antenatal clinics that act as designated sentinel sites in Odisha State, India, during the three months surveillance period and in three surveillance years: 2013, 2015, and 2017. All eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included. Information on their socio-demographic characteristics and blood samples were also collected.

Results: In total, 38,384 eligible pregnant women were included in the survey. Of these, 107 women were HIV positive, with an overall prevalence of 0.28%. HIV prevalence indicated a stabilizing trend between 2013 and 2017. However, pregnant women whose spouses were non-agricultural laborers, truck drivers, or migrants were significantly at higher risk of being infected. Likewise, HIV prevalence significantly increased over the years among pregnant women whose spouses were in the service sector (government or private). District-wise fluctuations in HIV prevalence was observed, with the district of Cuttack recording the highest prevalence among the districts.

Conclusion and Global Health Implications: Women who are spouses of non-agricultural laborers, truck drivers or migrants need focused interventions, such as creating awareness on HIV and its prevention. Migration, due to poverty and its impact on sexually transmitted diseases among migrants from low and middle-income countries, have been documented globally. Single male migrant specific interventions are recommended to halt the disease progression among pregnant women and general population in Odisha, India.

Key words: • HIV sentinel surveillance • Pregnant women • HIV prevalence • Socio-demographic factor • Odisha • India

 

Copyright © 2020 Santhakumar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unre-stricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
Association of Depression and Resilience with Fertility Quality of Life among patients presenting to the infertility Centre for treatment in Karachi, Pakistan
Authors: Bhamani Shireen Shehzad , Zahid Nida , Zahid Wajeeha , Farooq Salima , Sachwani Saima , Chapman Marilyn , Asad Nargis
Published: October 2020

Background: In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. Thus, the aim of this study was: 1. To compare the QoL of males and females presenting at an infertility centre for treatment, 2. To assess the association of QoL with resilience, depression, and other socio-demographic factors in males and females presenting at an infertility clinic for treatment.

Methods: An Analytical Cross-Sectional study was conducted and the study participants were recruited from the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12.

Results : After adjusting for the covariates we observed that the males who were less resilient their QoL was 8.47 units significantly lower and those who were depressed their QoL was 17.849 units significantly lower as compared to those who were more resilient and less depressed. Moreover, formal education, low monthly income, and friends were significantly associated with QoL among males . On the other hand, females who were less resilient their QoL was 8.606 units lower and those who were depressed their QoL was 19.387 units significantly lower as compared to those who were more resilient and less depressed. Additionally, formal education and low monthly income had a significant association with QoL among females.

Conclusion: Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems.
Chinese Public’s Knowledge, Perceived Severity, and Perceived Controllability of COVID-19 and Their Associations with Emotional and Behavioural Reactions, Social Participation, and Precautionary Behaviour: A National Survey
Authors: Li Jian-Bin , Yang An , Dou Kai , Wang Lin-Xin , Zhang Ming-Chen , Lin Xiao-Qi
Published: October 2020

Background: The outbreak of the coronavirus disease-19 (COVID-19) has caused enormous stress among the public in China. Intellectual input from various aspects is needed to fight against COVID-19, including understanding of the public’s emotion and behaviour and their antecedents from the psychological perspectives. Drawing upon the cognitive appraisal theory, this study examined three cognitive appraisals (i.e., perceived severity, perceived controllability, and knowledge of COVID-19) and their associations with a wide range of emotional and behavioural outcomes among the Chinese public. Methods: Participants were 4607 citizens (age range: 17–90 years, Mage=23.71 years) from 31 provinces in China and they took part in a cross-sectional survey online. Results: The results showed that the public’s emotional and behavioural reactions were slightly affected by the outbreak of COVID-19. Moreover, the public had limited participation in the events regarding COVID-19 but actively engaged in precautionary behaviour. In addition, results of structural equation model with latent variables revealed that the three appraisals were differentially related to the outcome variables (i.e., negative emotion, positive emotion, sleep problems, aggression, substance use, mobile phone use, social participation, and precautionary behaviour). Conclusions: The findings highlight the utility of cognitive appraisal, as a core process of coping stress, in explaining the public’s emotion and behaviour in the encounter of public health concern. Practically, the findings facilitate the government and practitioners to design and deliver targeted intervention programs to the public.
Recommendations to improve insurance coverage for physiotherapy services in Iran: A multi-criteria decision making approach
Authors: Shahabi Saeed , Heydari Seyed Taghi , Lankarani Kamran Bagheri , Zarei Leila
Published: October 2020

Background: High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and prioritized potential policy recommendations to improve insurance coverage for physiotherapy services in Iran.Methods: This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time. Results: Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g. informing policy-makers about physiotherapy services), collection of funds (e.g. placing value-added taxes on luxury goods and services), pooling of funds (e.g. moving allocated resources towards insurance [viz. third-party] mechanism), purchasing (e.g. using strategic purchasing), and benefit package (e.g. considering preventive interventions) as the main components of insurance coverage. Conclusion: The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.
Marker-trait association analysis for drought tolerance in smooth bromegrass
Authors: Saeidnia Fatemeh , Majidi Mohammad Mahdi , Mirlohi Aghafakhr
Published: October 2020

Background: Little information is available on the application of marker-trait association (MTA) analysis for traits related to drought tolerance in smooth bromegrass. The objectives of this study were to identify marker loci associated with important agronomic traits and drought tolerance indices as well as fining stable associations in a diverse panel of polycross derived genotypes of smooth bromegrass. Phenotypic evaluations were performed at two water environments (normal and drought stress) during two years; and association analysis was done with 626 SRAP markers. Results: The results of population structure analysis identified three main subpopulations possessing significant genetic differences. Under normal irrigation, 68 and 57 marker-trait associations were identified using general linear model (GLM) and mixed linear mode1 (MLM), respectively. While under deficit irrigation, 61 and 54 markers were associated with the genes controlling the studied traits, based on these two models, respectively. Some of the markers were associated with more than one trait. It was revealed that markers Me1/Em5-11, Me1/Em3-15, and Me5/Em4-7 were consistently linked with drought-tolerance indices. Conclusion: Following marker validation, the MTAs reported in this panel could be useful tools to initiate marker-assisted selection (MAS) and targeted trait introgression of smooth bromegrass under normal and deficit irrigation regimes, and possibly fine mapping and cloning of the underlying genes and QTLs.
Estimation of the Reproduction Number of Influenza A(H1N1)pdm2009 in South Korea Using Heterogeneous Models
Authors: Lee Yunjeong , Lee Dong Han , Kwon Hee-Dae , Kim Changsoo , lee jeehyun
Published: October 2020

Background: The reproduction number is one of the most crucial parameters in determining disease dynamics, providing a summary measure of the transmission potential. However, estimating this value is particularly challenging owing to the characteristics of epidemic data, including non-reproducibility and incompleteness.Methods: In this study, we propose mathematical models with different population structures; each of these models can produce data on the number of cases of the influenza A(H1N1)pdm09 epidemic in South Korea. These structured models incorporating the heterogeneity of age and region are used to estimate the reproduction numbers at various terminal times. Subsequently, the age- and region-specific reproduction numbers are also computed to analyze the differences illustrated in the incidence data. Results: The basic SIR fails to provide a reasonable estimation of the reproduction numbers. The estimated values demonstrate a large variation and remains outside of the feasible range for the influenza, regardless of the time period for data. Real-time estimation using age- and region-structured models demonstrated that the effective reproduction number rose sharply during mid-October when the number of patients increased dramatically. The reproduction number fell below unity at the end of October and stayed lower than unity indicating that the epidemic starts decreasing, which is consistent with the incidence data. Conclusions: Numerical results reveal that the introduction of heterogeneity into the population to represent the general characteristics of dynamics is essential for the robust estimation of parameters.
Tensile Mechanical Properties of Fly Ash Concrete at Early Age for Thermal Stress Analysis
Authors: Mimura Yoichi , Vimonsatit Vanissorn , Horiguchi Itaru , Yoshitake Isamu
Published: October 2020

The present study investigates tensile properties of concrete with and without fly ash at early age, such as tensile Young’s modulus, strength and creep. Some Young’s modulus of fly ash concrete for thermal crack analysis was compared with the tensile Young’s modulus, secant modulus, initial tangent modulus and linear modulus obtained from the direct tension test and compression test. The tensile creep test was also performed to obtain the specific creep behavior considering decrease in elastic strain due to stiffness development at early age during creep test. The results show that the Young's modulus for crack evaluation can be obtained from the compression test based on the stress range less than the splitting tensile strength, while the compressive secant modulus was smaller than the tensile Young's modulus. The decrease of the elastic strain at early age contributes more to the evaluation of the tensile creep than the use of the fly ash mixing.
Side Effects of Azathioprine in Patients with Ocular Behçet’s syndrome
Authors: Masoumi Maryam , Davatchi Fereydoun , Shahram Farhad , Akhlaghi Maassoumeh , Faezi Seyedeh Tahereh , Kavosi Hoda , Shadmanfar Soraya , Alikhani Majid , Moradi Soroush , Balasi Javad
Published: October 2020

BackgroundBehçet’s syndrome (BS) is a multifactorial, polygenic, autoinflammatory vasculitis characterized by recurrent oral and genital ulcers, uveitis, skin lesions, and arthritis. Azathioprine has been well established as an effective therapy among other immunosuppressive drugs; however, concerns remain about its safety. This study was conducted to determine the types and prevalence of adverse events related with azathioprine in patients with ocular BS.MethodsWe carried out a cross-sectional study of 165 patients with a confirmed diagnosis of BS who had ocular involvement. Data were collected retrospectively on disease-related characteristics and events including severity, recurrence, relapse, recovery and flare-up, as well as on azathioprine dosage and the duration of use.ResultsOf 165 enrolled patients, 103 (62.43%) were male and 62 (37.57%) were female. Adverse events of treatment with azathioprine occurred in 11 patients (6.67%). These side effects included elevation of liver enzymes in 4 patients (2.43%), hypersensitivity reaction in 2 patients (1.21%), leukopenia in 2 patients (1.21%), nausea in 1 patient (0.61%), skin tumor in 1 patient (0.61%), and concomitant pancreatitis and hepatitis in 1 patient (0.61%). Six of these patients discontinued treatment, and 5 of them tapered the dose. In addition, we observed severe leukopenia in 2 patients.ConclusionAdministration of azathioprine with due attention to the signs, symptoms, and severity of the disease, results in a reduced rate of adverse events and resolution of the ocular involvement in patients with BS.
Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil
Authors: Magno Laio , Leal Andrea Fachel , Knauth Daniela , Dourado Ines , Guimarães Mark Guimarães Drew Crosland , Santana Elis Santana Passos , Jordão Tiago Jordão , Rocha Gustavo Rocha Machado , Veras Maria Amélia Amélia , Kendall Carl Kendall , Pontes Alexandre Pontes Kerr , Brito Ana Maria , Kerr Ligia Kerr
Published: October 2020

Background: Brazil has a substantial population living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. Methods: Respondent-driven sampling (RDS) was used to recruit 4,176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results: For this analysis, 3,605 MSM were included . The acceptability of HIVST was 49.1%, lower among those had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.
Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse
Authors: Conrad Aislinn , Butcher Brandon , Oral Resmiye , Ronnenberg Megan , Peek-Asa Corinne
Published: October 2020

Objective To investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics. Methods We examined possible SBS, confirmed SBS, total SBS, and non-SBS abuse diagnoses among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database (N = 66,854). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure. Results The rate (per 100,000 census population) of total SBS diagnoses was 5.4 (± 0.3) between 1998 and 2014, whereas the rate of non-SBS abuse was 19.6 (± 1.0).The rate of confirmed SBS diagnoses increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnoses were 0.6 (± 0.2) in 1998, increasing to 2.4 (± 0.4) in 2014. Confirmed SBS diagnoses have declined since 2002, while possible SBS diagnoses have increased. All abuse types were more frequent among infants, males, children from low-income homes, and urban teaching hospitals. Conclusions We investigated seventeen-year trends of SBS diagnoses among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS suggests differences in norms for diagnosing SBS, which has implications for which cases are considered AHT. Future research should investigate diagnostic processes for SBS and whether all codes associated with abusive head injuries in young children are classified as AHT. Our findings also highlight the relativity defining and diagnosing SBS. Medical professionals find utility in diagnosing SBS, though may be more apt to apply possible SBS diagnoses to abusive head injuries in children. Clarifying norms for SBS diagnosis and refining definitions for AHT will ensure that young children presenting with abusive head injuries are included in overall counts of AHT. This baseline data, an essential component of child abuse surveillance, will enable ongoing efforts to track, prevent, and reduce child abuse.
Characteristics of acute ischemic stroke in hospitalized patients in Tibet: A retrospective comparative study
Authors: Lu Yuxuan , Zhuoga Cidan , Jin Haiqiang , Zhu Feiqi , Zhao Yuhua , Ding Zhijie , He Shihua , Du Ailian , Xu Jun , Luo Jingjing , Sun Yongan
Published: October 2020

Background: Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing.Methods: This study included the diagnoses of AIS patients from People’s Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.Results: In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P<0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P<0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, and smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P<0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases.Conclusion: In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.
Genomic profile of MYCN non-amplified neuroblastoma and potential for immunotherapeutic strategies in neuroblastoma
Authors: Lee Eunjin , Lee Ji Won , Lee Boram , Park Kyunghee , Shim Joonho , Yoo Keon Hee , Koo Hong Hoe , Sung Ki Woong , Park Woong-Yang
Published: October 2020

Background: MYCN amplification is the most important genomic feature in neuroblastoma (NB). However, limited studies have been conducted on the MYCN non-amplified NB including low- and intermediate-risk NB. Here, the genomic characteristics of MYCN non-amplified NB were studied to allow for the identification of biomarkers for molecular stratification.Methods: Fifty-eight whole exome sequencing (WES) and 48 whole transcriptome sequencing (WTS) samples of MYCN non-amplified NB were analysed. Forty-one patients harboured WES and WTS pairs.Results: In the MYCN non-amplified NB WES data, maximum recurrent mutations were found in MUC4 (26%), followed by RBMXL3 (19%), ALB (17%), and MUC16 and SEPD8 (14% each). Two gene fusions, CCDC32-CBX3 (10%) and SAMD5-SASH1 (6%), were recurrent in WTS analysis, and these fusions were detected mostly in non-high-risk patients with ganglioneuroblastoma histology. Analysis of risk-group-specific biomarkers showed that several genes and gene sets were differentially expressed between the risk groups, and some immune-related pathways tended to be activated in the high-risk group. Mutational signatures 6 and 18, which represent DNA mismatch repair (MMR) associated mutations, were commonly detected in 60% of the patients. In the tumour mutation burden (TMB) analysis, four patients showed high TMB (> 3 mutations/Mb), and had mutations in genes related to either MMR or homologous recombination. Excluding four outlier samples with TMB > 3 Mb, high-risk patients had significantly higher levels of TMB compared with the non-high-risk patients.Conclusions: This study provides novel insights into the genomic background of MYCN non-amplified NB. Activation of immune-related pathways in the high-risk group and the results of TMB and mutational signature analyses collectively suggest the need for further investigation to discover potential immunotherapeutic strategies for NB.
Covid-19 effects on the workload of Iranian healthcare workers
Authors: Shoja Esmail , Aghamohammadi Vahideh , Bazyar Hadi , Moghaddam Hamed Rezakhani , Nasiri Khadijeh , Dashti Mohammad , Choupani Ali , Garaee Masoumeh , Aliasgharzadeh Shafagh , Asgari Amin
Published: October 2020

Background: In this study, we aimed to evaluate the impact of the COVID-19 epidemic on the workload and mental health of Iranian medical staff using the General Health Questionnaire (GHQ-12) and NASA -Task Load Index (NASA-TLX) Questionnaire between March and April 2020, respectively.Methods: The present cross-sectional study was conducted from March 5th to April 5th, 2020. To evaluate the workload and mental health of participants NASA-TLX and GHQ-12 online questionnaires were distributed. Data were entered into software SPSS (Version 23) and T-test, ANOVA, Regression methods were used for data analysis.Results: Health workers who encountered COVID- 19 patients, were subjected to more task load compared to those who had no contact with COVID- 19 patients at the workplace (p<0.001). In terms of the subscale score of NASA-TLX, nurses had more scores in mental pressure, physical pressure, time pressure(temporal), and frustration compared to the other jobs (p<0.05). Moreover, nurses had significantly more workload compared to the other jobs.Conclusions: Type of job, the shift of work, educational level, and facing COVID-19 affected the score of NASA-TLX. NASA-TLX scores were higher in nursing compared to the scores of other health staff groups. The results of this study indicate that the scores of NASA-TLX and GHQ-12 among staff who had contact with COVID-19 patients were significantly higher than those who did not face COVID-19 patients. We suggested that a comprehensive assistance should be provided to support the well-being of healthcare workers especially nurses and healthcare workers who treated COVID-19 patients.
Influencing Factors for Prevention of Postpartum Hemorrhage and Early Detection of Women at Risk in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives
Authors: Bazirete Oliva , Nzayirambaho Manassé , Umubyeyi Aline , Uwimana Marie Chantal , Marilyn Evans
Published: October 2020

Background: Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory‐mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides to describe factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results: We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions: Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.
Climate change causes changes in biochemical markers of renal disease
Authors: Ephraim Richard Kobina Dadzie , Asamoah Christopher Amey , Abaka-Yawson Albert , Kwadzokpui Precious Kwablah , Adusei Samuel
Published: October 2020

Background: Climate change is a significant threat to the health of the Ghanaian people. Evidence abounds in Ghana that temperatures in all the ecological zones are rising, whereas rainfall levels have been generally reducing and patterns are increasingly becoming erratic. The study estimated the impact of climate variation between seasons on biochemical markers of renal disease.Methods: This study conveniently recruited 50 apparently healthy peasant farmers and hawkers at Wa in the Upper West Region of Ghana. A pre-study screening for hepatitis A and C, Diabetes mellitus, hypertension was done. Serum creatinine and urea levels were analyzed to rule out kidney preexisting renal disease . Baseline data was collected by estimating urea, creatinine, sodium, potassium, eGFR (estimated glomerular filtration rate) as well as for hemoglobin (Hb) and hematocrit (Hct) concentrations. Anthropometric data such as height, weight and blood pressure were measured by trained personnel. The study participants were closely followed and alerted deep in the dry season for the second sampling (urea, creatinine, hemoglobin, hematocrit, blood pressure, anthropometry)Results: This study recruited more males (58.82%) than females (41.15%), majority (52.92%) of which were aged 25-29 years with the youngest being 22 years and the eldest being 35 years. The study found body mass index (p<0.001), systolic blood pressure (p=0.019), creatinine (p<0.001), urea (p=0.013) and eGFR (p<0.001) to be significantly influenced by climate change. Stage 1 hypertension was predominant among the study participants during the dry season, 8 (15.69%) than was observed during the rainy season, 4 (7.84%) nonetheless the number of participants with normal BMI rose from 49.02% in the rainy season to 62.75% during the dry reason. Additionally, the study observed that the impact of climate change on systolic blood pressure and urea varied based on age and sex. Conclusion: This study revealed that climatic changes cause variations in various biochemical parameters used to assess renal function. Public health education on climatic changes and its implication including precautionary measures should be done among inhabitants of Wa and its environs to reduce its effect. Additionally, appropriate dietary patterns should also be advised to avoid the development of non-communicable diseases such as hypertension and obesity that are known principal causes of Chronic Kidney Disease (CKD).
Results from the First Kuwait National Bariatric Surgery Report
Authors: Al-Sabah Salman , Haddad Eliana Al , Jumaa Taleb , Abbad Jassim Al , Salam Fareed , Abbas Mustafa , Kandari Mubarak Al , Ozairi Aws Al
Published: October 2020

Background Currently, more than 30% of the population in the gulf demonstrate a body mass index(BMI) exceeding 30. This burden of obesity has proven to take a toll on the population; therefore, we created the first Kuwait National Bariatric Surgery Database to report on bariatric surgeries performed in Kuwait. Methods Data was collected from the six public hospitals in Kuwait. This data was then submitted to a merged National Registry. Data web portal were used to upload, merge, and analyze the data. Results The average age for participants was 32.6 years. The average preoperative BMI was 45.9kg/m2 for males and 43.3kg/m2 for females. 16.4% of males and 12.3% of females presented with type 2 diabetes, while the most prevalent obesity related disease was a poor functional status in both males and females(90.8% and 90.5%, respectively). Most procedures performed in Kuwait are sleeve gastrectomy. The most encountered in-hospital complication after primary bariatric surgery was bleeding(1.5%), with Roux-en-Y gastric bypass(RYGB) having the highest recorded rate of post-operative complications(3.6% bleeding). The overall rate of operative complications was 2.6%, which was most prevalent post-RYGB(10.3%) and lowest post-sleeve gastrectomy(2.5%). Conclusion The importance of tracking and documenting the journey and change in the rates of obesity and effectiveness of bariatric procedures in individual countries with significantly high obesity rates is imperative to be able to create a plan of action to tackle this worldwide epidemic. This report will be able to provide the population with an accurate accounting that demonstrates further the safety of bariatric/metabolic surgery.
Rsp Activates Expression of the Cnt System in Staphylococcus aureus
Authors: Vinué Laura , Hooper David C.
Published: October 2020

Background: The Cnt system is crucial for the optimal import of essential metals in metal-limiting conditions and contributes to virulence in S. aureus. In a screen for regulators of efflux pumps in a phage-based ultra-high-density transposon library, we identified Rsp as a candidate regulator of the cntE gene. Results: A two-fold decrease in expression of all genes of the cnt operon was observed by RT-qPCR in the rsp mutant compared to the parental strain, indicating that Rsp acts as an activator of the cnt operon. To determine whether the Rsp activation depends on iron, we compared mutant and parent cnt expression under varying metal conditions. A 2-fold reduction in cnt gene expression was detected in the rsp mutant in TSB, and a slightly smaller decrease (1.9, 1.7, and 1.5-fold changes for cntK, cmtA, and cntE respectively) was observed after addition of dipyridyl. The greatest decrease was seen with addition of FeSO4 (4.1, 5.3 and 6.3-fold changes for cntK, cmtA and cntE respectively). These findings suggest that Rsp activates the cnt operon in low and high iron conditions. To study the relationship between Rsp and the cnt repressors Fur and Zur, we created single and double mutants. Both fur and zur single mutants had significant increases in cnt gene expression compared to the parental strain, as did the fur rsp double mutant. The zur rsp double mutant also had a significant increase in cntK expression and a trend in increases in cntA and cntE expression just below statistical significance. Thus, the ability of Fur and Zur to repress cnt gene expression are not eliminated by the presence of Rsp. However, there were significantly smaller increases in cnt gene expression in the double mutants compared to single mutants, suggesting that Rsp activation can still occur in the absence of these repressors. To determine if Rsp directly modulates expression of cnt genes, incubation of purified Rsp caused a DNA-specific band shift for the cntK and cntA promoters. Conclusions: Rsp activation may act to maintain basal cellular levels of staphylopine to scavenge free metals when needed, in addition to metal dependent regulation by Fur and Zur.