bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical schools in India: pattern of establishment and impact on public health - a Geographic Information System (GIS) based exploratory study
Authors: Sabde Yogesh , Diwan Vishal , Mahadik Vijay K. , Parashar Vivek , Negandhi Himanshu , Trushna Tanwi , Zodpey Sanjay
Published: May 2020

Background

Indian medical education system is on the brink of a massive reform. The government of India has recently passed the National Medical Commission Bill (NMC Bill). It seeks to eliminate the existing shortage and maldistribution of health professionals in India. It also encourages establishment of medical schools in underserved areas. Hence this study explores the geographic distribution of medical schools in India to identify such under and over served areas. Special emphasis has been given to the mapping of new medical schools opened in the last decade to identify the ongoing pattern of expansion of medical education sector in India.

Methods

All medical schools retrieved from the online database of Medical Council of India were plotted on the map of India using geographic information system. Their pattern of establishment was identified. Medical school density was calculated to analyse the effect of medical school distribution on health care indicators.

Results

Presence of medical schools had a positive influence on the public health profile. But medical schools were not evenly distributed in the country. The national average medical school density in India amounted to 4.08 per 10 million population. Medical school density of provinces revealed a wide range from 0 (Nagaland, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep) to 72.12 (Puducherry). Medical schools were seen to be clustered in the vicinity of major cities as well as provincial capitals. Distance matrix revealed that the median distance of a new medical school from its nearest old medical school was just 22.81 Km with an IQR of 6.29 to 56.86 Km.

Conclusions

This study revealed the mal-distribution of medical schools in India. The problem is further compounded by selective opening of new medical schools within the catchment area of already established medical schools. Considering that medical schools showed a positive influence on public health, further research is needed to guide formulation of rules for medical school establishment in India.
Delays in diagnosing pulmonary tuberculosis within a context of medium incidence, Medellín, Colombia, 2017: an operational research
Authors: Rodríguez-Márquez Iader , Montes Fernando , Upegui Luz D. , Montoya Nilton , Vargas Nelly E. , Rojas Abelardo , Valencia Gloria C. , Álvarez Claudia M. , Uribe Leonardo , Ochoa Jesús
Published: May 2020

Background

Delay in tuberculosis (TB) diagnosis is one of the first obstacles for controlling the disease. Delays generate greater deterioration of the health of the patients and increase the possibilities of transmission and infection at home and in the community. The aim of the study was to identify profiles and individual variables associated with patient delays and health care system delays in patients with pulmonary tuberculosis (PTB) in Medellín, Colombia, a city that notifies 1400 new cases per year.

Methods

A retrospective cohort study in adults with PTB was conducted from May to September of 2017. Sociodemographic, health care-seeking behaviour, and clinical variables were measured. The outcomes were patient delay and health care system delay. The data were obtained from records of the local TB program, and a questionnaire was applied by the health care team that performs routine field visits. Simple correspondence analysis was used to identify groups (profiles), and their characteristics. Cox’s proportional hazards model was carried out to identify the variables associated with the delays.

Results

The study included 183 patients. The total delay median was 101 days (IQR: 64–163). Patient delay was of 35 days (IQR: 14–84), the profile with greater delay belonged to consumers of psychoactive substances. The health care system delay was of 27 days (IQR: 7–89), the attributes of the profile with greater delay were being a female, having more than two consultations before the diagnosis, and having prescribed antibiotics. Basic-medium educational level [HRa = 0.69; 95% CI (0.49–0.97)] and having a TB home contact [HRa = 0.68; 95% CI (0.48–0.96)] were associated with greater patient delay. Having negative acid-fast bacilli (AFB) smear [HRa = 0.64; 95% CI (0.45–0.92)] and more than two consultations before the diagnosis [HRa = 0.33; 95% CI (0.22–0.49)] was associated with greater health care system delay.

Conclusions

Data from epidemiological surveillance allowed locating risk groups with delays in TB diagnosis which requires the prioritisation of the local TB control program to promote early detection and prevention of adverse outcomes.
Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe
Authors: Johnson Cheryl , Neuman Melissa , MacPherson Peter , Choko Augustine , Quinn Caitlin , Wong Vincent J. , Hatzold Karin , Nyrienda Rose , Ncube Getrude , Baggaley Rachel , Terris-Prestholt Fern , Corbett Elizabeth L.
Published: May 2020

Background

Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84 and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to self-test for HIV and explored sociodemographic associations before large-scale implementation.

Methods

We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIV self-testing (HIVST) questions in Malawi and Zimbabwe in 2015–16. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not systematically asked this question.

Results

Of 31,385 individuals, 31.2% of men had never tested compared with 16.5% of women (p < 0.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2 and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR] = 1.55; 95% confidence interval [CI]: 1.37–1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR = 3.74; 95%CI: 1.39–10.03, p < 0.009]), and being ≥25 years old. Wealthier men had greater awareness of HIVST than poorer men (p < 0.001). The highest willingness to self-test (aOR = 3.74; 95%CI: 1.39–10.03, p < 0.009) was among men at high HIV-related sexual risk.

Conclusions

In 2015–16, many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience, willingness to self-test was high among Zimbabwean men, especially older men with moderate-to-high HIV-related sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale up. Programmes introducing, or planning to introduce, HIVST should consider including relevant questions in population-based surveys.
Positive health beliefs are associated with improvement of glycated hemoglobin and lipid profiles in Mexican patients with type 2 diabetes mellitus: a cross-sectional study
Authors: Muñoz-Torres Abril Violeta , Medina-Bravo Patricia , Valerio-Pérez Brenda Elizabeth , Mendoza-Salmeron Grecia , Escobedo-de la Peña Jorge , Velázquez-López Lubia
Published: May 2020

Background

Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient’s behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes.

Methods

An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative.

Results

The average age of patients was 54.7 ± 8.5 years, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach’s alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2 ± 1.7%) compared to those with neutral (9.0 ± 2.3%), or negative (8.8 ± 1.8%; p = 0.042).

The LDL-c levels were lower (p = 0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs.

Conclusions

Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.
Health demands and care of children with congenital Zika syndrome and their mothers in a Brazilian state
Authors: Santos-Pinto Cláudia Du Bocage , de Almeida Soares-Marangoni Daniele , Ferrari Fernando Pierette , Ajalla Maria Elizabeth Araújo , Venancio Fabio Antonio , da Rosa Thais Silveira , de Oliveira Everton Falcão
Published: May 2020

Background

A Zika virus (ZIKV) infection outbreak occurred in Brazil in 2015, accompanied by a marked increase in the number of newborns presenting with microcephaly and other neurological disorders. This characteristic set of birth defects was later termed congenital Zika syndrome (CZS). The therapeutic itinerary of mothers and children infected by ZIKV can be determined by several factors, including the relationship established with existing healthcare services. Here, we aimed to describe and analyze the extent to which children with CZS, born from 2015 to 2018 in the state of Mato Grosso do Sul, Brazil, and their mothers were treated according to the guidelines established by the Brazilian Ministry of Health.

Methods

This was a descriptive cross-sectional study that considered all children (and respective mothers) with confirmed or suspected CZS born in Mato Grosso do Sul. Children and their mothers were identified based on all suspected or confirmed cases of congenital anomalies in Mato Grosso do Sul that were reported to the Registry of Public Health Events. We analyzed data on the epidemiological profile of mother-child pairs and the care received by them. Data were summarized using statistical descriptive analysis.

Results

We showed that most mothers were white women (57%) with low income. Among pregnant women, 73% had a diagnosis of fever caused by ZIKV infection at a primary health care institution (PHCI), but only 36% received the necessary information regarding the risk of CZS. Over a third (36%) of the mothers did not receive guidance about childcare follow-up and 73% did not receive guidance regarding the availability of social support after childbirth. Gaps in medical care were observed mainly in pregnant women treated at a PHCI. Specialized assistance for children was adequate in most cases. Psychosocial support was not made available to women throughout their therapeutic itineraries.

Conclusions

Here, we identified gaps in the care of families and children with disabilities, which can have an important impact on their quality of life. Beyond protocols, practical interventions must cover all the needs that arise throughout the therapeutic itineraries not only of children but also of pregnant women and mothers.
Occupational post-traumatic stress disorder: an updated systematic review
Authors: Lee Wanhyung , Lee Yi-Ryoung , Yoon Jin-Ha , Lee Hye-Ji , Kang Mo-Yeol
Published: May 2020

Background

Although numerous studies on occupational post-traumatic stress disorder (PTSD) have been conducted prior to the 1950–2010 seminal systematic review by Skogstad et al., the prevalence, risk factors, and impact of this disorder following traumatic events in occupational settings remain unclear. This study aims to address this knowledge gap by reviewing the literature published after 2010.

Methods

We reviewed literature from databases such as PubMed and Google Scholar using PRISMA guidelines to identify studies that address occupational PTSD and examined the status (prevalence or incidence), the risk factors, and the health effects of PTSD among workers.

Results

In total, 123 articles were identified, and finally, 31 (25.2%) articles were selected after excluding duplicates. Various occupational traumatic physical events were reported such as natural or manmade disaster, explosion, accident, handling refugee corpses, or bullying at work. Risk of PTSD was closely associated with working conditions, severity of injury, history of mental disorder, occurrence of psychiatric symptoms at the time of the event, personality, interpersonal relationships, etc. Workers with PTSD were likely to experience a deterioration of physical and psychological health and impairment of social and occupational functioning.

Conclusions

Our review suggests that many workers remain highly vulnerable to occupational PTSD and its consequences.
Levels of support for the licensing of tobacco retailers in Australia: findings from the National Drug Strategy Household Survey 2004-2016
Authors: Baker John , Masood Mohd , Rahman Muhammad Aziz , Begg Stephen
Published: May 2020

Background

Assessing public opinion towards tobacco policies is important, particularly when determining the possible direction of future public health policies. The aim of this study was to describe the implementation of tobacco retailer licensing systems by state and territory governments in Australia, and to use the National Drug Strategy Household Survey (NDSHS) to assess levels of public support for a retailer licensing system in each jurisdiction over time and by a range of socio-demographic and behavioural attributes.

Methods

National and state/territory estimates of public support for a tobacco retailer licensing system were derived as proportions using NDSHS data from 2004 to 2016. The effect of one’s jurisdiction of residence on the likelihood of supporting such an initiative in 2016 was assessed using logistic regression while controlling for various socio-demographic and behavioural characteristics.

Results

Public support for a tobacco retailer licensing system ranged from a high of 67.2% (95% CI 66.5–67.9%) nationally in 2007 and declined to 59.5% (95% CI 58.9–60.2%) in 2016. In 2016, support was greatest amongst those from Tasmania, those aged 50 years and older, females, those from the least disadvantaged areas, those living in major cities, never-smokers and never-drinkers. After adjusting for the socio-demographic and behavioural attributes of respondents, those from Queensland were significantly less likely to support a licensing system (adjusted OR = 0.85, 95% CI 0.77–0.94) compared to those from other jurisdictions, while those from Tasmania were significantly more likely to support a licensing system compared to those from other jurisdictions (adjusted OR = 1.29, 95% CI 1.09–1.52).

Conclusions

A clear majority of the public support a tobacco retailer licensing system, regardless of whether or not such a system is already in place in their jurisdiction of residence. Tobacco control initiatives other than a retailer licensing system may explain some of the residual variations in support observed between jurisdictions.
Promotion of awareness and utilization of youth friendly service through multi-sectoral cooperation mechanism in China
Authors: Feng Ning , Jin Xi , Wu Jiuling , Wang Linhong
Published: May 2020

Background

Youth friendly services (YFS) was established in pilot areas in China. This study aimed to explore the promoting level on the awareness and utilization of YFS after the implementing of a multi-sectoral cooperation mechanism (MSCM) supported by social network theory (SNT) among multiple sectors related to young people reproductive health (YRH) closely.

Methods

A cross-sectional study with two separate self-administered questionnaire surveys was conducted before and after the implementing of a MSCM supported by SNT in both in-school and out-school unmarried young people aged 12–24 year-old in pilot areas in China. Both pre- and post- implementation surveys were conducted between December, 2008 and January, 2009, and between October, 2010 and January, 2011 respectively. The collected categorical data about the awareness on YFS in young people was described in percentage (%). χ 2 test was used to compare the differences between interventional and control areas, pre and after intervention, and changes in investigated areas after the intervention respectively. Binary logistic regression was used to analyze interventional effects after adjusting gender, in-school or out-school, and other factors. Significance level α was 0.05.

Results

The percentages of young people in interventional areas who could receive YRH education including that about YFS in schools, working sites and communities increased (OR = 15.485, 6.166, 3.723; 95% CI: 2.939~4.715, 4.014~9.473, 11.421~20.994 respectively) statistically significantly (P < 0.05). The percentages of young people in interventional areas who “have heard of YFS clinic” and “know that YFS clinic has been established in local area” (OR = 9.325, 11.244; 95% CI: 7.433~11.699, 8.780~14.399 respectively), and knowledge rates on YFS manner and contents also increased (OR = 14.830, 8.676; 95% CI: 9.728~22.607, 5.175~14.548 respectively) statistically significantly (P < 0.05). The increments of knowledge rates on YFS price, time, hotline number, contents on contraception, pregnancy and sexual harass/violence were statistically significant (P < 0.05). The satisfaction degree on this service has also increased (OR = 6.394, 95% CI: 2.789~14.655) statistically significantly (P < 0.05).

Conclusions

SNT is a helpful tool to facilitate the construction of an effective multi-sectoral cooperation mechanism to promote the awareness and satisfactory degree of YRH services.
Successful surgical drainage with intraoperative ultrasonography for amebic liver abscess refractory to metronidazole and percutaneous drainage: a case report
Authors: Kouzu Keita , Einama Takahiro , Nishikawa Makoto , Fukumura Makiko , Nagata Hiromi , Iwasaki Toshimitsu , Miyata Yoichi , Obuchi Yasuhiro , Hase Kazuo , Ueno Hideki , Kishi Yoji , Yamamoto Junji
Published: May 2020

Background

Metronidazole (MNZ) has been clearly established as a medication for amebic liver abscess. In uncomplicated cases, surgical drainage should be avoided. We report a case of amebic liver abscess refractory to MNZ that was successfully treated using preoperative computed tomography (CT) and percutaneous and surgical drainage with intraoperative ultrasonography (IOUS).

Case presentation

A 53-year-old man with high-grade fever was diagnosed with a cystic lesion on his right hepatic lobe using CT. Percutaneous drainage was performed, and antibacterial drugs were administered. However, the infection and condition of the patient worsened. Entamoeba histolytica was detected from pus within the mediastinal cavity. Hence, the patient was diagnosed with amebic liver abscess. After the diagnosis was established, we administered MNZ for 10 days. Despite this, the patient’s physical condition did not improve. Blood tests suggested impending disseminated intravascular coagulation (DIC). We performed surgical intervention to drain the amebic liver abscess refractory to conservative treatment. During surgery, imaging information from preoperative CT and IOUS enabled us to recognize the anatomical structures and determine the incision lines of the hepatic capsule and hepatic tissue. The patient’s DIC immediately regressed after surgery. Unfortunately, malnutrition and disuse syndrome contributed to the patient’s long recovery period. He was discharged 137 days post-surgery.

Conclusions

We reported a case of amebic liver abscess refractory to conservative treatment. Surgical drainage with preoperative CT and IOUS allowed us to safely and effectively perform complex abscess decompression.
Anti-inflammatory and cytotoxic evaluation of extracts from the flowering stage of Celosia argentea
Authors: Adegbaju Oluwafunmilayo Dorcas , Otunola Gloria Aderonke , Afolayan Anthony Jide
Published: May 2020

Background

This study was aimed at investigating the possible anti-inflammatory and cytotoxic effects of extracts from the flowering stage of C. argentea. This growth stage was chosen because of its high polyphenolic content and high antioxidant capacity.

Methods

Anti-inflammatory potential of the aqueous, acetone and methanol extracts of C. argentea was evaluated through the inhibition of nitric oxide production (LPS-induced) on stimulated macrophages (RAW 264.7), while MTT assay was used to assess cell viability with Silymarin as standard. Cytotoxicity of the plant extracts was evaluated on murine preadipocyte cell line (3 T3-L1) using the image-based method of two DNA-binding dyes; Hoechst 33342 and propidium iodide (PI) with melphalan as standard.

Results

Acetone extract exhibited moderate, dose-dependent anti-inflammatory activity with no significant toxicity to activated macrophages, however the aqueous and methanol extracts were unable to inhibit nitric oxide production at both trials. MTT assay and the toxicity assay revealed that the flowering stage extracts of C. argentea were not toxic to the RAW 264.7 macrophages and 3 T3-L1 cells at all the tested concentrations (0, 2, 50, 100 and 200 μg/mL).

Conclusions

These findings corroborate the traditional use of C. argentea for painful inflammatory conditions and encourage its possible use as lead for the development of novel, non-toxic, anti-inflammatory agents.
Distinct anti-proliferative effects of herbal melanin on human acute monocytic leukemia THP-1 cells and embryonic kidney HEK293 cells
Authors: El-Obeid Adila , Alajmi Hala , Harbi Mashael , Yahya Wesam Bin , Al-Eidi Hamad , Alaujan Monira , Haseeb Adil , Trivilegio Thadeo , Alhallaj Alshaimaa , Alghamdi Saleh , Ajlouni Abdul-Wali , Matou-Nasri Sabine
Published: May 2020

Background

Herbal melanin (HM) is a dark pigment extracted from the seed coat of Nigella sativa L. and known to exert biological effects via toll-like receptor 4 (TLR4). Recently, TLR4 was described as involved in natural programmed cell death (apoptosis). Tumor and embryonic cells are used as in vitro cellular models for drug and anti-cancer agent screening. To date, no cytotoxic studies have been reported of HM in TLR4-positive acute monocytic leukemia THP-1 cells compared to TLR4-negative human embryonic kidney HEK293 cells.

Methods

We studied the anti-proliferative effects of several HM concentrations on THP-1 and HEK293 cells by evaluating cell viability using the CellTiter-Glo® luminescent assay, assessing the TLR4 expression level, determining the apoptotic status, and analyzing the cell cycle distribution using flow cytometry. Apoptotic pathways were investigated using mitochondrial transition pore opening, caspase activity assays and immunoblot technology.

Results

Low HM concentrations did not affect THP-1 cell viability, but high HM concentrations (62.5–500 μg/mL) did decrease THP-1 cell viability and induced G0/G1 phase cell cycle arrest. Only at the highest concentration (500 μg/mL), HM slightly increased the TLR4 expression on the THP-1 cell surface, concomitantly upregulated TLR4 whole protein and gene expression, and induced apoptosis in THP-1 cells via activation of the extrinsic and intrinsic pathways. No change of apoptotic status was noticed in TLR4-negative HEK293 cells, although HM decreased HEK293 cell viability and induced cell growth arrest in the G2 phase.

Conclusion

HM exerts distinct anti-proliferative effects on human acute monocytic leukemia and embryonic kidney cells mainly through cell cycle interference in a TLR4-independent manner and through apoptosis induction in a TLR4-dependent manner, as observed in only the THP-1 cells.
Developing ActivABLES for community-dwelling stroke survivors using the Medical Research Council framework for complex interventions
Authors: Olafsdottir Steinunn A. , Jonsdottir Helga , Magnusson Charlotte , Caltenco Héctor , Kytö Mikko , Maye Laura , McGookin David , Bjartmarz Ingibjörg , Arnadottir Solveig Asa , Hjaltadottir Ingibjörg , Hafsteinsdottir Thora B.
Published: May 2020

Background

Novel technical solutions are called for to promote home-based exercise among community-dwelling stroke survivors supported by their caregivers. Lack of resources and knowledge about how to accomplish it, has been demonstrated. The objective of this study is to describe in detail the development of ActivABLES, a technical intervention to promote home-based exercise and physical activity engagement of community-dwelling stroke survivors with support from their caregivers.

Methods

The technical development process of ActivABLES was guided by the Medical Research Council (MRC) framework for development and evaluation of complex interventions as well as by principles of human-centred design and co-design. The main steps included: (1) Synthesis of evidence supporting the inclusion of balance exercises, mobility and walking exercises and exercises for the upper arm; (2) Implementation of initial user studies with qualitative data collection from individual interviews with stroke survivors, and focus group interviews with caregivers and health professionals; (3) Preliminary testing of eight prototypes with seven stroke survivors and their caregivers.

Results

After the preliminary testing of eight prototypes, four prototypes were not further developed whereas four prototypes were modified further. In addition, two new prototypes were developed, leaving six prototypes for further modification: 1) ActivFOAM for balance exercises, 2) WalkingSTARR to facilitate walking, 3) ActivBALL for hand exercises, 4) ActivSTICKS for upper arm exercises, and 5) ActivLAMP and 6) ActivTREE which both give visual feedback on progress of daily exercise and physical activities. ActivFOAM, ActivBALL and ActivSTICKS are all connected to a tablet where exercise instructions are given. All the exercise prototypes can be connected to ActivLAMP and ActivTREE to give feedback on how much exercise the user has done. Settings can be individualised and recommended daily time and/or repetition can easily be changed as the user progresses to higher activity levels.

Conclusions

The development process of ActivABLES was guided by the principles of human-centred design, with iterative testing of future users, and by the MRC framework of complex intervention, with a repeated process of development and testing. This process resulted in six prototypes which are available for feasibility testing among a small group of community-dwelling stroke survivors.
Adults’ cochlear implant journeys through care: a qualitative study
Authors: Rapport Frances , Hughes Sarah E. , Boisvert Isabelle , McMahon Catherine M. , Braithwaite Jeffrey , Faris Mona , Bierbaum Mia
Published: May 2020

Background

Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices.

Method

Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed.

Results

One hundred forty-three data-capture events disclosed 2 themes: 1) “The burden of hearing loss and the impact of Cochlear Implants”, and 2) “Professional Support and Practice, and HCPs Roles and Responsibilities”.

Conclusions

Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.
How do guideline developers identify, incorporate and report patient preferences? An international cross-sectional survey
Authors: Blackwood Jayden , Armstrong Melissa J. , Schaefer Corinna , Graham Ian D. , Knaapen Loes , Straus Sharon E. , Urquhart Robin , Gagliardi Anna R.
Published: May 2020

Background

Guidelines based on patient preferences differ from those developed solely by clinicians and may promote patient adherence to guideline recommendations. There is scant evidence on how to develop patient-informed guidelines. This study aimed to describe how guideline developers identify, incorporate and report patient preferences.

Methods

We employed a descriptive cross-sectional survey design. Eligible organizations were non-profit agencies who developed at least one guideline in the past five years and had considered patient preferences in guideline development. We identified developers through the Guidelines International Network and publicly-available guideline repositories, administered the survey online, and used summary statistics to report results.

Results

The response rate was 18.3% (52/284). Respondents included professional societies, and government, academic, charitable and healthcare delivery organizations from 18 countries with at least 1 to ≥6 years of experience generating patient-informed guidelines. Organizations most frequently identified preferences through patient panelists (86.5%) and published research (84.6%). Most organizations (48, 92.3%) used multiple approaches to identify preferences (median 3, range 1 to 5). Most often, organizations used preferences to generate recommendations (82.7%) or establish guideline questions (73.1%). Few organizations explicitly reported preferences; instead, they implicitly embedded preferences in guideline recommendations (82.7%), questions (73.1%), or point-of-care communication tools (61.5%). Most developers had little capacity to generate patient-informed guidelines. Few offered training to patients (30.8%), or had dedicated funding (28.9%), managers (9.6%) or staff (9.6%). Respondents identified numerous barriers to identifying preferences. They also identified processes, resources and clinician- and patient-strategies that can facilitate the development of patient-informed guidelines. In contrast to identifying preferences, developers noted few approaches for, or barriers or facilitators of incorporating or reporting preferences.

Conclusions

Developers emphasized the need for knowledge on how to identify, incorporate and report patient preferences in guidelines. In particular, how to use patient preferences to formulate recommendations, and transparently report patient preferences and the influence of preferences on guidelines is unknown. Still, insights from responding developers may help others who may be struggling to generate guidelines informed by patient preferences.
Genomes of the dinoflagellate Polarella glacialis encode tandemly repeated single-exon genes with adaptive functions
Authors: Stephens Timothy G. , González-Pech Raúl A. , Cheng Yuanyuan , Mohamed Amin R. , Burt David W. , Bhattacharya Debashish , Ragan Mark A. , Chan Cheong Xin
Published: May 2020

Background

Dinoflagellates are taxonomically diverse and ecologically important phytoplankton that are ubiquitously present in marine and freshwater environments. Mostly photosynthetic, dinoflagellates provide the basis of aquatic primary production; most taxa are free-living, while some can form symbiotic and parasitic associations with other organisms. However, knowledge of the molecular mechanisms that underpin the adaptation of these organisms to diverse ecological niches is limited by the scarce availability of genomic data, partly due to their large genome sizes estimated up to 250 Gbp. Currently available dinoflagellate genome data are restricted to Symbiodiniaceae (particularly symbionts of reef-building corals) and parasitic lineages, from taxa that have smaller genome size ranges, while genomic information from more diverse free-living species is still lacking.

Results

Here, we present two draft diploid genome assemblies of the free-living dinoflagellate Polarella glacialis, isolated from the Arctic and Antarctica. We found that about 68% of the genomes are composed of repetitive sequence, with long terminal repeats likely contributing to intra-species structural divergence and distinct genome sizes (3.0 and 2.7 Gbp). For each genome, guided using full-length transcriptome data, we predicted > 50,000 high-quality protein-coding genes, of which ~40% are in unidirectional gene clusters and ~25% comprise single exons. Multi-genome comparison unveiled genes specific to P. glacialis and a common, putatively bacterial origin of ice-binding domains in cold-adapted dinoflagellates.

Conclusions

Our results elucidate how selection acts within the context of a complex genome structure to facilitate local adaptation. Because most dinoflagellate genes are constitutively expressed, Polarella glacialis has enhanced transcriptional responses via unidirectional, tandem duplication of single-exon genes that encode functions critical to survival in cold, low-light polar environments. These genomes provide a foundational reference for future research on dinoflagellate evolution.
Arthroscopic approaches to and anatomy of the shoulder joint of cattle: a cadaver study
Authors: Fadul Mahmoud , von Rotz Alois , Alsaaod Maher , Sato Reiichiro , Steiner Adrian
Published: May 2020

Background

Arthroscopic surgery is described as a minimally invasive technique for diagnosis, exploration and treatment of joint disorders. It allows intraarticular structures to be assessed accurately, thereby improving the diagnostic capabilities, and it broadens the spectrum of surgical techniques feasible for treatment of articular pathologies in cattle.

This study aimed to assess for cattle the described arthroscopic approaches to the shoulder joint of horses, and to describe the appearance of the corresponding intraarticular structures of the shoulder joint. Additionally, to perform histological examination where tissues were identified and assessed arthroscopically, but the tissue type was uncertain using cadaveric limbs from cattle of different age categories without any signs of orthopedic diseases of the front limbs.

Results

An anatomic and arthroscopic investigation with 34-cadaveric forelimbs from 20-cattle was performed. The arthroscope was inserted either immediately cranial or 1-cm caudal to the tendon of the infraspinatus muscle for the cranial and caudal approaches, respectively. The shoulder joints were examined with the limbs in either horizontal non-pulled position, abducted non-pulled position using a three-pod limb holder adjustable in height, or horizontal manually pulled position. Arthroscopy was performed using a rigid 30°arthroscope (18-cm length, 4-mm outer diameter) to view the synovial pouches with their synovial villi and the following structures: cranial rim of the glenoid, cranial portion of the humeral head, incisura-glenoidalis, caudal rim of the glenoid, caudal portion of the humeral head, and cranial and caudal cul-de-sac. Abduction of the limb allowed improved visualization of the lateral portion of the joint. Pulling the limb facilitated investigation of the medial portion of the joint. Generally, the distention range was higher in younger as compared to adult cattle, and visualization of the medial portion of the joint was, therefore, facilitated in younger animals. The main complications observed were subcutaneous fluid extravasations and partial-thickness articular cartilages wear-lines.

Conclusion

The described arthroscopic techniques allowed good overall visualization of the most relevant anatomical structures within the healthy cadaveric joint. Further investigations are warranted to evaluate the diagnostic and therapeutic applications of these techniques and the prognosis of arthroscopic surgery as a tool for the treatment of joint lesions.
Computed tomographic features of the prostatic gland in neutered and intact dogs
Authors: Kuhnt N. , Harder L. K. , Nolte I. , Wefstaedt P.
Published: May 2020

Background

Aim was to investigate age-dependent changes in the prostate of castrated dogs in computed tomographic (CT) examination.

Thirty-six canine prostates were evaluated in pre- and post-contrast CT scans. Dogs were divided in groups with homogenous prostatic tissue (25/36) and with tissue alterations (11/36). Prostatic attenuation in Hounsfield Units (HU) and prostatic size were measured and a ratio of the prostatic size to the sixth lumbar vertebra was calculated. Additionally, the CT images of the prostate were compared with ultrasound examination.

Results

In pre-contrast CT scans no significant differences were found in prostatic size between homogenous and altered prostatic tissue groups whereas prostatic attenuation differed significantly in post-contrast CT between these groups. The homogenous tissue pattern of homogeneous prostates could be confirmed in CT images and in ultrasound examination. Concerning prostates with alterations, the results differed between ultrasound and CT examination in four cases of 11 dogs with tissue alterations.

Conclusions

CT is beneficial to examine the prostate of castrated dogs. The prostatic attenuation is characteristic for the prostatic morphology, which can vary due to ageing processes. Differences in attenuation and size can be found between prostates of castrated and intact dogs. Using contrast agent, CT can visualize prostatic alterations, which were not seen in ultrasound. The presented results should be considered preliminary until a study with larger sample size and histologic examination of the prostates is performed.
Critically appraised topic on adverse food reactions of companion animals (9): time to flare of cutaneous signs after a dietary challenge in dogs and cats with food allergies
Authors: Olivry Thierry , Mueller Ralf S.
Published: May 2020

Background

At this time, elimination diets followed by oral food challenges (OFCs) represent the “gold standard” for diagnosing skin-manifesting food allergies (FA) in dogs and cats. Regrettably, there is no clear consensus on how long one should wait for clinical signs to flare after an OFC before diagnosing or ruling-out a FA in a dog or a cat.

Results

We searched two databases on October 23, 2019 to look for specific information on the time for a flare of clinical signs to occur during OFCs after elimination diets in dogs and cats with skin-manifesting FAs. Altogether, we reviewed the study results of nine papers that included 234 dogs and four articles containing data from 83 cats. As multiple OFCs could be done in the same patient and not all animals included were subjected to an OFC, we were able to compile 315 and 72 times to flare (TTF) after an OFC in dogs and cats, respectively. When regrouping all cases together, about 9% of dogs and 27% of cats exhibited a flare of clinical signs in the first day after an OFC; 21% of dogs and 29% of cats had such relapse by the end of the second day. The time needed for 50 and 90% of dogs to exhibit a deterioration of clinical signs (TTF50and TTF90) was 5 and 14, respectively; in cats, these times were 4 and 7 days, respectively. By 14 days after an OFC, nearly all food-allergic patients from both species had had a relapse of clinical signs. These results are limited by the likely under-reporting of flares that occur on the first day immediately following an OFC, the time in which IgE-mediated acute allergic reactions typically develop.

Conclusion

Veterinary clinicians performing an OFC need to wait for 14 and 7 days for more than 90% of dogs and cats with a skin-manifesting FA to have a flare of clinical signs, respectively.
Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up
Authors: Xanthouli Panagiota , Koegler Maria , Marra Alberto M. , Benjamin Nicola , Fischer Lukas , Eichstaedt Christina A. , Harutyunova Satenik , Nagel Christian , Grünig Ekkehard , Egenlauf Benjamin
Published: May 2020

Background

The objective of this study was to analyze prognostic factors and risk stratification in patients with pulmonary arterial hypertension (PAH) and comorbidities.

Methods

Patients with invasively diagnosed PAH were included in the analysis. Comorbidities were clinically diagnosed as proposed in the 6th World Symposium of pulmonary hypertension. Uni- and multivariate analysis were employed for identification of factors predicting survival and time to first clinical worsening (TTCW). Risk stratification was based on parameters from ESC/ERS-guidelines 2015.

Results

In total 142 patients were enrolled in the study, 90 of them were diagnosed as PAH without and 52 with comorbidities. All patients received targeted PAH therapy and were followed for 3.3 ± 2.4 years. In PAH patients without comorbidities survival and TTCW were significantly associated with reduced 6-min walking distance (6MWD), elevated N-terminal pro brain natriuretic peptide (NT-proBNP), WHO-functional class (WHO-FC) and right atrial (RA) area. In the multivariate analysis, 6MWD was an independent predictor for survival (p = 0.002) and WHO-FC for TTCW (p = 0.001). In patients with PAH and comorbidities these parameters had no significant association with survival and TTCW. Average risk score was significantly associated with survival (p = 0.001) and TTCW (p = 0.013) in PAH but not in PAH with comorbidities (both p > 0.05; figure 1).

Conclusion

Risk stratification based on ESC/ERS-guidelines could only be confirmed in patients without comorbidities, but not in patients with PAH and comorbidities. The data of this study suggest, that a different risk stratification needs to be applied to PAH patients with comorbidities. Further studies are needed to confirm these results.

Trial registration

Not applicable, retrospective registry.
Nine glycolysis-related gene signature predicting the survival of patients with endometrial adenocarcinoma
Authors: Liu JinHui , Li SiYue , Feng Gao , Meng HuangYang , Nie SiPei , Sun Rui , Yang Jing , Cheng WenJun
Published: May 2020

Background

Endometrial cancer is the fourth most common cancer in women. The death rate for endometrial cancer has increased. Glycolysis of cellular respiration is a complex reaction and is the first step in most carbohydrate catabolism, which was proved to participate in tumors.

Methods

We analyzed the sample data of over 500 patients from TCGA database. The bioinformatic analysis included GSEA, cox and lasso regression analysis to select prognostic genes, as well as construction of a prognostic model and a nomogram for OS evaluation. The immunohistochemistry staining, survival analysis and expression level validation were also performed. Maftools package was for mutation analysis. GSEA identified Glycolysis was the most related pathway to EC. qRT-PCR verified the expression level of hub gene in clinical samples.

Results

According to the prognostic model using the train set, 9 glycolysis-related genes including B3GALT6, PAM, LCT, GMPPB, GLCE, DCN, CAPN5, GYS2 and FBP2 were identified as prognosis-related genes. Based on nine gene signature, the EC patients could be classified into high and low risk subgroups, and patients with high risk score showed shorter survival time. Time-dependent ROC analysis and Cox regression suggested that the risk score predicted EC prognosis accurately and independently. Analysis of test and train sets yielded consistent results A nomogram which incorporated the 9-mRNA signature and clinical features was also built for prognostic prediction. Immunohistochemistry staining and TCGA validation showed that expression levels of these genes do differ between EC and normal tissue samples. GSEA revealed that the samples of the low-risk group were mainly concentrated on Bile Acid Metabolism. Patients in the low-risk group displayed obvious mutation signatures compared with those in the high-risk group. The expression levels of B3GALT6, DCN, FBP2 and GYS2 are lower in tumor samples and higher in normal tissue samples. The expression of CAPN5 and LCT in clinical sample tissues is just the opposite.

Conclusion

This study found that the Glycolysis pathway is associated with EC and screened for hub genes on the Glycolysis pathway, which may serve as new target for the treatment of EC.
Genomic characterization of a newly established esophageal squamous cell carcinoma cell line from China and published esophageal squamous cell carcinoma cell lines
Authors: Li Xiang , Tian Dongping , Guo Yi , Qiu Shiyue , Xu Zexin , Deng Wen , Su Min
Published: May 2020

Background

Esophageal squamous cell carcinoma (ESCC) is one of the most prevalent malignancies and a major cause of cancer related death worldwide, especially in China. Cell lines are widely used disease models for basic medical research, however, well characterized ESCC cell models from China were seldom reported. Misidentifying and cross-contaminations of cell lines also hamper the way of producing solid and reproductive data.

Methods

CSEC216 was originated from a 45-year-old male ESCC patient from Chaoshan littoral, China. Specimens were minced into fragments and seeded in T-25 flask for primary culture. Immunoflourescence staining was performed for identifying the origination and proliferation activity. In vitro migration and invasion abilities was tested by transwell assay. DNA Short Tandem Repeats profiling was implemented for cell authorization. Karyotype was investigated by spectrum karyotyping. Whole genome sequencing was utilized to investigate genomic alterations. Background information and genomic mutation data of published ESCC cell lines were obtained from online databases.

Results

CSEC216 was an uncontaminated cell line, exhibited epithelial cell features with polygonal morphology and adherent growth as monolayer. Immuno staining demonstrated its epithelial origination and high proliferation rate. The Population Doubling time was 29.7 h. The karyotype demonstrated tumor cell patterns with aneuploidy and complex chromosomal aberrations. Mutation signatures, genes with SNA or CNA of CSEC216 and published ESCC cell lines were similar with the mutation spectrum of original ESCC tumors.

Conclusions

ESCC cell line CSEC216 from high incidence region in China was established with no cross-contamination. Biological features were studied. Genomic mutation features of CSEC216 and 28 ESCC cell lines were characterized which provided thorough cytogenetic background that facilitated future usage.