bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the Quality of Antenatal Care Services and the Associated Risk Factors in Tanzania
Authors: Hussein Abdalla , Mbishi Jackline
Published: June 2020

Background

This study gives the finding of the assessment made on the quality of antenatal care (ANC) services received by women in Tanzania during pregnancy and the associated risk factors.
Methods

We used the data from the 2015-16Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS). The sample included 6,924 women who gave birth in the five years before the survey and having at least one ANC visit in the most current pregnancy. The quality of ANC services provided was assessed using six questions on receipt of recommended components of ANC services. The responses of the individual components were summed up to generate the ANC service provision score. In so doing, the women who received all six components were considered to receive good quality ANC services. A weighted logistic regression model was employed in the examination of the factors associated with the quality of ANC services.
Results

The average service provision score was 4.4 out of a total of 6. Approximately, 31% of the women received good quality ANC services. The most provided ANC components were blood sample measurement (87%) and iron tablets/syrup (82.1%). The urine sample (60%) was the least offered ANC service. The results of the adjusted logistic regression model revealed that age, place of residence, education level, the time of the first ANC visit, number of ANC visits, and family wealth index were significant factors associated with the quality of ANC services.
Conclusions

In terms of service provision, the quality of ANC service in Tanzania is suboptimal. With differences by observed risk factors, there must be more efforts to strengthen the quality of ANC services and to remove the differences.
Predictive equations for evaluation for resting energy expenditure in Brazilian patients with type 2 diabetes: What can we use?
Authors: Grassi Thaiciane , Boeno Francesco Pinto , de Freitas Mauren Minuzzo , de Paula Tatiana Pedroso , Viana Luciana Vercoza , de Oliveira Alvaro Reischak , Steemburgo Thais
Published: June 2020

Background: Evaluation of the resting energy expenditure (REE) is essential to ensure an appropriate dietary prescription for patients with type 2 diabetes. The aim of this record was to evaluate the accuracy of predictive equations for REE estimation in patients with type 2 diabetes, considering indirect calorimetry (IC) as the reference method.Methods: A cross-sectional study was performed in outpatients with type 2 diabetes. Clinical, body composition by electrical bioimpedance and, laboratory variables were evaluated. The REE was measured by IC (QUARK RMR, Cosmed, Rome, Italy) and estimated by eleven predictive equations. Data were analyzed using Bland–Altman plots, paired t-tests, and Pearson’s correlation coefficients.Results: 62 patients were evaluated [50% female; mean age 63.1 ± 5.2 years; diabetes duration of 11 (1-36) years, and mean A1C of 7.6 ± 1.2%]. There was a wide variation in the accuracy of REE values predicted by equations when compared to IC REE measurement. In all patients, Ikeda and Mifflin St-Jeor equations were that most underestimated REE. And, the equations that overestimated the REE were proposed by Dietary Reference Intakes and Huang. The most accurate equations were FAO/WHO/UNO in women (-1.8% difference) and Oxford in men (-1.3% difference).Conclusion: In patients with type 2 diabetes, in the absence of IC, FAO/WHO/UNO and Oxford equations provide the best REE prediction in comparison to measured REE for women and men, respectively.
Knowledge, attitude, and practices (KAP) towards COVID-19 among Nepalese residents during the COVID-19 outbreak: An online cross-sectional study
Authors: Paudel Sachina , Shrestha Prabin , Karmacharya Isha , Pathak Om Krishna
Published: June 2020

Background.

The objective of this study was to assess the knowledge, attitude and practices of COVID-19 among Nepalese population, as containment of the disease is only possible with the change in behaviours as preventive measures.
Methodology.

A web-based cross-sectional survey was conducted for a period of two month among Nepalese residents aged ≥ 18 years using a previously validated tool. Unrestricted self-selected, convenient sampling method was adopted to generate a heterogeneous sample. Data were analysed in SPSS version 22 using chi-square/Fisher-exact test, independent t-test, multiple linear regression and binary logistic regression.
Results.

Out of 766 participants, 78.3% were aged 20–39 years and 58.2% were residents of province 3. One-third of the respondents were students followed by health workers. The rates for correct answer for COVID-19 knowledge questionnaire ranged from 30–99% with health workers and participants with bachelor’s degree having significantly better knowledge. Of the total participants, 71.5% agreed that COVID-19 will be effectively controlled and 80% were assured that Nepal could win the fight against COVID-19. The majority of the participants had not visited any crowded place (93.1%) which was significantly associated with age, marital status, gender, education, occupation, province of residence, and knowledge score of COVID-19 and 92.4% participants wore masks while going out which significantly differed across gender.
Conclusion.

There is a need to provide education and awareness about COVID-19 to Nepalese people focusing on the areas of knowledge gap so that Nepal can have victory against COVID-19.
Early predictive factors of progression from severe type to critical ill type in patients with Coronavirus Disease 2019: A retrospective cohort study
Authors: Li Nan , Kong Hao , Zheng Xi-Zi , Li Xue-Ying , Ma Jing , Zhang Hong , Wang Dong-Xin , Li Hai-Chao , Liu Xin-Min
Published: June 2020

Background: The current worldwide pandemic of Coronavirus Disease 2019 (COVID-19) has posed a serious threat to global public health, and the mortality rate of critical ill patients remains high. The purpose of this study was to identify factors that early predict the progression of COVID-19 from severe to critical illness.Methods: This retrospective cohort study included adult patients with severe or critical ill COVID-19 who were consecutively admitted to the Zhongfaxincheng campus of Tongji Hospital (Wuhan, China) from February 8 to 18, 2020. Baseline variables, data at hospital admission and during hospital stay, as well as clinical outcomes were collected from electronic medical records system. The primary endpoint was the development of critical illness. A multivariable logistic regression model was used to identify independent factors that were associated with the progression from severe to critical illness.Results: A total of 138 patients were included in the analysis; of them 119 were diagnosed as severe cases and 16 as critical ill cases at hospital admission. During hospital stay, 19 more severe cases progressed to critical illness. For all enrolled patients, longer duration from diagnosis to admission (odds ratio [OR] 1.108, 95% CI 1.022-1.202; P=0.013), pulse oxygen saturation at admission <93% (OR 5.775, 95% CI 1.257-26.535; P=0.024), higher neutrophil count (OR 1.495, 95% CI 1.177-1.899; P=0.001) and higher creatine kinase-MB level at admission (OR 2.449, 95% CI 1.089-5.511; P=0.030) were associated with a higher risk, whereas higher lymphocyte count at admission (OR 0.149, 95% CI 0.026-0.852; P=0.032) was associated with a lower risk of critical illness development. For the subgroup of severe cases at hospital admission, the above factors except creatine kinase-MB level were also found to have similar correlation with critical illness development.Conclusions: Higher neutrophil count and lower lymphocyte count at admission were early independent predictors of progression to critical illness in severe COVID-19 patients.
Effect of extra-virgin olive oil on lipid profile and inflammatory biomarkers in patients undergoing coronary angiography: a randomized, controlled, clinical trial
Authors: Khandouzi Nafiseh , Zahedmehr Ali , Nasrollahzadeh Javad
Published: June 2020

Background

Olive oil, rich in mono-unsaturated fatty acid and the main fat in the Mediterranean diet, has long been considered to be favorable for cardiovascular health. The present study was conducted to compare the effects of high polyphenol extra-virgin olive oil (EVOO) with low polyphenol refined olive oil (ROO) on some cardiovascular risk factors in patients undergoing coronary angiography.
Methods

In a randomized, controlled, parallel-arm, clinical trial, 40 patients (aged 54.83 ± 7.04 years) with at least one classic cardiovascular risk factor (hypertension, dyslipidemia, or diabetes) who referred to coronary angiography were randomly allocated to two groups and received 25 mL EVOO (n = 20) or ROO (n = 20) daily for 6 weeks. Fasting blood was collected and plasma lipids, malondialdehyde (MDA), C-reactive protein (CRP) as well as, inflammatory cytokines in ex-vivo lipopolysaccharide (LPS)-stimulated whole blood culture were measured at the baseline and after the dietary intervention.
Results

Baseline characteristics were similar between the two groups. Plasma LDL-cholesterol significantly reduced in EVOO group (-9.52 ± 20.44 vs 8.68 ± 18.77 mg/dL, p = 0.007 for EVOO and ROO respectively), whereas total cholesterol/HDL-cholesterol had no significant changes. EVOO resulted in significant reduction in plasma CRP (-0.40 ± 0.52 vs 0.007 ± 0.42 mg/L, p = 0.01 for EVOO and ROO respectively) and increased ex-vivo whole blood LPS-stimulated IL-10 production (12.13 ± 33.64 vs -17.47 ± 49.04 pg/mL, p = 0.035 for EVOO and ROO respectively). However, there were no significant differences in LPS-stimulated IL-6 and plasma MDA levels between the two groups.
Conclusions

Daily consumption of polyphenol-rich EVOO in subjects who have been under medical treatment with risk-reducing agents could additionally improve LDL-C and selected inflammatory markers.
Trial registration:
NCT03796780 at clinicaltrial.gov (12/29/2018)
Evaluation of a structured e-learning-based approach to CT anatomy of the paranasal sinuses for medical students
Authors: Krahe Anna Marleen , Ketterer Manuel Christoph , Offergeld Christian , Hildenbrand Tanja
Published: June 2020

Background: Computed tomography (CT) anatomy is not an integral part of undergraduate medical training in many countries. Radiology seems to be well suited for new online based teaching methods. The aim of the study was to evaluate whether e-learning is appropriate to introduce complex learning contents such as sinus CT anatomy in novices and to assess the usefulness of a sinus CT checklist to identify relevant anatomical variants in medical students. Material: Medical students were asked to assess sinus CT scans for anatomical variants before and after the implementation of the CLOSE mnemonic. Sinus CT anatomy and the CLOSE mnemonic were introduced by e-learning. The rate of correctly identified variants and the results of the individual CLOSE items were recorded and compared with those of otolaryngology residents. A questionnaire was distributed for subjective evaluation of the usefulness of the checklist and e-learning.Results: Ten students took part in the study. The rate of correctly identified variants improved significantly from 33.3% to 61.1%. The analysis of the individual CLOSE items showed a significant improvement for C, S and E in students and C, L and S in otolaryngology residents. The students identified more anatomical variants compared to the residents. The subjective evaluation of the CLOSE mnemonic and e-learning was very positive.Conclusion: E-learning was able to transfer complex learning contents in previously non-trained medical students and was evaluated as an appropriate introduction to the topics. The structured assessment of paranasal sinus CT scans using the CLOSE criteria can significantly improve the recognition of anatomical variants.
Plasma levels of long-acting injectable antipsychotics in outpatient care: a retrospective analysis
Authors: Hýža Martin , Petr Šilhán , Eva Češková , Tomáš Skřont , Ivana Kacířová , Romana Uřinovská , Milan Grundmann
Published: June 2020

Background
The antipsychotic efficacy in schizophrenia depends on its availability in the organism. Although therapeutic outcomes remain still far from satisfactory, therapeutic drug monitoring is not a common part of clinical practice during a treatment with long-acting injectable antipsychotics (LAI AP). The real effectiveness of LAI AP is thus uncertain.
Methods
We made a retrospective evaluation of plasma levels of LAI AP. Collection of blood samples was performed just before the drug application and one week later. Fourty patients with a stabilized clinical condition and steady-state plasma levels were included.
Results
In the observed cohort of patients, flupentixol decanoate (n = 23) was the most often used drug, followed by fluphenazine decanoate (n = 7), haloperidol decanoate (n = 5), paliperidon palmitate (n = 3), and risperidone microspheres (n = 2). Just 5 of 40 patients were treated with a monotherapy. At the time before the application, 60% of the patients did not reach the therapeutic reference range (TRR) and 20% of the patients had an undetectable plasma level. At the time of collection of the second blood samples performed after 7 days, 24% of the patients were under the TRR.
Conclusion
We have found the surprisingly high incidence of plasma levels under the TRR in patients treated with LAI AP. Notwithstanding the individual variability in pharmacokinetics, it seems the LAI AP may be underdosed in the usual clinical practice.
Predictors of dropout from maternal continuum of care in Ethiopia: evidence from the 2016 population-based health survey
Authors: Boltena Minyahil Tadesse , Mohamedsanni Afrah , Asamoah Benedict Oppong , Lemma Lire , Gebre Meklit Tesfaye , Khatib Ziad , Temesgen Kababa , Kebede Abraham Sahlemichael
Published: June 2020

IntroductionIntegrated primary health care service provided by skilled birth attendants is linked to safe childbirth and postnatal care, vitally improves maternal, newborn, and child health outcomes. Despite a significant reduction in maternal and neonatal mortality in Ethiopia, low maternal service utilization, and dropout from the maternal continuum of care continues to be a major challenge. Therefore, this study aimed to investigate the individual and community predictors of dropout from the maternal continuum of care in Ethiopia.MethodsWe used data from the 2016 Ethiopian demographic and health survey (EDHS). Women who had a birth in the 5 years preceding the survey were included. Dropout from the maternal continuum of care was the outcome of this study. This includes, attending less than four antenatal care visits (<4 ANC), a dropout from skilled birth attendance (SBA) after having 4 or more ANC, and dropout from postnatal care (PNC) after having SBA. Multilevel logistic regression analysis was employed. The mixed effect and variation in the outcome were expressed by the intracluster correlation coefficient (ICC).ResultsHigher dropouts from SBA to PNC (85%) and from ≥4 ANC to SBA (43.4%) in the maternal continuum of care were observed. Women from the poorest wealth quantile (AOR=2.31,95% CI 1.69,3.16), not covered by health insurance (AOR=1.44, 95% CI, 1.01,2.06), and residing in a community with high poverty (AOR=1.28,95% CI, 1.01,1.63) were more likely to attend inadequate ANC. On the other side, distance from a health facility (AOR=1.45, 95% CI, 1.12,1.88), lower community media exposure (AOR=1.6, 95% CI, 1.14,2.23) and rural residency (AOR=3.03, 95% CI, 1.75,5.26) were associated with dropout from SBA after attending ANC visits. Living in Somali, Harari, and Dire Dawa significantly associated with drop out from the PNC after SBA.ConclusionThe pattern of dropout from the maternal continuum of care was higher in Ethiopia. Maternal education, wealth index, community media exposure, and distance from a health facility were the factors associated with dropouts from the maternal continuum of care. Home care strategies and contextual understanding of the barriers to the PNC service is needed.
Analysis of individual-level and community-level effects on advanced maternal age pregnancy in Nigeria
Authors: Solanke Lukman Bola , Oduyoye Olumuyiwa Adebisi , Oni Tosin Olajide
Published: June 2020

Background: Advanced Maternal Age (AMA) pregnancy refers to pregnancy in women aged 35 years or older at the time of delivery. Existing studies have been more concerned with the obstetrics implication of AMA pregnancy. The associated social factors such as the individual and community level factors have remained largely unexplored particularly in population-based studies. This study examines the individual and community level factors associated with AMA pregnancy in Nigeria.Methods: Data were extracted from the 2018 Nigeria Demographic and Health Survey. A weighted sample of 13,105 women was analysed. The outcome variable was AMA pregnancy. The explanatory variables were individual characteristics (age, marital status, media exposure, current contraceptive use, period spent schooling, female autonomy, remarriage and income group) and community characteristics (proportion who delayed marriage in community, community level of female higher education, proportion of female in professional occupation in community, proportion of divorced or separated women in community, proportion of women in commuter marriage, type of community and geo-political zone of residence). Three mixed-effects multilevel logistic regression models were estimated. Results: Findings reveal 10.9% prevalence of AMA pregnancy in Nigeria. While the odds of AMA pregnancy were lower among women in very advanced (AOR=0.592, p<0.001; 95% CI: 0.509-0.688) and extremely advanced (AOR=0.290, p<0.001; 95% CI: 0.239-0.353) (AOR=1.794, p<0.001; 95% CI: 1.580-2.008) age groups, the odds were higher among women who had high exposure to mass media (AOR=1.794, p<0.001; 95% CI: 1.580-2.008), long schooling period (AOR=2.680, p<0.001; 95% CI: 2.058-3.488), remarried (AOR=2.269, p<0.001; 95% CI: 1.915-2.688) and from richest households (AOR=1.271, p<0.05; 95% CI: 1.098-1.472). The values of the Intra-Class Correlation (ICC) across the three fitted models reveal significant effects of the community characteristics on the odds of AMA pregnancy.Conclusion: Individual and community characteristics have important effects on AMA pregnancy. Health planners and authorities in the country should include AMA pregnancy as one of the priority areas of women’s health and safe motherhood strategies in addition to raising awareness of the obstetrics implication of AMA pregnancy through community-based public health education programme.
Influence of Socio-Economic, Demographic and Climate Factors on the Regional Distribution of Dengue in the United States and Mexico
Authors: Watts Matthew , Kotsilla Panagiota , Mortyn P Graham , Monteys Victor Sarto i , Brancati Cesira Urzi
Published: June 2020

Background: Dengue is one of the important vector-borne diseases in the world today; it infects tens of millions of people each year and has been on the rise since the 1950s. In this study, we develop a set of indicators that help us examine the impact of socio-economic and demographic factors on the occurrence of dengue in regions of the United States and Mexico. Methods: We assess the relationship between dengue occurrence in humans, climate factors (temperature and minimum quarterly rainfall), socio-economic factors (such as household income, regional rates of education, housing overcrowding, life expectancy, and medical resources), and demographic factors (such as migration flows, age structure of the population, and population density). Areas at risk of dengue are first selected based on the predicted presence of at least one of the two mosquito vectors responsible for dengue’s transmission: Aedes aegypti and Aedes albopictus. In those regions where the vectors had a high probability of presence, we assess the impact of the composite socio-economic indicators (derived through factor analysis to account for collinearity), and three composite demographic indicators (also derived from factor analysis) on the regional distribution of dengue cases, controlling for climate and spatial correlation. Results: We found that an increase of one unit in one of our socio-economic indicators representing labour force with at least secondary education, better broadband access, and rooms per inhabitant, a higher proportions of active physicians is related to a drop in the occurrence of dengue, whereas the demographic indicators such as population density, age structure of the population and population growth showed no significant impact after taking climate into account. More importantly, our socio-economic indicator can also explain differences in the occurrence of dengue across Mexico, whereas simpler measures, such as regional GDP could not. Conclusions: These results suggest that the set of indicators developed is a better indicator than GDP at predicting the distribution of dengue, by capturing information that is much more tailored to poverty related conditions which aid dengue transmission. Given that data for these indicators are available at a sub-national scale for OECD countries and selected OECD non-member economies, these indices may help us better understand factors responsible for the global distribution of dengue and also, given a warming climate, may help us to better predict vulnerable populations.
Evaluation of the Content Validity Index of the Australian Canadian hand OA Index, the Patient-Rated Wrist/Hand Evaluation and the Thumb Disability Exam in people with hand arthritis
Authors: Bobos Pavlos , MacDermid Joy C , Boutsikari Eleni C. , Lalone Emily A. , Ferreira Louis , Grewal Ruby
Published: June 2020

BackgroundThe Australian Canadian hand OA Index (AUSCAN), the Patient-Rated Wrist/Hand Evaluation (PRWHE) and the Thumb Disability Exam (TDX) are patient-reported outcome measures (PROM) used to assess pain and hand function in patients with hand arthritis. This study evaluated the content validity of PRWHE, AUSCAN and TDX. MethodsThis study enrolled participants with hand arthritis to rate the items of all 3 PROM in terms of relevance and clarity. The Content Validity Index (CVI) was computed for each item in each scale (I-CVI) as well as for the overall scale (S-CVI). Kappa was used to determine the inter-rater agreement among the experts. ResultsOverall, 64 individuals with hand arthritis (27% with OA, 67% with rheumatoid arthritis and 6% with psoriatic arthritis) participated in the study. The I-CVI for all items and all scales was very high (I-CVI > 0.76) and the modified Kappa agreement among the raters demonstrated excellent agreement (k>0.76).The S-CVI for all PROMs was found very high for relevance (PRWHE = 0.85, 95% CI 0.82 to 0.88; TDX = 0.87, 95% CI 0.85 to 0.89 and AUSCAN = 0.92, 95% CI 0.90 to 0.94) and for clarity (PRWHE = 0.95, 95% CI 0.93 to 0.97; TDX = 0.91, 95% CI 0.89 to 0.94 and AUSCAN = 0.99, 95% CI 0.98 to 1.00) respectively. ConclusionsThis study demonstrated very high content validity indices for the PRWHE, AUSCAN, and TDX; with strong consensus across reviewers. This augments prior statistical evidence supporting statistical measurement properties, to provide support for the content validity.
A Systematic Review and Metanalyis of Soil Transmitted Helminths Infections Among Preschool and School-age Children in Ethiopia: Evaluation of Neglected Tropica Diseases (NTDS) Elimination Program by 2020
Authors: Chelkeba Legese , Melaku Tsegaye , Emana Daniel , Jimma Worku
Published: June 2020

Background: Comprehensive nationwide on prevalence, geographic distribution of different species and time trends of soil-transmitted helminths (STHs) are lacking. Therefore, the aim of this study was to provide a summary and location of the available data on STHs infection among preschool and school-age children in Ethiopia. Methods: The search were carried out in Medline via PubMed, Scopus, Science Direct, Web of Science and Google Scholar on data published between 1995 to Fabruary 2020 for studies describing rate of STHs infection among preschool and school-age in Ethiopian. We followed Patient, intervention, Comparsion and Outcome (PICO) approach to identify the studies. Endnote citation manager software version X9 for Windows was utilized to collect and organize search outcomes (into relevant and irrelevant studies) and for removal duplicate articles . We conducted meta-regression to understand the trends and the source of heterogeneity and pooled the prevalence using ‘metaprop’ command using STATA software version 14.Results: A total of 29,311 of the 61,690 children examined during the period under review were infected with one or more species of intestinal parasites yielding an overall prevalence of 48 % (95%CI: 43-53%). The overall pooled estimate of STHs was 33% (95% CI: 28-38%). The prevalence was 44% (95%CI : 31% - 58%) in SNNPR, 34%((95%CI : 28% - 41%) in Amhara region, 31% (95%CI : 19% - 43%) in Oromia region and 10% (95%CI : 7% - 12%) in Tigray region. Soil-transmitted helminths infection rate has been decreasing from 44% (95% CI:30-57%) pre-Mass Drug Administration (MDA) era (1997-2012) to 30% (95% CI:25-34%) post-MDA (2013-2020), although statistically not significant (p = 0.45). A. lumbricoides was the predominant species with a prevalence of 17%. Conclusion: Southern Nations Nationalities and Peoples Region , Amhara and Oromia regions carry the highest burden and are categorized to Moderate Risk Zones (MRZ) and therefore, requiring mass drug administration (MDA) once annually with Albendazole or Mebendazole. Prevalence of SHTs decreased after MDA compared to before MDA, but the decline was not statistically significant. A. lumbricoides was the predominant species of STHs among preschool and school-age children in Ethiopia.
Design and study of Solid Waste Management in Ranchi, Jharkhand
Authors: Aman Ankish , Srivast PK
Published: June 2020

Solid waste management (SWM) have becomes a very serious concern globally. The lack of individual responsibilities as well as proper attitude and approach leads to this issue. Rapid industrialization, increase in population and further increase in standard of living and poor waste management have increased the serous health issue. Ranchi city need to be taken care by various new SWM techniques, proper management skill and adequate care the diseases and improve medical conditions. This paper deals with the proper description of the current MSWM process and the real time scenario where every individual is a source of waste creation. The effect of growing population of last ten years outcome of waste quality and quantity generated throughout these years have been discussed. It is observed that more than 4000 tons of waste per month is being generated. Researches shows that the disposal of solid waste requires 2,700,000 m2 area for the landfill up to the year 2030. Far sustainable development and effective management it is suggested that implementation of newer technologies, training of common people, and effective implementation of government policies will help to come out of these current issues.
Achene morphology and pericarp anatomy of Anemone Hepatica and Pulsatilla (Anemoninae, Ranunculaceae)
Authors: Ghimire Balkrishna , Son Dong Chan , Yum Dabin , Kim Jae Hyun , Jeong Mi Jin
Published: June 2020

Background

Fruit morphological characters have contributing useful taxonomic data and thus used to discriminate the species in different taxonomic rank. The fruit and seed morphology and anatomy in the family Ranunculaceae has been a long history and proved to be a great value for its phylogeny.
Methods

Achene morphology and pericarp anatomy of 12 taxa representing three genera (Anemone, Hepatica, and Pulsatilla) of tribe Anemoninae were investigated using microtome and light microscopy (LM) to evaluate taxonomic implications of achene characters.
Results

The achenes of Anemone were elliptical or obovoid and beaked, whereas the achene of Hepatica and Pulsatilla were obovoid and elliptical, respectively. Noticeable variations in both quantitative and qualitative features of achenes were observed among the species of three genera. One-way ANOVA indicated that the quantitative achene variables among the species were highly significant (P < 0.001). Pearson’s correlation coefficient also showed a significant correlation between different achene variables. The pericarp structure, particularly the number of cell layers and cell form in exocarp and endocarp seems to very useful for species delimitation in Amenome and Hepatica. The nature of endotesta could provide a substantial proof for sub-generic classification in Anemone. The UPGMA analysis also showed the utility of achene features for taxonomic groupings of the species within studied genera.
Conclusion

Although the sampling specimens represented a limited range of taxa the achene features and pericarp anatomy provide a reasonable source for the taxonomic treatment of studied genera within the tribe.
Impact of barometric pressure on adhesive small bowel obstruction: A retrospective study
Authors: Yamamoto Yuta , Miyagawa Yusuke , Kitazawa Masato , Tanaka Hiokazu , Kuroiwa Masatsugu , Hondo Nao , Koyama Makoto , Nakamura Satoshi , Tokumaru Shigeo , Muranaka Futoshi , Soejima Yuji
Published: June 2020

Background
Adhesive small bowel obstruction (ASBO) is one of the most common causes of postoperative morbidity. According to Boyle’s law, decreased barometric pressure causes the volume of intestinal gas to expand. We aimed to elucidate the relationship between barometric pressure and ASBO.
Methods
We divided 215 admissions of 120 patients with ASBO into three groups: fasting group with response to fasting (n = 51); decompression group with successful treatment of gastrointestinal decompression (n = 104); and surgery group that required emergency or elective surgery to treat ASBO (n = 60). We compared and examined clinical backgrounds, findings on admission, and barometric pressure during the peri-onset period (29 days: from 14 days before to 14 days after the onset of ASBO).
Results
There were significant difference among the three groups in gender, history of ASBO, hospital length of stay, and barometric pressure on the onset day of ASBO. Barometric pressure on the onset day was significantly higher in the fasting group than in the decompression group (p = 0.005). During pre-onset day 5 to post-onset day 2, fluctuations in the barometric pressure in the fasting and decompression groups showed reciprocal changes with a symmetrical axis overlapping the median barometric pressure in Matsumoto City, and the fluctuations tapered over time after onset. In the fasting group, the barometric pressure on the onset day was significantly higher than that on pre-onset days 14, 11, 7, 4, 3, 2; post-onset days 3, 10; and the median pressure in Matsumoto City. Conversely, in the decompression group, the barometric pressure on the onset day was lower than that on pre-onset days 14, 5 − 2; post-onset days 1, 2, 7, 8, 11, 13, 14; and the median pressure in Matsumoto City. In the surgery group, the barometric pressure on the onset day was equivalent to those on the other days.
Conclusion
ASBO with response to conservative treatment is vulnerable to barometric pressure. Additionally, ASBO successfully treated with fasting and decompression is associated with a different barometric pressure on the onset day and reciprocal fluctuations in the barometric pressure during the peri-onset period.
Estimating the impact of donor programs on child mortality in low- and middle-income countries: a synthetic control analysis of child health programs funded by the United States Agency for International Development
Authors: Weiss William M. , Bhumika Piya , Andrus Althea , Cohen Robert
Published: June 2020

Background Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the United States and the United Kingdom. Direct attribution of impact to large scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes. Methods This study uses the synthetic control analysis method to estimate the impact of one donor’s funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016. Results In the study period (2000-16), countries with above average USAID funding had an under-fiver mortality rate lower than the synthetic control by an average of 29 deaths per 1,000 live births (year to year range of 2 – 38). This finding was stable across several sensitivity analyses. Conclusions The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.
A four-step strategy for handling missing outcome data in randomised trials affected by a pandemic
Authors: Cro Suzie , Morris Tim P , Kahan Brennan C , Cornelius Victoria R , Carpenter James R
Published: June 2020

Background
The coronavirus pandemic (Covid-19) presents a variety of challenges for ongoing clinical trials, including an inevitably higher rate of missing outcome data, with new and non-standard reasons for missingness. International drug trial guidelines recommend trialists review plans for handling missing data in the conduct and statistical analysis, but clear recommendations are lacking.
Methods
We present a four-step strategy for handling missing outcome data in the analysis of randomised trials that are ongoing during a pandemic. We consider handling missing data arising due to (i) participant infection, (ii) treatment disruptions and (iii) loss to follow-up. We consider both settings where treatment effects for a ‘pandemic-free world’ and ‘world including a pandemic’ are of interest.
Results
In any trial, investigators should; (1) Clarify the treatment estimand of interest; (2) Establish what data are missing for the estimand at hand; (3) Perform primary analysis under the most plausible missing data assumptions followed by; (4) Sensitivity analysis under alternative plausible assumptions. To obtain an estimate of the treatment effect in a ‘pandemic-free world’, data from participants clinically affected by the pandemic (directly via infection or indirectly via treatment disruptions) are not relevant and can be set to missing. For primary analysis, a missing-at-random assumption that conditions on all observed data that are expected to be associated with both the outcome and missingness may be most plausible. For the treatment effect in the ‘world including a pandemic’, all participant data is relevant and should be included in the analysis. For primary analysis, a missing-at-random assumption – potentially incorporating a pandemic time-period indicator and participant infection status – or a missing-not-at-random assumption with a poorer response may be most relevant, depending on the setting. In all scenarios, sensitivity analysis under credible missing-not-at-random assumptions should be used to evaluate the robustness of results. We highlight controlled multiple imputation as an accessible tool for conducting sensitivity analyses.
Conclusions
Missing data problems will be exacerbated for trials active during the Covid-19 pandemic. This four-step strategy will facilitate clear thinking about the appropriate analysis for relevant questions of interest.
Media representations of COVID-19 public health policies: assessing the portrayal of essential health services in Canadian print media
Authors: Ogbogu Ubaka , Hardcastle Lorian
Published: June 2020

Aims: The study assessed how the Canadian print media represented essential healthcare services during the COVID-19 pandemic, including the controversial decision to include liquor and cannabis stores in essential services lists.Methods: Quantitative content analysis of sixty-seven articles published in major Canadian English language newspapers between March 23 and April 1, 2020. Articles were analyzed and coded by two raters. Ratings were analyzed in SPSS.Results and Discussion: Few articles in the sample discussed essential healthcare services and the inclusion of liquor and cannabis stores in essential services lists. Majority of the articles that discussed both topics framed the discussion positively and consistently with current knowledge and evidence.Conclusion: Canadian print media representations of essential healthcare services and associated public debate are largely descriptive and, therefore, fail to engage critically with or advance public understanding of an important health policy issue.
Comparative Parameters Evaluation of Internal Combustion Engines Naturally Aspired and Supercharged With Hybrid Turbocharger
Authors: Rares Chiriac , Chiru Anghel
Published: June 2020

Internal combustion engines have an operating efficiency that can be exploited to increase their performance. Some of the waste gases can be recovered through technical solutions such as turbocharging. The turbocharging solution is one of the most popular technical solutions for increasing the energy performance of internal combustion engines. This requires an analysis of the energy balance of the internal combustion engine. This shows that there is a significant reserve of energy in the exhaust gases, which can be used to increase the engine efficiency. One solution is to use this energy to drive a turbine coupled with an electric generator. This article aims to present the result of the experimental research of the hybrid turbocharger, simulating and validating the new solutions for increasing the energy performance of internal combustion engines through hybrid turbochargers using a coupled electric generator. The simulations will be performed using AMESim software developed by Siemens to demonstrate through calculations the efficiency of new solutions, such as a hybrid turbocharger. The tests will be performed using an diesel internal combustion engine with a cylinder capacity of 1.9 liters which is also simulated with AMESim software. The residual exhaust gases of the internal combustion engine will drive the hybrid turbocharger turbine and generate electricity. Electricity can then be used for storage in the car battery or for consumption by the car's electrical system. The article also includes a comparative study between the power and torque of the naturally aspirated internal combustion engine equipped with a hybrid turbocharger.
Construction and Analysis of a circRNA-Mediated ceRNA Network in Lung Adenocarcinoma
Authors: Wang Zhaojun , Li Haifeng , Wei Li , Zhang Junhang
Published: June 2020

Background: Circular RNAs (circRNAs), a new class of regulatory noncoding RNAs, are involved in gene regulation and may play a role in cancer development. This study aimed to identify circRNAs involved in lung adenocarcinoma (LUAD) using bioinformatics analysis.Methods: CircRNA (GSE101684, GSE101586), miRNA (GSE135918), and mRNA (GSE130779) microarray datasets were downloaded from the Gene Expression Omnibus (GEO) database to identify differentially expressed circRNAs (DECs), miRNAs (DEMs), and mRNAs (DEGs) in LUAD. Circinteractome and StarBase were used to predict miRNAs and mRNAs, respectively. A circRNA-miRNA-mRNA-ceRNA network was constructed. Patient survival was analyzed using UALCAN, and a sub-network was established.Results: Hsa_circ_0072088 was identified as a differentially expressed (upregulated) circRNA in the two datasets. Intersection analysis identified hsa-miR-532-3p and hsa-miR-942 as the two miRNAs with the highest potential for binding to hsa_circ_0072088. Differential expression analysis and target gene prediction were performed to build a ceRNA network of hsa_circ_0072088 using Circinteractome/StarBase 3.0. Intersection analysis showed that TMEM52, IL24, POF1B, KIF1A, NHS, LBH, HIST2H2BE, ABCC3, PYCR1, CD79A, IGF2BP3, ANKRD17, GTSE1, MKI67, CLSPN, PLAU, LUC7L, MAGIX, GPATCH4, and ABAT were potential downstream mRNAs. The association between the expression level of 20 DEGs and LUAD patient survival was analyzed using UALCAN, which showed that IGF2BP3, MKI67, CD79A, and ABAT were related to patient survival.Conclusion: The circRNA hsa_circ_0072088, the miRNAs hsa-miR-532-3p and hsa-miR-942-5p, and the genes IGF2BP3, MKI67, CD79A, and ABAT may serve as prognostic markers in LUAD.
Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series
Authors: Xu Lujie , Ye Wensong , Li Haibing , Xu Jingfang , Zhu Weiwei , Yang Yi
Published: June 2020

Background

Medial epicondyle fracture comprises a considerable proportion of pediatric elbow injury. The fracture fragment is typically pulled distally by the muscle and the ligament. This study aims to suggest proper recognition of a subset of the fracture that differs from its usual presentation.
Methods

A retrospective case study was conducted during 2011–2016. Of those cases, a subset was identified as proximally displaced (atypical) ones. Distinctive radiologic images, as well as the injury causes, demographic data, clinical signs, treatment ways, and final follow-ups regarding these atypical ones, were presented and discussed. The fracture mechanism was carefully inferred from former theories and the operative findings, and a tentative management strategy was suggested.
Results

Seven out of 112 cases were distinguished as the atypical, which represents 6.25% of the whole sample. Injury causes were all direct or combined direct/indirect force injuries instead of indirect force mostly seen in the typical. Five were operated while two nonoperatively treated. Operated cases revealed stripping of medial epicondyle from its surrounding periosteum/muscle origin or even cartilage. The fracture fragment was either pulled by proximal periosteum or even proximally dissociated. The outcomes of those atypical were mostly acceptable despite some minor defects.
Conclusion

The proximally displaced cases do constitute a portion of medial humeral epicondyle fracture in children. As well as its skeletal manifestation, awareness of its injury mechanism and soft tissue damage is required. Precise restoration of its anatomical structure might be vital for its treatment. Further scientific work is needed regarding its mechanism and management.
Level of evidence:
Level 4.
Employment Changes among Chinese Family Caregivers of Long-Term Cancer Survivors
Authors: Liu Siqi , Su Mingzhu , Yao Nengliang , Zhang Nan , Wang Jialin , Anderson Roger. T. , Sun Xiaojie
Published: June 2020

Background To describe the effect that providing cancer care to long-term cancer survivors has on the employment status of family caregivers (FCGs), and identify cancer-related characteristics that influence FCGs’ employment status in the post-treatment phase in China. Methods We surveyed 1155 cancer survivors (>1 year since completing treatment) from the cross‐sectional study “China Survey of Experiences with Cancer”. Participants reported changes in employment status of their FCGs. Descriptive statistics characterized the sample of survivors and FCGs’ employment status. Separate multivariable logistic regression models were conducted to examine the association between participant cancer characteristics and changes in FCGs’ employment status. Results In the primary treatment phase, 45.6% of all FCGs reduced their working hours and 17.4% stopped working altogether. In the post-treatment phase, 25.2% of FCGs reduced working hours and 6.6% stopped working. A higher probability of change in employment status among FCGs was associated with the following cancer-related characteristics: late-stage diagnosis, chemotherapy treatment, comorbidity, and limited ability to perform physical and mental tasks. Conclusions Cancer treatment and post-treatment demands may have a great number of impacts on the employment and economic productivity of Chinese FCGs. Interventions to assist them in maintaining employment are warranted across the whole survivorship trajectory.
New mutation in PTEN identified in patient with rare bilateral choroidal ganglioneuroma
Authors: Jiang Zhaoxin , Zhang Ting , Chen Chonglin , Sun Limei , Li Songshan , Ding Xiaoyan
Published: June 2020

Background
Choroidal ganglioneuroma is an extremely rare tumor, with little known regarding its pathogenesis. The present study aimed to investigate the phenotype and genetic alterations in one sporadic patient with rare bilateral choroidal ganglioneuroma.
Methods
A 6-year-old boy with histological diagnosis of bilateral ganglioneuroma was recruited in this study. Comprehensive ophthalmic examinations were performed in the patient. Genomic DNA was extracted from peripheral blood collected from the patient, the patient's unaffected family members, and from 200 unrelated control subjects from the same population. Whole exome sequencing was carried out and raw reads were aligned to the human genome reference (hg19) using the Burrows Wheeler Aligner. All available family members were subjected to Sanger sequencing for segregation analysis.
Results
Bilateral and extensive retinal detachments were observed in OCT. The diffuse thickening of choroid was identified in B scan and MRI. Genetic analysis revealed the presence of a novel heterozygous PTEN frameshift mutation, c.498delA (p.Thr167LeufsTer16), in exon 6. It was identified in the affected individual, but not in any of the unaffected family members. Genetic analysis showed that there was no mutant in neurofibromatosis-related genes. There were no obvious abnormalities in other organs in comprehensive systemic examinations.
Conclusions
A novel de novo PTEN mutation was identified in a bilateral choroidal ganglioneuroma case. Although PTEN mutation has been considered to induces multiple abnormalities, choroidal ganglioneuroma can be the first manifestation without abnormalities in other organs. Further studies are needed to confirm this new association between choroidal ganglioneuroma and the PTEN mutation.
The effects of gasification technology on IGFC system efficiency
Authors: Li Pingping , Jin Xianlin , Guo Zhongshan , You Xiaobin , Li Hu , Yao Jinsong , Jiang Lilong , Li Chufu
Published: June 2020

As one of the significant part of IGFC (integrated gasification fuel cell) system, coal gasification technology has an important effect on system efficiency as well as technological process. To figure out what kind of gasifier technology could benefit IGFC system most, we select two representative gasifiers for comparison, which are E-Gas gasifier and Shell gasifier. In this study MW-level E-gas IGFC system and Shell IGFC system models are developed respectively, moreover, the energy analysis of two systems are carried out simultaneously. The results show that SOFC DC Power efficiency and system net plant efficiency of E-gas IGFC system are 52.82% and 50.89% , both higher than Shell IGFC system, which are 49.24% and 49.74%; under the same design conditions, gasifier with high content of CH 4 would be easier to obtain higher SOFC power efficiency as well as system net efficiency. The present work is helpful to provide gasifier selection suggestions for large-scale IGFC system.