bluuebunny/crossref_metadata_2025 huggingface dataset:
Eu, professor de teatro para crianças pequenas? Relato de uma experiência vivida como estagiário no curso de teatro-licenciatura
Authors: Cremonini Felipe , Zanella Andrisa Kemel
Published: December 2019

Este trabalho busca relatar a experiência vivida na Educação Infantil em uma escola pública do município de Pelotas/RS, problematizando os desafios e as surpresas da experiência de inserção como professor de teatro para crianças pequenas. O trabalho, realizado durante o Estágio I – Educação Infantil ou Ensino Fundamental, no Curso de Teatro – Licenciatura da UFPel, englobou a contação de histórias, brincadeiras tradicionais e jogos teatrais. Como aprendizado resultante dessa experiência, para os alunos foi o fato de poderem compreender o que era teatro e reconhecer seus personagens, figurinos, cenários e conceitos de ator/atriz e autor/autora. E para o estagiário, o aprendizado foi se desarmar da academia e suas rígidas regras e prazos e reaprender a fazer teatro de forma mais espontânea, livre de justificativas poéticas e trabalhar com o corpo e sua humanidade, transformando isso em arte e educação.
O tema da saúde na educação física escolar em três periódicos da educação física brasileira
Authors: Oliveira Victor José Machado de
Published: December 2019

Objetivo: Este estudo objetiva investigar a produção do conhecimento acerca do tema da saúde na Educação Física escolar. Métodos: A metodologia caracterizou-se pela natureza qualitativa e bibliométrica e por seu caráter documental e exploratório. Foi realizado um levantamento em três periódicos: Movimento; Revista Brasileira de Ciências do Esporte; Pensar a Prática. Resultados e Discussão: Verificou-se que o “peso” das publicações referentes ao tema investigado é tímido diante da demanda instaurada no cenário nacional. Conclusão: Há dois grandes movimentos dentro da produção analisada: 1) um reforça o entendimento de saúde orientado nas Ciências Naturais e Biológica; 2) outro, busca superar a concepção restrita (biológica) de saúde a partir das Ciências Sociais e Humanas. Por último ressalta-se a necessidade de ampliar o número de periódicos investigados a fim de prover novos dados e, assim, fortalecer o tema investigado.
Relanzamiento de la Revista Psicológica Herediana
Authors: López Villavicencio Carlos
Published: December 2019

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Relación entre sentido de coherencia y adhesión al tratamiento en mujeres adultas con cáncer de mama de un hospital nacional de Lima Metropolitana
Authors: Orihuela Anaya Rita Selene
Published: December 2019

El objetivo fue conocer la relación entre sentido de coherencia (SOC) y adhesión al tratamiento en 100 mujeres adultas con cáncer de mama de un hospital de Lima Metropolitana. Busca identificar también la relación entre el SOC y las variables de conductas de adhesión presentes, motivos, competencias funcionales pasadas y presentes. Se utilizó el cuestionario OLQ29 de Antonovsky y el cuestionario para medir variables psicológicas y conductas de adhesión, adaptado por Mejía. Se encontró una fuerte correlación entre SOC y adhesión al tratamiento (0,809), siendo el SOC predictor de la adhesión (65,44%). La variable estadio no representa mayor influencia en la relación que existente entre el SOC y la adhesión al tratamiento
Perfil epidemiológico e complicações cirúrgicas de mulheres submetidas a cirurgias para disfunção do assoalho pélvico em centro de referência do estado do Ceará, no período de 2014 a 2016
Authors: Muniz Ana Larissa Pinheiro , Bilhar Andreisa Paiva de Monteiro , Bezerra Leonardo Robson Pinheiro Sobreira , Ribeiro Ana Carolina Montes , Oliveira Samily Cordeiro de
Published: December 2019

Introdução: A disfunção do assoalho pélvico é uma condição comum e responsável por importante morbidade em mulheres, o prolapso de órgãos pélvicos (POP) e a incontinência urinária (IU), são as disfunções mais prevalentes. Objetivos: Avaliar perfil epidemiológico e resultados cirúrgicos de pacientes operadas para correção de prolapso de órgãos pélvicos (POP) e incontinência urinária (IU) em hospital público terciário no Ceará. Métodos: Estudo retrospectivo, análise de prontuários de 204 pacientes submetidas a cirurgias para correção de POP e IU no período de 2014 a 2016. Resultados: A média etária encontrada foi de 59,4 anos, 79,9% possuíam parto vaginal prévio. As principais queixas foram: bola ou peso vaginal (67,6%), IU de esforço (22%) e IU mista (22%). A cirurgia mais realizada para correção de POP foi a colpoplastia anterior (51,4%), e para IU foi a cirurgia de SLING – TOT (74,3%). Em relação às complicações cirúrgicas, foram 10 casos de complicações intraoperatórias, complicações pós-operatórias imediatas ocorreram em 28 pacientes (13,7%), sendo as mais prevalentes a dor intensa e a retenção urinária, apenas 2,9% pacientes foram reoperadas. Conclusão: Os procedimentos cirúrgicos apresentaram taxas de complicações e recidivas, semelhante ao relatado na literatura atual, alguns procedimentos tendo mais riscos que outros.
Análise epidemiológica e da sobrevida de pacientes com câncer de hipofaringe
Authors: Costa e Silva Thiago Demétrio Nogueira , Oliveira Emidiana Raquel Rodrigues de Souza , Costa Sheila Maria da Conceição , Carlos Cláudia Isabel Silva
Published: December 2019

Introdução: o câncer de hipofaringe possui um dos piores prognóstico dos tumores de cabeça e pescoço. A despeito dos avanços na Oncologia, a sobrevida livre de doença ainda é baixa. Objetivo: traçar o perfil clínico e epidemiológico de pacientes com carcinoma epidermoide de hipofaringe e analisar a sobrevida. Método: foi realizado estudo retrospectivo por meio dos prontuários de pacientes com a doença atendidos em um centro de oncologia no período de 2006 a 2013. Os dados foram analisados por estatística descritiva exploratória. A sobrevida foi descrita pelo método de Kaplan-Meier. Resultados: houve predomínio de homens (86,4%), com idade média de 57,5 anos, pardos (52,6%), agricultores (38,1%), tabagistas (93,7%) e sem histórico familiar de câncer (62,5%). A queixa inicial mais relatada foi a odinofagia (45,5%). Na maioria dos casos, o tumor encontrava-se no recesso piriforme (50,0%), em estádio avançado (95,2%), sendo tratado predominantemente com radioterapia associada à quimioterapia (59,1%). A sobrevida média dos pacientes foi de 204,5 dias, enquanto que a taxa de mortalidade foi de 72,7%. Conclusão: o padrão encontrado é semelhante ao de outros estudos. A alta taxa de pacientes em estádio avançado e o alto índice de mortalidade indica diagnóstico tardio, o que reflete a necessidade de ações preventivas.
Mola hidatiforme parcial e completa: características clínicas e histológicas
Authors: Almeida Larissa Oliveira Galindo , Sousa Edson de Macedo , Ribeiro Ana Carolina Montes , Cavalcante Diane Isabelle Magno , Feitosa Francisco Edson Lucena , Coelho Raquel Autran
Published: December 2019

Introdução: a doença trofoblástica gestacional (DTG) compreende um grupo heterogêneo de proliferação celular originada a partir do epitélio trofoblástico, dividindo-se em mola hidatiforme completa ou parcial e em neoplasias trofoblásticas gestacionais. A mola hidatiforme ocorre em torno de 1:200-400 gestações no Brasil. Objetivo: avaliar fatores clínicos e epidemiológicos relacionados aos achados histopatológicos de DTG entre mulheres do estado do Ceará, Brasil. Metodologia: pesquisa quantitativa, descritiva, transversal, do tipo retrospectivo, por meio de revisão de prontuários, totalizando 203 pacientes com diagnóstico histopatológico confirmado entre 2012 e 2015. Avaliou-se dados clínico-epidemiológicos e laboratoriais para os casos de mola hidatiforme completa (MHC) e de mola hidatiforme parcial (MHP). Resultados: foram identificados 203 casos de doença trofoblástica gestacional, 49,2% casos de MHC e 49,7% de MHP. Não houve diferença estatisticamente significante para idade, paridade, recidiva do sangramento, presença de hipertensão, tipo de sangramento à internação, eliminação de vesículas, cistos tecaluteínicos de ovário e evolução para neoplasias trofoblásticas gestacionais (NTG) entre mulheres com MHC e MHP. A presença de sangramento no momento da internação foi observada em 76,9% nos casos de MHC e em 85,5% nos de MHP. 14,3% dos casos de MHC e 12,1% dos casos de MHP evoluíram para NTG. Conclusão: não houve diferença estatisticamente significante entre fatores clínico-epidemiológicos para mulheres com MHC e MHP.
Avaliação da terapêutica em pacientes de alto risco cardiovascular
Authors: Freire Juliana Gomes , Silva Ricardo Pereira
Published: December 2019

Segundo o estudo Global Burden of Diseases, para o ano de 2020, a doença cardiovascular (DCV) permanecerá como a principal causa de óbito e incapacidade em ambos os sexos, no Brasil e no mundo. Em nosso país, as DCV são responsáveis por alta frequência de internações, ocasionando altos custos médicos e socioeconômicos. Daí a necessidade de se melhorar a abordagem desses pacientes. Objetivo: registrar a prática clínica vigente na prescrição das intervenções farmacológicas baseadas em evidência. Metodologia: estudo observacional, transversal e descritivo desenvolvido entre os pacientes do HUWC, no período de abril de 2014 a maio de 2015, incluindo indivíduos de alto risco cardiovascular. Resultados: a faixa etária prevalente situou-se entre 50 e 70 anos; 64,7% eram mulheres; 68,5% eram pardos e 24,7% brancos. Hipertensão arterial sistêmica, dislipidemia e diabetes mellitus constituíram os principais fatores de risco cardiovasculares. Cerca de 64,6% dos pacientes apresentavam pressão arterial sob controle. Conclusão: O uso da terapia otimizada se encontra aquém da ideal; a maior parcela da população em estudo atingiu a meta para controle de PA.
AISI 4340 MALZEMESİNİN TORNA İLE İŞLEMESİNDE GRİ İLİŞKİSEL ANALİZ YÖNTEMİ KULLANILARAK UYGUN TAKIM TUTUCU (KATER) SEÇİMİNE KARAR VERİLMESİ
Authors: YILMAZ Emre , GÜNGÖR Ferhat , HARTOMACIOĞLU Selim
Published: December 2019

Endüstride amaç; ürünün en kısa zamanda, maliyet olarak düşük
ve kalite bakımından yüksek özellik göstermesi beklenir. Bu özellikleri
taşıması için mühendisler çokça bu konular hakkında çalışmalar yapmışlardır. Ürünün
istenilen özellikleri taşıması için işleme esnasında kullanılan kesme parametrelerde
optimizasyon yapılması çok önem kazanmaktadır.

Bu çalışmada parametreleri optimizasyonu için GİA(Gri
İlişkisel Analiz) yöntemi kullanılmıştır. GİA az bilgi ve belirsizlik durumda
kullanılabilecek bir yöntemdir. Çalışmada iş parçası olarak AISI 4340 çeliği
kullanılmıştır. İşleme yöntemi olarak tornalama işlemi, kesme parametreleri ise
kesme derinliği 0,4 ve 0,8 mm, ilerleme miktarı olarak 7,9 ve 12,6 mm/dak,
takım tutucu imal yöntemi olarak normal ve dövme yoluyla üretilmiş takım
tutucular kullanılmıştır. Bu iki farklı takım tutucunun en iyi özelliğinin
görebilmek için GİA yöntemine göre değerlendirildi.
Hibrid Motorlu “Tuzla Jeep Willys Markalı” Aracın Tasarımı Ve Karakteristiği
Authors: SİMAV Osman , BÜYÜKKARCI Buket , KOSA Ergin
Published: December 2019

Otomobiller hiç kuşkusuz günümüzün en
önemli araçları arasındadır. Birbirinden farklı teknolojiye sahip pek çok
çeşidiyle hayatımızda yer almaktadırlar. Özellikle son dönemlerde sıkça gündeme
gelen fosil yakıtların rezervlerinin ilerleyen yıllarda tükenmekle karşı
karşıya olması ve bunun dışında fosil yakıtlar nedeniyle doğaya verilen zararın
en aza düşürülmesi için alternatif yakıtlar ve bunların uygulanabileceği
teknolojiye sahip otomobillerin üretimi konusunda çalışmalar yapılmaktadır.
Bunlar arasında günümüzde oldukça yaygınlaşan elektrikli ve hibrid araçlar
dikkat çekmektedir.

Bu çalışmada Türkiye’nin ilk motorlu
aracı olarak 1955 yılında İstanbul Tuzla’da özel sektör yatırımı olarak kurulan
ve 1970’de Kara Kuvvetleri Komutanlığı’na devredilen Jeep Willys aracı ele
alınmıştır. Bu araç kullanıldığı dönemlerde büyük ilgi görmüş ve yolu olmayan
köylerde ulaştırmada, traktör olarak tarımda ve çekici olarak yollarda gerçek çok
amaçlı kullanım imkânı sunmuştur. 2006’da imalatına son verilen bu araçtan
trafikte dolaşan binlerce adedinin bulunduğu bilinmektedir. Bu aracın hibrid
elektrikli bir modelinin tasarımının sonuçları bu çalışmada işlenmiştir.
Metabolism of Histone Deacetylase Proteins Opsonizes Tumor Cells to Checkpoint Inhibitory Immunotherapies
Authors: Dent Paul , Booth Laurence , Poklepovic Andrew
Published: December 2019

LC3-associated phagocytosis, a distinct form of autophagy, plays a key role in antigen presentation. Autophagy itself plays a central role in the regulation of cellular metabolism. Proteins that regulate autophagy include the AMPK which senses high levels of AMP, and mTOR, which integrates amino acid and fatty acid metabolism with autophagy. More recently, autophagy has been demonstrated to regulate tumor cell immunogenicity via the degradation of histone deacetylase proteins. Individual drugs and drug combinations that activate the ATM-AMPK pathway and inactivate mTOR, cause autophagosome formation. The maturation of autophagosomes into autolysosomes causes the autophagic degradation of histone deacetylase proteins who regulate the transcription of PD-L1, Class I MHCA, ODC and IDO1. Indeed, drug combinations that do not contain an HDAC inhibitor can nevertheless act as de facto HDAC inhibitors, via autophagic degradation of HDAC proteins. Such drug combinations simultaneously kill tumor cells via immunogenic autophagy and in parallel opsonize tumor cells to checkpoint inhibitor immunotherapies via reduced expression of PD-L1, ODC and IDO1, and increased expression of Class I MHCA.
Exploring Mammalian Genome within Phase-Separated Nuclear Bodies: Implications for the Regulation of Gene Expression
Authors: Lesne Annick , Baudement Marie-Odile , Rebouissou Cosette , Forné Thierry
Published: December 2019

The importance of genome organization at the supranucleosomal scale in the control of gene expression is increasingly recognized today. In mammals, Topologically Associating Domains (TADs) and the active / inactive chromosomal compartments are two of the main nuclear structures that contribute to this organization level. However, recent works reviewed here indicate that, at specific loci, chromatin interactions with nuclear bodies could also be crucial to regulate genome functions, in particular transcription. They moreover suggest that these nuclear bodies are membrane-less organelles dynamically self-assembled and disassembled through mechanisms of phase separation. We have recently developed a novel genome-wide experimental method, High-salt Recovered Sequences sequencing (HRS-seq), which allows the identification of chromatin regions associated with large ribonucleoprotein (RNP) complexes and nuclear bodies. We argue that the physical nature of such RNP complexes and nuclear bodies appears to be central in their ability to promote efficient interactions between distant genomic regions. The development of novel experimental approaches, including our HRS-seq method, is opening new avenues to understand how self-assembly of phase separated nuclear bodies possibly contributes to mammalian genome organization and gene expression.
Designing and Disseminating Metrics to Support Jurisdictional Efforts to End the Public Health Threat Posed by HIV Epidemics
Authors: Nash Denis
Published: December 2019

The US Department of Health and Human Services has launched a large-scale plan that aims to “End the HIV Epidemic” (EtHE) in America, including ambitious goals and targets over the next 5 to 10 years.

To be successful, the EtHE Plan will require timely dissemination of relevant metrics to inform the broad array of stakeholders who are in a position to act in support of the plan’s goals. Metrics should include both population health outcome metrics and implementation metrics that track the deployment and uptake of specific intervention delivery strategies. In addition to the usual HIV care continuum metrics that include all people living with HIV in the denominator, metrics dedicated to those not yet reached (i.e., as the denominator) are essential to help target EtHE implementation efforts. Special attention is required around metrics and targets that inform and drive action on HIV-related health disparities.

Well-chosen metrics and a well-designed dissemination system can serve as important tools to assess the progress of the EtHE Plan, and to identify and disseminate lessons learned quickly within and across jurisdictions aiming to end HIV as a local public health threat.
The issue of education of the soul and mysticism
Authors: Haydarova Hanifa Burkhanovna
Published: December 2019

This article analyzes the problem of self-education and the problem of spirituality, which is one of the central issues of mysticism and philosophy. It also provides an overview of the lustful views of a number of prominent figures of mysticism.
Scientific and theoretical bases of efficiency of farm facilities
Authors: Akbarova Barno Shukhratovna
Published: December 2019

The article is devoted to the peculiarities of agriculture in Uzbekistan and the problems of agrarian reforms and institutional transformations, the search for new organizational forms and management methods capable of ensuring the effective use of land, water, material and financial resources, as well as prospects for the development of the agricultural sector of the republic.
Health on the Move--Challenges in Work and Lifestyle Changes for Performing Artists
Authors: Ackermann Bronwen J
Published: December 2019

Abstract: This issue of MPPA raises awareness once more of the highly specific needs of performing artists, and the specialised kind of support or assessment that will be required to optimally manage their health care needs. As reported in this issue, Kawano et al. concluded that highly
expressive task-specific movements are often a normal part of the technical requirements for a dance routine, and analysing whether dancers are safe to perform these manoeuvres requires a highly trained eye and experience. Not only that, but their beliefs on how such movements affect their
risk of injury may be influenced by perspectives within the dance culture (Hendry et al.). To be able to assess dancers and their injury risk requires health professionals to have substantial experience, as general health assessment measures are unlikely to be adequate to meet their highly
complex performance demands (Clarke et al.). Similar experience is required in understanding the complex demands of the wide spectrum of musical performance, acting, and other artistic pursuits, including understanding strategies to help performing artists manage their workloads. Problems
are highlighted with the impact of fatigue on circus (Decker et al.) and dance activities (Jarvis et al.), with work and training loads playing a role in affecting movement patterns and health status. Further research may clarify other factors contributing to fatigue in performing artists,
as many issues such as travel, diet, and mood will contribute to feelings of fatigue.
The Lived Experience of Orchestral String Musicians with Playing Related Pain
Authors: Bourne Deanna , Hallaran Amy , Mackie Jane
Published: December 2019

OBJECTIVE: Rates of pain are high among musicians, and string musicians may be particularly at risk. The aim of the study was to investigate the lived experience of orchestral string musicians with playing-related pain. METHODS: The study used a Heideggerian phenomenological approach.
Five professional and university-level string musicians were interviewed about their experience of playing-related pain, and transcriptions of their interviews were analysed using thematic analysis. RESULTS: Participants engaged in a variety of types of musical performance, however they described
orchestral playing as contributing the most to their pain. Pain led to increased focus on the body and less engagement in the music. They experienced a sense of loss in multiple domains of their lives, yet also described personal growth as a result of their pain. Participants were more likely
to disclose their pain in student orchestras than in professional ones. CONCLUSION: Pain impacts multiple domains of musician’s lives, and therefore must be addressed holistically by healthcare providers. While musicians are finding that it is becoming more acceptable to discuss their
pain, pain is still not adequately addressed. Understanding the experience of musicians with playing-related pain could help healthcare professionals to better serve this unique population.
HDsEMG Activity of the Lumbar Erector Spinae in Violin Players: Comparison of Two Chairs
Authors: Russo Alessandro , Aranceta-Garza Alejandra , D’Emanuele Samuel , Serafino Francesca , Merletti Roberto
Published: December 2019

This study compared an ergonomic alternative chair (A-chair) with a standard orchestra chair (O-chair) used by a group of 9 violin players. The features of the high-density surface EMG (HDsEMG) of the lumbar erector spinae muscles were used for the comparison. The violinists played
the same pieces of music for 2 hrs without interruption on each chair in 2 different days, 1 week apart. HDsEMG was recorded for 20 s every 5 minutes using two electrode arrays of 16 × 8 electrodes each, one on each side of the spine and placed between the T11 and L4 levels. The sEMG
was non-stationary and burst-like patterns were observed on 8 out of 9 violinists. The mean root mean square (RMS) and mean spectral frequency (MNF) value over the region of activity (ROA), the centroid of the ROA, the rates of change in time of the spatial mean of the RMS and MNF values,
and the burst frequencies associated with the two chairs were compared. Statistically significant reductions of RMS were observed in each violinist between the O-chair and A-chair (range 11.80−78.36%). No significant changes of other spatial or spectral sEMG features were globally observed
versus time or between chairs but were demonstrated by some subjects. It is concluded that the A-chair is associated with a decrease of the sEMG amplitude of the ESM without changes of the spatial and temporal patterns of muscle activation.
Predicting the need for supportive services after discharged from hospital: a systematic review
Authors: Kobewka Daniel , Mulpuru Sunita , Chassé Michaël , Thavorn Kednapa , Lavallée Luke , English Shane , Neilipovitz Benjamin , Neilipovitz Jonathan , Forster Alan , McIsaac Daniel
Published: December 2019

Background To identify models and variables that predict the need for supportive services after discharge from acute care hospital. Methods We performed a systematic review searching the MEDLINE, CINAHL, EMBASE, and COCHRANE databases from inception to May 1st 2017. We selected studies that derived and validated a prediction model for the need for supportive services after hospital discharge for patients admitted non-electively to a medical ward. We extracted cohort characteristics, model characteristics and variables screened and included in final predictive models. Risk of bias was assessed using the Quality in Prognostic Studies tool. Results Our search identified 3362 unique references. Full text review identified 6 models. Models had good discrimination in derivation (c-statistics >0.75) and validation (c-statistics >0.70) cohorts. There was high quality evidence that age, impaired physical function, disabilities in performing activities of daily living, absence of an informal care giver and frailty predict the need for supportive services after discharge. Stroke was the only unique diagnosis with at least moderate evidence of an independent effect on the outcome. No models were externally validated, and all were at moderate or higher risk of bias. Conclusions Deficits in the ability to perform activities of daily living, and the absence of informal care givers in the home environment are the most direct determinants of the need for support services after hospital discharge. Trial Registration: This review was registered with PROSPERO #CRD42016037144
Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update
Authors: Ahn SangNam , Hussein Mustafa , Mahmood Asos , Smith Matthew Lee
Published: December 2019

Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.
A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)
Authors: Khaligh-Razavi Seyed-Mahdi , Sadeghi Maryam , Khanbagi Mahdiyeh , Kalafatis Chris , Nabavi Seyed Massood
Published: December 2019

Background
Cognitive impairment is common in patients with MS. Accurate and repeatable measures of cognition have the potential to be used as a marker of disease activity.
Methods
We developed a 5-minute computerized test to measure cognitive dysfunction in patients with MS. The proposed test –named Integrated Cognitive Assessment (ICA)– is self-administered and language-independent. 91 MS patients and 83 healthy controls (HC) took part in substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA’s test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In substudy 2, we recruited 48 MS patients, and examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores.

Results
ICA demonstrated excellent test-retest reliability (r=0.94), with no learning bias (i.e. no significant practice effect); and had high level of convergent validity with BICAMS. ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated a high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r=-0.79) between ICA score and the level of NfL in MS patients.

Conclusions
ICA has the potential to be used as a digital biomarker for assessment and monitoring of cognitive performance in MS patients. In comparison to standard cognitive tools for MS (e.g. BICAMS), ICA is shorter in duration, does not show a learning bias, is independent of language, and takes advantage of artificial intelligence (AI) to identify cognitive status of patients more accurately. Being a digital test, it further has the potential for easier electronic health record or research database integration.
Does chemoradiotherapy benefit elderly patients with esophageal squamous cell cancer? A propensity-score matched analysis on multicenter data ( 3JECROG R-03A )
Authors: Chen Mingqiu , Liu Xiao hong , Han Chun , Wang Xin , Zhao Yidian , Pang Qingsong , Sun Xinchen , Li Gaofeng , Zhang Kaixian , Li Ling , Qiao Xueying , Lin Yu , Chen Junqiang , Xiao Zefen
Published: December 2019

Aim The aim of the present study was to assess the efficacy of concurrent chemoradiotherapy (CRT) or radiotherapy alone (RT-alone) in elderly patients with esophageal squamous cell carcinoma (ESCC). Methods The clinical data of patients with ESCC treated with RT-alone or CRT were collected and retrospectively reviewed. The 1-, 3- and 5-year overall survival (OS) rates and the clinical characteristics correlated with survival were analyzed statistically. Propensity score matching (PSM) analyses were used to compensate for differences in baseline characteristics between the CRT and RT-alone groups to confirm the survival difference. Results A total of 729 patients fulfilling the inclusion criteria were reviewed. Diabetes, primary tumor volume (pTV), primary tumor location (pTLo), clinical T stage,(cT) clinical N stage (cN), clinical M stage (cM) and short-term response to RT were independent factors influencing OS (P=0.002-0.044). The 5-year OS rate was 26.6%, 26.0% and 30.1% in the whole cohort, RT-alone and CRT groups, respectively. The survival difference between RT alone and CRT was not significant before or following PSM. Compared with the corresponding subgroups treated with RT alone, CRT significantly benefited patients with diabetes (P=0.003), cT4 (P=0.030) and cN0 (P=0.049), whereas no benefit was identified between CRT and RT alone in the other subgroups, including cT1-3, cN1, cM, pTLo, pTV, age and gender. Conclusions CRT with the current chemotherapy regimens may not improve the survival of elderly ESCC patients compared to RT-alone, except in patients with cT4 stage, cN0 stage or diabetes. However, due to the limitation of the retrospective nature of the current study, further clinical trials are required for confirmation. Key words: Concurrent chemoradiotherapy; Elderly; Esophageal squamous cell carcinoma; Survival
Comparative transcriptome profiling provides insights into plant salt tolerance in seashore paspalum (Paspalum vaginatum)
Authors: Wu Peipei , Cogill Steven , Qiu Yijian , Li Zhigang , Zhou Man , Hu Qian , Chang Zhihui , Noorai Rooksana E. , Xia Xiaoxia , Saski Christopher , Raymer Paul , Luo Hong
Published: December 2019

Background: Seashore paspalum (Paspalum vaginatum), a halophytic warm-seasoned perennial grass, is tolerant of many environmental stresses, especially salt stress. To investigate molecular mechanisms underlying salinity tolerance in seashore paspalum, physiological characteristics and global transcription profiles of highly (Supreme) and moderately (Parish) salinity-tolerant cultivars under normal and salt stressed conditions were analyzed. Results: Physiological characterization comparing highly (Supreme) and moderately (Parish) salinity-tolerant cultivars revealed that Supreme’s higher salinity tolerance is associated with higher Na+ and Ca2+ accumulation under normal conditions and further increase of Na+ under salt-treated conditions (400 mM NaCl), possibly by vacuolar sequestration. Moreover, K+ retention under salt treatment occurs in both cultivars, suggesting that it may be a conserved mechanism for prevention of Na+ toxicity. We sequenced the transcriptome of the two cultivars under both normal and salt-treated conditions (400 mM NaCl) using RNA-seq. De novo assembly of about 153 million high-quality reads and identification of Open Reading Frames (ORFs) uncovered a total of 82,608 non-redundant unigenes, of which 3,250 genes were identified as transcription factors (TFs). Gene Ontology (GO) annotation revealed the presence of genes involved in diverse cellular processes in seashore paspalum’s transcriptome. Differential expression analysis identified a total of 828 and 2,222 genes that are responsive to high salinity for Supreme and Parish, respectively. “Oxidation-reduction process” and “nucleic acid binding” are significantly enriched GOs among differentially expressed genes in both cultivars under salt treatment. Interestingly, compared to Parish, a number of salt stress induced transcription factors are enriched and show higher abundance in Supreme under normal conditions, possibly due to enhanced Ca2+ signaling transduction out of Na+ accumulation, which may be another contributor to Supreme’s higher salinity tolerance. Conclusion: Physiological and genomics analyses of seashore paspalum reveal major molecular underpinnings contributing to plant response to salt stress in this halophytic warm-seasoned perennial grass. The data obtained provide valuable molecular resources for functional studies and developing strategies to engineer plant salinity tolerance.
Heart Failure Management Insights from Primary Care Physicians and Allied Health Care Providers in Southwestern Ontario
Authors: Silva Narlon C Boa Sorte , Pulford Roseanne W , Lee Douglas S. , Petrella Robert J
Published: December 2019

Background It remains to be determined whether collaborative strategies to improve and sustain overall health in patients with heart failure (HF) are currently being adopted by health care professionals. We surveyed primary care physicians, nurses and allied health care professionals in Southwestern Ontario regarding how they currently manage HF patients and how they perceive limitations, barriers and challenges in achieving optimal management in these patients. Methods We developed an online survey based on field expertise and a review of pertinent literature in HF management. We analyzed quantitative data collected via an online questionnaire powered by Qualtrics®. The survey included 87 items, including multiple choice and free text questions. We collected participant demographic and educational background, and information relating to general clinical practice and specific to HF management. The survey was 25 minutes long and was administered in October and November of 2018 Results We included 118 health care professionals from network lists of affiliated physicians and clinics of the department of Family Medicine at Western University; 88.1% (n=104) were physicians while 11.9% (n=14) were identified as other health care professionals. Two-thirds of our respondents were females (n=72) and nearly one-third were males (n=38). The survey included mostly family physicians (n=74) and family medicine residents (n=25). Most respondents indicated co-managing their HF patients with other health care professionals, including cardiologists and internists. The vast majority of respondents reported preferring to manage their HF patients as part of a team rather than alone. As well, the majority respondents (n=47) indicated being satisfied with the way they currently manage their HF patients; however, some indicated that practice set up and communication resources, followed by experience and education relating to HF guidelines, current drug therapy and medical management were important barriers to optimal management of HF patients. Consultations Most respondents indicated HF management was satisfactory, however, a minority did identify some areas for improvement (communication systems, work more collaborative as a team, education resources and access to specialists). Future research should consider these factors in developing strategies to enhance primary care involvement in co-management of HF patients, within collaborative and multidisciplinary systems of care.
In depth analysis of the association of FTO SNP (rs9939609) with expression of the classical phenotype of PCOS: a Sri Lankan study
Authors: Branavan Umayal , Wijesundera Sulochana , Chandrasekharan Visvanath , Arambepola Carukshi , Wijeyaratne Chandrika
Published: December 2019

Background: PCOS is a common disorder of women due to genetic, endocrine and environmental effects that manifests from puberty. The rs9939609 variant of fat mass and obesity associated (FTO) gene is linked to metabolic derangement in PCOS. We previously identified FTO (rs9939609) as a susceptibility locus for PCOS among Sri Lankan women and also explored the role of kisspeptin. Associated factors of the FTO candidate gene among South Asians with PCOS are unknown.
Methods: This study aimed to determine the association between FTO (rs9939609) polymorphism with clinical (BMI, acanthosis nigricans, hirsutism) and biochemical (serum kisspeptin and testosterone levels) characteristics of PCOS in a cohort of Sri Lankan women. Genetic and clinical data including serum kisspeptin and testosterone concentrations of our previously reported cases (n=55) and controls (n=110) were re-analyzed, specifically for an association with rs9939609 variant of FTO gene.
Results: Logistic regression analysis (AA – OR=5.7, 95% CI=2.41-13.63, p<0.05) and genetic inheritance analysis (AA – OR=5.49, 95%CI=2.34-12.88, p<0.05) showed that FTO (rs9939609) polymorphism is significantly associated with PCOS and its metabolic manifestations. Serum testosterone was significantly higher in affected women with mutant genotypes (AA+AT) than the normal allele (TT) (p<0.05). Although serum kisspeptin was higher in subjects with PCOS and mutant alleles than controls, this difference was not significant (p>0.05).
Conclusion: FTO gene variant rs9939609 is associated with hyperandrogenemia and metabolic manifestations of PCOS among women of Sri Lankan descent with the well-characterized phenotype. Serum kisspeptin and the FTO genotypes lack a significant association when adjusted for confounders.
Transcriptome analysis of Pueraria candollei var. mirifica for gene discovery in the biosyntheses of isoflavones and miroestrol
Authors: Suntichaikamolkul Nithiwat , Tantisuwanichkul Kittiya , Prombutara Pinidphon , Kobtrakul Khwanlada , Zumsteg Julie , Wannachart Siriporn , Schaller Hubert , Yamazaki Mami , Saito Kazuki , De-eknamkul Wanchai , Vimolmangkang Sornkanok , Sirikantaramas Supaart
Published: December 2019

Background: Pueraria candollei var. mirifica, a Thai medicinal plant used traditionally as a rejuvenating herb, is known as a rich source of phytoestrogens, including isoflavonoids and the highly estrogenic miroestrol and deoxymiroestrol. Although these active constituents in P. candollei var. mirifica have been known for some time, actual knowledge regarding their biosynthetic genes remains unknown.
Results: Miroestrol biosynthesis was reconsidered and the most plausible mechanism starting from the isoflavonoid daidzein was proposed. A de novo transcriptome analysis was conducted using combined P. candollei var. mirifica tissues of young leaves, mature leaves, tuberous cortices, and cortex-excised tubers. A total of 166,923 contigs was assembled for functional annotation using protein databases and as a library for identification of genes that are potentially involved in the biosynthesis of isoflavonoids and miroestrol. Twenty-one differentially expressed genes from four separate libraries were identified as candidates involved in these biosynthetic pathways, and their respective expressions were validated by quantitative real-time reverse transcription polymerase chain reaction. Notably, isoflavonoid and miroestrol profiling generated by LC-MS/MS was positively correlated with expression levels of isoflavonoid biosynthetic genes across the four types of tissues. Moreover, we identified R2R3 MYB transcription factors that may be involved in the regulation of isoflavonoid biosynthesis in P. candollei var. mirifica. To confirm the function of a key-isoflavone biosynthetic gene, P. candollei var. mirifica isoflavone synthase identified in our library was transiently co-expressed with an Arabidopsis MYB12 transcription factor (AtMYB12) in Nicotiana benthamiana leaves. Remarkably, the combined expression of these proteins led to the production of the isoflavone genistein.
Conclusions: Our results provide compelling evidence regarding the integration of transcriptome and metabolome as a powerful tool for identifying biosynthetic genes and transcription factors possibly involved in the isoflavonoid and miroestrol biosyntheses in P. candollei var. mirifica.
Prevalence and factors associated with intestinal parasitic infections among food handlers working at higher public University student’s cafeterias and public food establishments in Ethiopia: a systematic review and meta-analysis
Authors: Alemnew Birhan , Gedefaw Getnet , Diress Gedefaw , Bizuneh Asmamaw Demis
Published: December 2019

Background: Intestinal infection is still an important public health problem in low-income countries. Food handlers may be infected by a wide range of enteropathogens and have been implicated in the transmission of many infections to the public. Therefore, the aim of this review was to produce the pooled prevalence and factors associated with intestinal parasitic infections among food handlers working at higher public University student’s cafeterias and public food establishments in Ethiopia. Methods: Articles published in PubMed/Medline, Hinari, Web of Science, Science Direct, and Google Scholar were used using a search strategy. Observational studies (cross-sectional, cohort and case-control) revealing the prevalence and factors associated with intestinal parasitic infections at higher public University student’s cafeterias and public food establishments were incorporated. Two authors have reviewed the extraction and appraisal of the study using the extraction format. Meta-analysis was computed using STATA version 14 statistical software. Heterogeneity of the study was assessed using Cochrane Q test statistics and I2 test. The pooled prevalence of the intestinal parasitic infection and associated factors among food handlers was calculated by the random-effect model. Results: Out of 138 reviewed studies, 18 studies were included to estimate the pooled prevalence of intestinal parasitic infections among food handlers in Ethiopia. All the eighteen articles were included in the analysis. This study revealed that the pooled prevalence of intestinal parasitic infections was 28.5% (95%CI: 27.4, 29.7). E.histolytica 6.38 (95%Cl: 5.73, 7.04), A.lumbricodes 4.12 (95%Cl: 3.56, 4.67), and G. lamblia 3.12(95%Cl: 2.65, 3.60) were the most common intestinal parasitic infections in this study. Fingernail trimming 3.04 (95% CI: 2.19, 4.22), hand washing after defecation 2.71 (95%CI: 1.93, 3.82), hand washing after touching any body parts 2.41 (95%CI: 1.64, 3.56), medical checkup 2.26 (95%CI: 1.57, 3.25), food safety training 1.79 (95%CI: 1.30, 2.45) were factors significantly associated with intestinal parasitic infections. Conclusion: Parasitic infections among food handlers were significantly high. Fingernail trimming, hand washing after defecation, hand washing after touching any body parts, regular medical checkup and food safety training were significantly associated with intestinal parasitic infections. Keywords: Prevalence, intestinal parasite, associated factors, meta-analysis, systematic review, Ethiopia.
Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province
Authors: Jiang Weixi , Xu Xiaolin , Tang Shenglan , Xu Ling , Zhang Yaoguang , Elbers Chris , Cobelens Frank , Yan Lijing
Published: December 2019

Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication. Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE). Results : After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure ( P <0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service ( P <0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR=2.02, P <0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population. Conclusions: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.
Heart rate agreement between the 20-meter shuttle run test and virtual system in healthy children: a cross-sectional study
Authors: moran cristiane , CORSO SIMONE DAL , BOMBIG MARIA TERESA , SERRA ANDREY JORGE , PEREIRA SILVANA ALVES , PECCIN MARIA STELLA
Published: December 2019

Background: Earlier studies evaluated the physiological responses to video games in children with different clinical conditions; however, no study has compared active video games with an incremental field test in healthy children. The purpose of this study was to verify the agreement between the 20-meter shuttle run test (20m-SRT) and virtual system (VS). Methods: This is a cross-sectional study of 235 children (9.0 ± 0.8 years, 109 boys). The two tests were performed one week apart and the children were instructed not to engage in any physical exercise or sports in the 24 hours preceding each test. Their resting heart rate was monitored for one minute and then throughout the tests. To evaluate the influence of motivation on the 20 m SRT and (VS), at the end of the tests the children were asked to rate their motivation on a scale of zero to 10, zero being “not cool” and 10 “awesome”. Perceived exertion at the end of the tests was assessed using the modified Borg scale. Results: Maximum heart rate (HRmax) did not differ between the 20m-SRT and VS (194.4 ± 10.2 bpm vs. 193.2 ± 13.8 bpm, respectively). Both tests were similar for intensity > and < 96% HRmax. The children showed greater exertion on the Borg scale and motivation during the VS. The multiple logistic regression model showed that motivation (p=0.98), sex (p=0.53), age (p=0.61), nutritional status (p=0.65), and speed (p=0.18) were not predictive factors of the child’s reaching HRmax. Conclusion: VS can be used as a tool to evaluate the intensity of maximal exercise tests, given that the percentage of children who achieved HRmax did not differ between the VS and 20m SRT. The perceived exertion scales were correlated, but only the modified Borg scale correlated with HRmax in the 20m SRT. The tests are motivational, and most children obtained the maximum VS score. Keywords: cardiology; child; exercise; physical fitness; virtual reality; Incremental stress test