bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility and Evaluation of a Large-Scale External Validation Approach for Patient-Level Prediction in an International Data Network: Validation of models predicting stroke in female patients newly diagnosed with atrial fibrillation.
Authors: Reps Jenna Marie , Williams Ross D , You Seng Chan , Falconer Thomas , Minty Evan , Callahan Alison , Ryan Patrick B , Park Rae Woong , Lim Hong-Seok , Rijnbeek Peter
Published: May 2020

Background To demonstrate how the Observational Healthcare Data Science and Informatics (OHDSI) collaborative network and standardization can be utilized to scale-up external validation of patient-level prediction models by enabling validation across a large number of heterogeneous observational healthcare datasets.Methods Five previously published prognostic models (ATRIA, CHADS2, CHADS2VASC, Q-Stroke and Framingham) that predict future risk of stroke in patients with atrial fibrillation were replicated using the OHDSI frameworks. A network study was run that enabled the five models to be externally validated across nine observational healthcare datasets spanning three countries and five independent sites. Results The five existing models were able to be integrated into the OHDSI framework for patient-level prediction and they obtained mean c-statistics ranging between 0.57-0.63 across the 6 databases with sufficient data to predict stroke within 1 year of initial atrial fibrillation diagnosis for females with atrial fibrillation. This was comparable with existing validation studies. The validation network study was run across nine datasets within 60 days once the models were replicated. An R package for the study was published at https://github.com/OHDSI/StudyProtocolSandbox/tree/master/ExistingStrokeRiskExternalValidation .Conclusion This study demonstrates the ability to scale up external validation of patient-level prediction models using a collaboration of researchers and a data standardization that enable models to be readily shared across data sites. External validation is necessary to understand the transportability or reproducibility of a prediction model, but without collaborative approaches it can take three or more years for a model to be validated by one independent researcher. In this paper we show it is possible to both scale-up and speed-up external validation by showing how validation can be done across multiple databases in less than 2 months. We recommend that researchers developing new prediction models use the OHDSI network to externally validate their models.
Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet
Authors: Mansson Linda , Lundin-Olsson Lillemor , Skelton Dawn A , Janols Rebecka , Lindgren Helena , Rosendahl Erik , Sandlund Marlene
Published: May 2020

Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet.Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start.Results: Sixty-seven participants, with mean age 77±4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p=.078). In both groups 50-59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p=.001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p=.026) degree of being content, and feeling supported by the programme (p=.044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p=.036).Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise.Trial registration: ClinTrial: NCT02916849
Feasibility cluster randomised controlled trial evaluating a theory-driven group-based complex intervention versus usual physiotherapy to support self-management of osteoarthritis and low back pain (SOLAS)
Authors: Hurley Deirdre , Jeffares Isabelle , Hall Amanda M , Keogh Alison , Toomey Elaine , McArdle Danielle , McDonough Suzanne M , Guerin Suzanne , Segurado Ricardo , Matthews James
Published: May 2020

Background The Self-management of Osteoarthritis (OA) and Low back pain (LBP) through Activity and Skills (SOLAS) theory-driven group-based complex intervention was developed primarily for the evaluation of its acceptability to patients and physiotherapists and the feasibility of trial procedures, to inform the potential for a definitive trial. Methods This assessor-blinded multicentre two-arm parallel cluster randomised controlled feasibility trial compared the SOLAS intervention to usual individual physiotherapy (UP; pragmatic control group). Patients with OA of the hip, knee, lumbar spine and/or chronic LBP were recruited in primary care physiotherapy clinics (i.e. clusters) in Dublin, Ireland between September 2014 and November 2015. The primary feasibility objectives were evaluated using quantitative methods and individual telephone interviews with purposive samples of participants and physiotherapists. A range of secondary outcomes were collected at baseline, 6 weeks (behaviour change only), 2 months and 6 months to explore the preliminary effects of the intervention. Analysis was by intention-to-treat according to participants’ cluster allocation and involved descriptive analysis of the quantitative data and inductive thematic analysis of the qualitative interviews. A linear mixed model was used to contrast change over time in participant secondary outcomes between treatment arms, while adjusting for study waves and clusters. Results 14 clusters were recruited (7 per trial arm), each cluster participated in two waves of recruitment, with the average cluster size below the target of six participants (Intervention: mean (SD) =4.92 (1.31), range 2-7; UP: mean (SD) =5.08 (2.43), range 1-9). 120 participants (83.3% of n=144 expected) were recruited (Intervention n=59; UP n=61), with follow up data obtained from 80.8% (n=97) at 6 weeks, 84.2% (n=101) at 2 months and 71.7% (n=86) at 6 months. Most participants received treatment as allocated (Intervention n=49; UP n=54). The qualitative interviews (12 participants; 10 PTs) found the Intervention and trial procedures acceptable and appropriate, with minimal feasible adaptations required. Linear mixed methods showed improvements in most secondary outcomes at 2 and 6 months with small between group effects. Conclusions While the SOLAS intervention and trial procedures were acceptable to participants and PTs, the recruitment of enough participants is the biggest obstacle to a definitive trial. Trial Registration: ISRCTN Registry, ISRCTN49875385, Registered 26 March 2014. https://doi.org/10.1186/ISRCTN49875385
A comparative study of Long Interspersed Element-1 Protein Immunoreactivity in Cutaneous Malignancies
Authors: Zolfaghari Mohammad Ali , Karimi Abbas , Kalantari Elham , Korourian Alireza , Ghanadan Alireza , Kamyab Kambiz , Esmaili Nafiseh , Razavi Amir Nader Emami , Madjd Zahra
Published: May 2020

Background: Skin cancer is the most common cancer worldwide and commonly classified into malignant melanoma (MM) and Nonmelanoma skin cancers (NMSCs), which mainly include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The extent to which Long Interspersed Element-1 (LINE-1, L1) ORF1p is expressed in cutaneous malignancies remains to be evaluated. This study aimed to assess LINE-1 ORF1p immunoreactivity in various skin cancer subtypes. Method:The expression level of LINE-1 ORF1p was evaluated in 95 skin cancer specimens comprising 36 (37.9%) BCC, 28 (29.5%) SCC, and 31 (32.6%) melanoma using the tissue microarray (TMA) technique. Then the association between expression of LINE-1 encoded protein and clinicopathological parameters was analyzed. Results: We showed that LINE-1 ORF1p expression level was substantially higher in BCC and SCC patients compared with melanoma samples (p < 0.001). BCC cases had a higher LINE-1 histochemical score (H-score) compared with SCC cases (p = 0.004). In SCC samples, a lower level of LINE-1 ORF1p expression was associated with age younger than the mean (p = 0.041). At the same time, no significant correlation was found between LINE-1 ORF1p expression and other clinicopathological parameters (all p > 0.05). Conclusions: According to our observation, LINE-1 ORF1p immunoreactivity in various skin tumor subtypes extends previous studies of LINE-1 expression in different cancers. LINE-1ORF1p overexpression in NMSCs compared with MM can be considered with caution as a tumor-specific antigen for NMSCs.
The Role of Patient-provider Communication: a qualitative study of patient attitudes regarding co-occurring depression and chronic diseases in Malawi
Authors: Akiba Christopher , Zimba Chifundo C , Thom Annie , Matewere Maureen , Go Vivian , Pence Brian , Gaynes Bradley Neil , Masiye Jones
Published: May 2020

Background: Globally, depression is a leading cause of morbidity and mortality particularly in Low and Middle-Income Countries (LMICs). The burden of non-communicable diseases (NCDs) are also increasing in LMICs, the conditions frequently co-occur and exacerbate NCD outcomes. Depression interventions alone are not effective at improving NCD outcomes, resulting in wide-reaching calls for integrated services. Integrated services are in a nascent phase in LMICs in general and in Malawi in particular. This manuscript serves to clarify Malawian patients’ attitudes and perceptions towards depression integration into routine NCD services. Methods: Ten District Hospitals were selected for data collection and 2 participants were interviewed from each site (N=20). An iterative approach to concept-driven coding was applied to facilitate the formation of similarities, differences, and connections between codes. Results: While patients infrequently described moderate depression as a medical condition, and held various attitudes regarding treatments, they agreed on the appropriateness of integrated services. Patients’ respect for their providers led them to support integration. Patients discussed how medical knowledge is highly regarded, revealing a power dynamic with their providers. Patients further acknowledged the importance of a provider’s communication in shaping a patient’s feelings about depression. Conclusions: Training and interventions that facilitate providers’ abilities to transfer their medical knowledge, use strategies to channel their power, and engage patients in a meaningful and collaborative relationship will be key to successfully integrating depression treatment into Malawian NCD clinics. Trial Registration: This work served as part of formative data collection for National Institute of Mental Health (NIMH) Trail NCT03711786 registered on 10th October, 2018
Hospitalizations for viral respiratory infections in children under 2 years of age: epidemiology and in-hospital complications
Authors: Zurita-Cruz Jessie , Gutierrez-Gonzalez Alejandro , Manuel-Apolinar Leticia , Fernández-Gárate José Esteban , Arellano-Flores María Luisa , Eng Roberto Alejandro Correa Gonzalez , Vazquez-Rosales Guillermo , Sanchez-Armas Rocio , Cisneros Nelly
Published: May 2020

Background: Viral respiratory infections (VRIs) are a frequent cause of hospitalization in children under 24 months of age. A history of prematurity or heart disease may be a risk factor for complications in patients hospitalized for VRI. The objective was to describe epidemiological data for children hospitalized for IRV and aged 1 to 24 months and to identify risk factors for the presence of in-hospital complications and mortality over a period of 5 years. Methods : This was a cross-sectional study. Patients registered with VRI codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219 (based on International Classification of Diseases [ICD-10]) from 2013 to 2017 were included. Three subanalyses were performed to compare (1) patients with pathological history (prematurity, bronchopulmonary dysplasia [BPD] and congenital heart disease [CHD]), (2) diagnoses (pneumonia, acute bronchitis, and acute bronchiolitis), and (3) admission to the pediatric intensive care unit. Days of hospital stay, in-hospital complications, invasive medical procedure and mortality were analyzed. Statistical analysis : VRI hospitalization prevalence was described. For comparison between groups, Student's t-test, ANOVA and the Chi2 test were applied. To identify factors related to days of hospital stay, in-hospital complications and mortality, a linear and logistic regression model was performed. Results: A total of 66,304 hospitalizations were reported. The average age was 14.7 weeks; hospitalization events were higher in winter (39%), followed by autumn (27.3%). A total of 371 (0.56%) patients died. A total of 7,068 (10.6%) hospitalized patients with pathological histories were identified. The presence of BPD (coefficient = 1.6), CHD (coefficient = 1.2), diagnosis of pneumonia (coefficient = 1.2), in-hospital complications (coefficient = 2.1) and invasive medical procedures (coefficient = 15.7) were the most common factors that increased the length of hospital stay. Risk factors for in-hospital complications and mortality were invasive medical procedure (OR = 3.3 & 11.7), BPD (OR=1.8 & 1.6), CHD (OR = 4.6 & 3.4) and diagnosis of pneumonia (OR= 1.8 & 4.2). Conclusions: Risk factors for morbidity and mortality in patients hospitalized for VRIs are BPD and CHD, diagnosis of pneumonia and invasive medical procedure.
A Tunisian version of the Confusion Assessment Method for the intensive care unit (CAM-ICU): translation and validation
Authors: Saida Imen Ben , Kortli Saiid , Amamou Badii , Kacem Nawres , Ghardallou Mariem , Ely Eugene Wesley , Saad Helmi Ben , Boussarsar Mohamed
Published: May 2020

Background. Delirium is common in critically ill patients and it is associated with poor outcomes. In Tunisia, however, it is still underdiagnosed as there is no validated screening tool. The aim of this study was to translate and to validate a Tunisian version of the CAM-ICU. Methods. For the validation and inter-rater reliability assessment of the Tunisian CAM-ICU, two trained intensivists independently evaluated delirium in the patients admitted to the ICU between October 2017 and June 2018. All the patients consecutively admitted to the ICU for more than 24 hours and having a Richmond Agitation-Sedation Scale greater than or equal to “-3” were assessed for delirium excluding those with stroke, dementia, psychosis or persistent coma. The results were compared with the reference evaluation carried out by a psychiatrist using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The inter-rater reliability was calculated using the kappa (κ) statistic. The CAM-ICU concurrent validity was assessed using Cronbach’s α coefficient, sensitivity, specificity as well as positive and negative predictive values (PPV and NPV, respectively) for the two Tunisian CAM-ICU raters. Results. The study involved 137 patients [median (IQR) age: 60 [49-68] years, male sex (n=102), invasive mechanical ventilation (n=49)]. Using the DSM-V criteria evaluations, 46 patients were diagnosed with delirium. When applying the Tunisian version of the CAM-ICU, 38(27.7%) patients were diagnosed with delirium for the first rater and 45(32.6%) patients for the second one. The Tunisian CAM-ICU showed a very-high inter-rater reliability for both intensivists (κ = 0.844, p<0.001). Using the DSM-V rater as the reference standard, the sensitivity of the two intensivists’ evaluations was 80.4 vs. 95.7%. Specificity was 98.9% for both. The Cronbach’s α of the first and second raters’ evaluations using the Tunisian version of the CAM-ICU were 0.886 and 0.887, respectively. Conclusions. The Tunisian version of the CAM-ICU showed almost perfect validity and reliability in detecting delirium in critically ill patients. It could therefore be used in Tunisian ICUs or where Tunisian translators are available following appropriate training. Trial registration. Not applicable.
The circulating level of Non-coding RNA for breast cancer diagnosis
Authors: wang miao , gu yao , zhang jie , jia zhaojun , wu huijian
Published: May 2020

Background: The expression of non-coding RNAs were closely related to breast cancer progression. However, there were no systemic analysis of non-coding RNAs in breast cancer diagnosis of the blood circulatory system. Herein, we aimed to collect all the evidence to test the potential role of non-coding RNAs as novel biomarkers in human breast cancers. Methods: A comprehensive search strategy was used to search relevant literatures in the Web of Science, PubMed, and Embase databases from January 2012 to November 2019. The correlation of non-coding RNAs expression in serum, plasma or blood circulatory system and the diagnostic accuracy of BC markers were analyzed. The methodological quality of each study was assessed using the QUADAS-2. Statistical analysis was used the STATA (version 12.0), Meta-Disc (version 1.4) and Review Manager (version 5.3) software. Results: The present meta-analysis of the non-coding RNAs expression data of BC patients and healthy specimens’ bloodfrom 2392 patients in 24 publications (32 studies). The pooled sensitivity, specificity, and AUC values were 0.82, 0.83, and 0.89, respectively. Subgroup analyses showed that the expression of non-coding RNA (miRNA, circRNA, andlncRNA) in the blood circulatory system (including blood, plasma, and serum) of BC was more prone to be detected in TNM stage and subtype of BC group, with a high value of the sensitivity and AUC. Conclusions: The blood circulatory system (including blood, plasma, and serum) of miRNAs, circRNAs, and lncRNAs detection may be effective for diagnosing breast cancer, particularly in TNM stage, subtype of BC (ER/PgR, PR or HER2/c-erbB-2) group of breast cancer. Further studies are needed to identify the value of these non-coding RNAs as novel markers in clinical.
Machine Learning Approaches to Predict Peak Demand Days of Cardiovascular Admissions Considering Environmental Exposure
Authors: Qiu Hang , Luo Lin , Su Ziqi , Zhou Li , Wang Liya , Chen Yucheng
Published: May 2020

Background: Accumulating evidence has linked environmental exposure, such as ambient air pollution and meteorological factors, to the development and severity of cardiovascular diseases (CVDs), resulting in increased healthcare demand. Effective prediction of demand for healthcare services, particularly those associated with peak events of CVDs, can be useful in optimizing the allocation of medical resources. However, few studies have attempted to adopt machine learning approaches with excellent predictive abilities to forecast the healthcare demand for CVDs. This study aims to develop and compare several machine learning models in predicting the peak demand days of CVDs admissions using the hospital admissions data, air quality data and meteorological data in Chengdu, China from 2015 to 2017.Methods: Six machine learning algorithms, including logistic regression (LR), support vector machine (SVM), artificial neural network (ANN), random forest (RF), extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM) were applied to build the predictive models with a unique feature set. The area under a receiver operating characteristic curve (AUC), logarithmic loss function, accuracy, sensitivity, specificity, precision, and F1 score were used to evaluate the predictive performances of the six models.Results: The LightGBM model exhibited the highest AUC (0.940, 95% CI: 0.900-0.980), which was significantly higher than that of LR (0.842, 95% CI: 0.783-0.901), SVM (0.834, 95% CI: 0.774-0.894) and ANN (0.890, 95% CI: 0.836-0.944), but did not differ significantly from that of RF (0.926, 95% CI: 0.879-0.974) and XGBoost (0.930, 95% CI: 0.878-0.982). In addition, the LightGBM has the optimal logarithmic loss function (0.218), accuracy (91.3%), specificity (94.1%), precision (0.695), and F1 score (0.725). Feature importance identification indicated that the contribution rate of meteorological conditions and air pollutants for the prediction was 32% and 43%, respectively.Conclusion: This study suggests that ensemble learning models, especially the LightGBM model, can be used to effectively predict the peak events of CVDs admissions, and therefore could be a very useful decision-making tool for medical resource management.
Knowledge, Attitude, and Practices (KAP) of Diabetics towards Diabetes and Diabetic Retinopathy in Riyadh, Saudi Arabia: Cross-sectional study
Authors: Al-Yahya Abdulrahman Abdullah , Alsulaiman Alwaleed Mohammad , Almizel Abdulrahman , barri Abdulrahman Mohammed , Adel Fadwa Al
Published: May 2020

Objective : To identify the knowledge, attitude, and practices (KAP) of diabetic patients towards diabetes and diabetic retinopathy in Riyadh, Saudi Arabia. Methods: This cross sectional study was conducted in 50 randomly selected primary care centers and two university hospitals in Riyadh, Saudi Arabia, between May and December 2018. Diabetic patients ≥ 18 years old were enrolled in the study. A validated KAP-45 questionnaire was used to assess the KAP levels of diabetics towards diabetes and diabetic retinopathy. Results: A total of 313 participants were enrolled in the study. The majority were males 168(59.8%). The median age was 49 ±24, and the median duration of diabetes was 8 ±11 years. The average knowledge score for diabetes was good 10. While, the average knowledge score for diabetic retinopathy was suboptimal 4.5. The average attitude scores for both diabetes and diabetic retinopathy were suboptimal 0 and 2 respectively. The average practice score for diabetes was good 5 while it was low 3 for diabetic retinopathy. The most common barrier to comply with regular follow up was inadequate knowledge about the importance of periodic eye exam 47.1%(107). Conclusions: It is important to improve education and awareness of DM and diabetic retinopathy among diabetics, as it’s essential for controlling the disease and reducing its complications, by improving patient compliance to treatment and follow up.
Determination of efficacy and toxicity of diclofenac microemulsion formulation for musculoskeletal pain: an observational study
Authors: Banh Hoan Linh , Cave Andrew
Published: May 2020

OBJECTIVE : Musculoskeletal pain is often caused by injury to the bones, muscles, tendons, ligaments or nerves. Symptoms can be localized or generalized. Mild-moderate symptoms are treated with topical/oral over the counter drugs. Microemulsion delivery formulations are thermodynamically stable, have superior bioavailability and better penetration of lipophilic and hydrophilic drug into the dermis. A prospective observational study in patients: 18 years or older, with mild-moderate musculoskeletal pain; with severe pain without adequate pain control; with severe pain and could not tolerate oral agents; with renal impairment were invited to try diclofenac 2% in microemulsion foam. They were followed up at 2 and 4 weeks. A 50% reduction on a visual analog pain scale was considered success. Adverse events were defined as irritation, gastrointestinal upset/bleed, rectal bleed, and hematemesis. The objective was to determine the efficacy and toxicity of diclofenac 2% in microemulsion foam. RESULTS : Thirteen consecutive patients with musculoskeletal pain consented to participate. Two patients were lost to follow up. Two of the 11 patients reported minimal improvement, while nine patients reported minimum 50% reduction. No adverse effects were reported. Diclofenac 2% in microemulsion foam is effective in the treatment of mild to moderate musculoskeletal pain and well tolerated.
A pilot study on a potential relationship between leg bone length and sprint performance in sprinters; Are there any event-related differences in 100-m and 400-m sprints?
Authors: Tomita Daichi , Suga Tadashi , Terada Masafumi , Tanaka Takahiro , Miyake Yuto , Ueno Hiromasa , Otsuka Mitsuo , Nagano Akinori , Isaka Tadao
Published: May 2020

Objective: This study examined the relationship between leg bone length and sprint performance in sprinters. The leg bone lengths in 28 100-m specialized sprinters and 28 400-m specialized sprinters were measured using magnetic resonance imaging. The lengths of the upper and lower leg bones were assessed by calculating the lengths of the femur and tibia, respectively. To minimize differences in body size among participants, both bone lengths were normalized to body height. The ratio of the tibial length to femoral length was calculated to evaluate the interaction between the lengths of the upper and lower leg bones. International Amateur Athletic Federation (IAAF) scores, based on the personal best times of the sprinters in each group were used as parameters for sprint performance. Results: There were no significant correlations between absolute and relative lengths of the femur and tibia and IAAF scores in both 100-m and 400-m sprinters. By contrast, the ratio of the tibial length to femoral length correlated significantly with IAAF score in 400-m sprinters ( r = 0.445, P = 0.018), but not 100-m sprinters. These findings suggest that the leg bone lengths may play an important role in achieving superior long sprint performance in 400-m specialized sprinters.
A method to audit and score implementation of knowledge translation (KT) interventions in large health regions – an observational pilot study using rectal cancer surgery in Ontario
Authors: Simunovic Marko , Fahim Christine , Coates Angela , Urbach David , Earle Craig , Grubac Vanja , Brouwers Melissa , O'Brien Mary Ann , Baxter Nancy
Published: May 2020

Background: Across Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers. Ontario is divided administratively into 14 health regions. We piloted a method to audit and score for each region of the province the KT interventions implemented to improve the quality of rectal cancer surgery. Methods: We interviewed stakeholders to audit KT interventions used in respective regions over years 2006 to 2014. Results were summarized into narrative and visual forms. KT experts reviewed these data and then, for each region, scored implementation of KT interventions using a 20-item KT Signature Assessment Tool. Scores could range from 20-100 with higher scores commensurate with greater KT intervention implementation. Results: There were thirty interviews. KT experts produced scores for each region that were bimodally distributed, with an average score for 2 regions of 78 (range 73-83) and for 12 regions of 30.5 (range 22-38). Conclusion: Our methods efficiently identified two groups with similar KT Signature scores. Two regions had relatively high scores reflecting numerous KT interventions and the use of sustained iterative approaches in addition to those encouraged by the provincial cancer agency, while 12 regions had relatively low scores reflecting minimal activities. These groupings will be used for future comparative quantitative analyses to help determine if higher KT signature scores correlate with improved measures for region-level quality of rectal cancer surgery.
Factors Influencing the Use of Reproductive Health Services Among Young Women in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey
Authors: Thapa Naba Raj
Published: May 2020

Background: About one fifth of the total populations are young people aged 15-24 years in Nepal. Utilization of reproductive health services is a key component for preventing young women from different sexual and reproductive health problems. Thus, the objective of the study is to determine the factors influencing the use of reproductive health services among young women in Nepal. Methods: Data is extracted from the 2016 Nepal Demographic and Health Survey (NDHS) datasets. In where the weighted sample population for modern contraceptive use is restricted to the 1593 young women, 1606 young women for the antenatal care and skilled birth attendants. And three reproductive health indicators were selected as outcome variables of reproductive health service utilization for the analysis- modern contraceptive use, at least four antenatal care visits, and use of skilled birth attendance in delivery. Likewise, all calculations were based on standard sample weight of Nepal DHS. Results: The study has found that 21% of young women used modern contraception, 71% attended at least four ANC visits, and 67% utilized a skilled birth attendant at delivery. Young women of Janajati, women who have 1-2, and 3 and more living children, women who participate household decision-making, and have exposure to media were more likely to use modern contraceptives, whereas women who want more children were less likely to use modern contraceptives. Higher education attainments, higher wealth quintile, and lower birth order were associated with higher level of receiving at least four ANC visits and skilled birth attendants among young women. But young women who wanted more children, and who have had access to media have higher odds of receiving at least four ANC visits and women who attend four and more ANC visits have higher odds of using skilled birth attendants. Conclusion: Cleared, to improve the use of reproductive health services among young women, efforts should be made to enrich target in the young women of low education level, low economic status, higher birth order, and low exposure to media. Further research is required to detect the barriers that effects use of reproductive health services among young women.
Effect of 1.8-mm steep-axis clear corneal incision on the posterior corneal astigmatism in candidates for toric IOL implantation
Authors: Li Xi , Chen Xiang , He Suhong , Xu Wen
Published: May 2020

Background: In the present study, we aimed to analyze the effects of cataract surgery using a 1.8-mm steep-axis clear corneal incision (CCI) on the posterior corneal surfaces based on the keratometry from the rotating Scheimpflug imaging device (Pentacam HR) in candidates for toric intraocular lens (IOL) implantation. Methods: Preoperative and at least 1-month postoperative data measured by Pentacam HR were collected in patients for toric IOL implantation. Surgically induced astigmatism on the posterior cornea (P-SIA) was calculated based on the preoperative and postoperative keratometric data, and the related factors of P-SIA were analyzed. Results: A total of 60 eyes from 56 patients were enrolled. The preoperative anterior, posterior and total corneal astigmatism was 1.58±0.61 D ,0.28±0.22 D and 1.70 ± 0.52 D respectively. The postoperative anterior, posterior and total corneal astigmatism was 1.26±0.68 D, 0.41±0.26 D and 1.30 ± 0.51 D respectively. The astigmatism was significantly decreased on anterior surface (P＜0.001, paired t-test) and increased on posterior surface (P＜0.001, paired t-test). The mean of P-SIA calculated by Holladay–Cravy–Koch method was 0.34±0.20 D, with 0.5 D or greater accounting for 26.7%. A statistically significant correlation was observed between the P-SIA and preoperative anterior corneal astigmatism (r = 0.29, P=0.024), as well as preoperative posterior corneal astigmatism (r=0.27, P=0.038). Multivariate regression analysis showed the preoperative anterior and posterior corneal astigmatism had a significant effect on P-SIA (F=7.344, P=0.001). Conclusions: In candidates for toric IOL implantation with a 1.8-mm steep-axis CCI, the incision caused a significant reduction of the anterior corneal astigmatism but an increase of the posterior corneal astigmatism. P-SIA could not be ignored, and it played a significant role in SIA, especially in cases with higher preoperative anterior or posterior corneal astigmatism.
Telemedical care improves quality of life in patients with schizophrenia and bipolar disorder. Results of a randomized controlled trial
Authors: Stentzel Ulrike , Berg Neeltje van den , Strobel Lara N. , Schulte Josephine , Langosch Jens M. , Hoffmann Wolfgang , Grabe Hans J.
Published: May 2020

Background: Schizophrenia and bipolar disorder are serious psychiatric disorders with a high disease burden, many years lived with disability and a high level of risk of relapses and re-hospitalisations. Besides, both diseases are often accompanied with a reduced quality of life. A low quality of life is one predictor for relapses. This study examines whether a telemedical care programme can improve quality of life. Methods: “Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) is a prospective controlled randomised intervention trial to implement and evaluate a telemedical care concept for patients with schizophrenia and bipolar disorder. Participants were randomised in an intervention or a control group. The intervention group received telemedical care including regular, individualised telephone calls and SMS messages. The quality of life was measured with the German version of WHOQOL-BREF. Effects of telemedicine on quality of life after 6 months were analysed using t-tests to compare the intervention with the control group. Participants also evaluated the telemedical care program based on a short standardised interview.Results: 118 participants were recruited, thereof 57.6% men (n = 68). Participants were 43 years old on average (SD) 13)). The IG showed higher QoL scores than the control group (CG) 6 months after the baseline for the WHOQOL total sum score (t-test (CI) 93.1 (92.4-93.8) vs 89.7 (88.8-90.6), p < 0.0001) and for 4 of 5 domains: global 62.0 (60.9-63.0) vs. 56.8 (55.6-58.1), p < 0.0001; physical health 63.8 (63.0-64.7) vs. 59.6 (58.5-60.6), p < 0.0001; psychological 60.9 (60.0-61.9) vs. 56.4 (55.1-57.6), p < 0.0001; environment 70.8 (70.1-71.6) vs. 67.5 (66.7-68.3), p < 0.0001).Conclusion: The Tecla telemedical care concept has led to improvements in quality of life for patients with severe psychiatric disorders. It provides a low-threshold and suitable component of psychiatric treatment. Trial registration: German Clinical Trials Register, DRKS00008548, registered 21 May 2015 – retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do
The features of polyglutamine regions depend on their evolutionary stability
Authors: Mier Pablo , Andrade-Navarro Miguel A.
Published: May 2020

Background: Polyglutamine regions (polyQ) are one of the most studied and prevalent homorepeats in eukaryotes. They have a particular length-dependent codon usage, which relates to a characteristic CAG-slippage mechanism. Pathologically expanded tracts of polyQ are known to form aggregates and are involved in the development of several human neurodegenerative diseases. The non-pathogenic function of polyQ is to mediate protein-protein interactions via a coiled-coil pairing with an interactor. They are usually located in a helical context. Results: Here we study the stability of polyQ regions in evolution, using a set of 60 proteomes from four distinct taxonomic groups (Insecta, Teleostei, Sauria and Mammalia). The polyQ regions can be distinctly grouped in three categories based on their evolutionary stability: stable, unstable by length variation (inserted), and unstable by mutations (mutated). PolyQ regions in these categories can be significantly distinguished by their glutamine codon usage, and we show that the CAG-slippage mechanism is predominant in inserted polyQ of Sauria and Mammalia. The polyQ amino acid context is also influenced by the polyQ stability, with a higher proportion of proline residues around inserted polyQ. By studying the secondary structure of the sequences surrounding polyQ regions, we found that regarding the structural conformation around a polyQ, its stability category is more relevant than its taxonomic information. The protein-protein interaction capacity of a polyQ is also affected by its stability, as stable polyQ have more interactors than unstable polyQ.Conclusions: Our results show that apart from the sequence of a polyQ, information about its orthologous sequences is needed to assess its function. Codon usage, amino acid context, structural conformation and the protein-protein interaction capacity of polyQ from all studied taxa critically depend on the region stability. There are however some taxa-specific polyQ features that override this importance. We conclude that a taxa-driven evolutionary analysis is of the highest importance for the comprehensive study of any feature of polyglutamine regions.
Fine Needle Biopsy of Malignant Tumors of the Liver: a Retrospective Study of 624 Cases from a Single Institution Experience
Authors: Zhang Lin , Cai Zhenjian , Rodriguez Joe , Zhang Songlin , Thomas Jaiyeola , Zhu Hui
Published: May 2020

Background: Liver is one of the most common organs involved by metastatic neoplasms. In addition, a number of primary tumors can arise in the liver. Fine needle biopsy (FNB) is the most commonly used method for diagnosis of liver masses. Not much literature is available during the past ten years about FNB of liver tumors. All large studies were performed more than fifteen years ago. With the introduction of new disease entities, new tumor classification systems, and new diagnostic methods, updated documentation of FNB of liver neoplasms is much needed. Methods: Liver FNB cases that were diagnosed as “Positive for Malignancy” between 2010 and 2018 were retrieved from the cytopathology database in our institution. Patient medical records, cytopathology and surgical pathology reports, and slides from selected cases were retrieved and reviewed. Results: Over 30 different types of malignant tumors were identified in 624 malignant FNB cases, with the most common tumors being metastatic colorectal and pancreatic adenocarcinomas. Rare tumors include EBV-positive leiomyosarcoma, mesothelioma, and paraganglioma, among others. A subset of patients presented with widespread metastases involving liver with no known history. Identify the primary sites in those cases can be challenging. We also found that in our practice, a significant numbers of hepatocellular carcinoma were diagnosed by FNB in recent years. Conclusions: A tremendous variety of neoplasms can occur in liver. Accurate diagnosis is essential for proper patient management. Familiarization with morphological features and judicious usage of ancillary studies are essential for accurate diagnosis.
Partial trisomy 4q and monosomy 5p inherited from a maternal translocationt(4;5)(q33;p15) in three adverse pregnancies
Authors: Zhang Jingbo , Zhang Bei , Liu Tong , Xie Huihui , Zhai Jingfang
Published: May 2020

Background: Carriers of balanced reciprocal chromosomal translocations are at known reproductive risk for offspring with unbalanced genotypes and resultantly abnormal phenotypes. Once fertilization of a balanced translocation gamete with a normal gamete, the partial monomer or partial trisomy embryo will undergo abortion, fetal arrest or fetal malformations. We reported a woman with chromosomal balanced translocation who had two adverse pregnancies. Prenatal diagnosis was made for her third pregnancy to provide genetic counseling and guide her fertility. Case presentation: We presented a woman with chromosomal balanced translocation who had three adverse pregnancies. Routine G banding and CNV-seq were used to analyze the chromosome karyotypes and copy number variants of amniotic fluid cells and peripheral blood. The karyotype of the woman was 46,XX,t(4;5)(q33;p15). During her first pregnancy, odinopoeia was performed due to fetal edema and abdominal fluid. The umbilical cord tissue of the fetus was examined by CNV-seq. The results showed a genomic gain of 24.18 Mb at 4q32.3-q35.2 and a genomic deletion of 10.84 Mb at 5p15.33-p15.2 and 2.36 Mb at 15q11.1-q11.2. During her second pregnancy, she did not receive a prenatal diagnosis because a routine prenatal ultrasound examination found no abnormalities. In 2016, she gave birth to a boy.. The karyotype the of the boy was 46,XY,der(5)t(4;5)(q33;p15)mat. The results of CNV-seq showed a deletion of short arm of chromosome 5 capturing regions 5p15.33p15.2, a copy gain of the distal region of chromosome 4 at segment 4q32.3q35.2, a duplication of chromosome 1 at segment 1q41q42.11 and a duplication of chromosome 17 at segment 17p12. During her third pregnancy, she underwent amniocentesis at 17 weeks of gestation. Chromosome karyotype hinted 46,XY,der(5)t(4;5)(q33;p15)mat. Results of CNV-seq showed a deletion of short arm (p) of chromosome 5 at the segment 5p15.33p15.2 and a duplication of the distal region of chromosome 4 at segment 4q32.3q35.2.Conclusions: Chromosomal abnormalities in three pregnancies were inherited from the mother. Preimplantation genetic diagnosis is recommended to prevent the birth of children with chromosomal abnormalities.
Assessment of the prevention and control effects on the outbreak of COVID-19 in Hunan, China: Based on a SEIAR Dynamic Model
Authors: ZHA Wen-ting , ZHOU Nan , LI Guoqun , LI Weitong , ZHANG Siyu , ZHANG Heng , CHEN Mengxiang , FENG Ruihua , LI Tong , Su Yi , lv yuan
Published: May 2020

Background A new infectious disease, Coronavirus disease 2019 (COVID-19) has been first reported during December 2019 in Wuhan, China, cases have been exported to other cities and abroad rapidly. Hunan is the neighboring province of Wuhan, a series of preventive and control measures were taken to control the outbreak of COVID-19. It is critical to assess these measures on the epidemic progression for the benefit of global expectation.Method: A Susceptible-exposed-infections/asymptomatic-removed (SEIAR) model was established to evaluate the effect of preventive measures. Berkeley Madonna 8.3.18 was employed for the model simulation and prediction, and the curve-fitting problem was solved by Runge-Kutta fourth-order method.Results In this study, we found that Rt was 2.71 from January 21 to 27 and reduced to 0.21 after January 27, 2020. If measures have not been fully launched, patients in Hunan would reach the maximum (8.96 million) on March 25, 2020, and end in about 208 days; when measures have been fully launched, patients in Hunan would just reach the maximum (699) on February 9, 2020, and end in about 56 days, which was very closed to the actual situation.Conclusion The outbreak of COVID-19 in Hunan, China has been well controlled under current measures, full implementation of measures could reduce the peak value, short the time to peak and duration of the outbreak effectively, which could provide a reference for controlling of COVID-19 for other countries.
How effective are digital interventions in increasing flu vaccination amongst pregnant women? A systematic review protocol
Authors: Parsons Jo , Atherton Helen
Published: May 2020

Background Pregnant women and their unborn babies are at increased risk of complications as a result of flu, yet uptake of the flu vaccination in the UK remains low. Digital interventions have proven effectiveness in changing health behaviour, but their effectiveness in increasing flu vaccination amongst pregnant women has not been examined. This protocol details the design and methodology of a systematic review and meta-analysis, examining the effectiveness of digital interventions in increasing flu vaccination amongst pregnant women. Methods Bibliographic databases will be searched using appropriate search terms related to vaccination, pregnancy and flu. Randomised, non-randomised, quasi randomised controlled trials and other quantitative study designs will be eligible for inclusion, and studies will present the rate of flu vaccination amongst pregnant women of digital interventions compared to non-digital interventions, or usual care. No date or study country restrictions will be put on included studies, but studies will be published in English. Discussion This is the first known systematic review to examine the effectiveness of digital interventions in increasing the rate of flu vaccination amongst pregnant women. This review has the potential to inform whether digital interventions are an appropriate and successful method of increasing flu vaccination amongst pregnant women, and to determine which mode of digital intervention is most effective. Registration This systematic review is registered on the international prospective register of systematic reviews (PROSPERO). Registration number to follow.
Tea consumption and measures of attention and psychomotor speed in the very old: The Newcastle 85+ Longitudinal Study
Authors: Okello Edward Jonathan , Mendonça Nuno , Stephan Blossom , Muniz-Terrera Graciela , Wesnes Keith , Siervo Mario
Published: May 2020

Background
A number of studies have indicated a beneficial effect of tea consumption on the reduction of risk of cognitive impairment and dementia in older aged populations. However, there is a paucity of data on these associations in the very old defined as individuals aged 85 years and over. We investigated the relationship between tea consumption in the very old and measures of global cognitive function, memory, attention and psychomotor speed.
Method:
Longitudinal (5-years), population-based cohort study of individuals aged 85 + years in the North East of England, United Kingdom. Participants were community-dwelling and institutionalized men and women recruited through general medical practices (n = 676). Baseline tea consumption and longitudinal measures of global and domain specific (memory, speed and attention) cognitive function, linear mixed models, controlling for demographic (e.g. age, sex and education) and health variables were used to determine whether tea consumption was protective against cognitive decline.
Results
Tea consumption was not associated with cognitive function at baseline on any measure (unadjusted and adjusted analyses). In the linear mixed effects models adjusted for age, sex, education and disease co-morbidity, higher tea consumption was associated with significantly better attention (focused and sustained attention), and psychomotor speed (complex tasks only) over five-years follow-up. However, there was no association between tea consumption and global cognitive function, memory or performance on simple speed tasks over time.
Conclusions
In this cohort study of the very old and non-demented (85 + years) we found that higher (vs. lower) tea consumption was associated with better performance over time on measures of focused and sustained attention and some psychomotor speed tasks. No associations with global cognition, memory or easy speed tasks (simple Reaction Time or Word Recognition) were detected. The results have implications for the development of possible diet-based interventions focused on improving cognitive function in the very old age group.