bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic bilateral L4-5 facet fracture dislocation: a case presentation with mechanism of injury
Authors: Fok Kevin Chi Him , Cheung Jason Pui Yin
Published: November 2019

Background

Traumatic bilateral locked facet joints at L4–5 level are a rare entity. A careful review only revealed four case reports. This case presented with an unusual mechanism of injury.

Case presentation

We present a case of a 40-year-old male who suffered bilateral L4–5 traumatic facet fracture dislocation following a fall injury. The dislocation was associated with fractures of bilateral L4 inferior articular processes, left L4 pedicle, L4 spinous process and postero-inferior body of L4. He presented with cauda-equina syndrome and underwent emergency decompression, reduction and instrumented fusion.

Conclusion

The biomechanics of the lumbar spine may differ with each individual. L4–5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury.
Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis
Authors: Kizaki Kazuha , Shanmugaraj Ajaykumar , Yamashita Fumiharu , Simunovic Nicole , Duong Andrew , Khanna Vickas , Ayeni Olufemi R.
Published: November 2019

Background

Total knee arthroplasty using patient-specific instrumentation (TKA-PSI), which are disposable cutting block guides generated to fit each patient’s 3-dimensional knee anatomy, has been developed to treat patients with end-stage osteoarthritis of the knee. Surrogate markers such as radiographic malalignment have been well investigated, however, patient-important outcomes are not well examined to elucidate the efficacy of TKA-PSI. The aim of this review is to determine if TKA-PSI improves patient-reported outcome measures (PROM), surgery time, blood loss, transfusion and complications (e.g. surgical site infection, deep venous thrombosis, and revision TKA).

Methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ongoing clinical trials. For PROMs, surgery time, blood loss, and transfusion rate, we included randomized controlled trials (RCT) comparing TKA-PSI and standard TKA to treat osteoarthritis of the knee. For complications, we also included non-randomized comparative studies (non-RCT).

Results

This review includes 38 studies, 24 of which were RCT and 14 of which were non-RCT. These included a total of 3487 patients. The predominant population in the included studies highly reflected the general population, with 62% being female, aged over 60 and having end-stage osteoarthritis of the knee. TKA-PSI did not improve PROMs as compared to standard TKA for less than 1-year (mean difference 0.48, 95% confidence interval (CI) -1.92–0.97 in the Oxford knee score, mean 3-month follow-up) and for 1-year or more (mean difference 0.25, 95%CI − 4.39–4.89 in the WOMAC score, mean 29-month follow-up). TKA-PSI did not reduce surgery time (mean difference − 3.09 min, 95%CI -6.73–0.55). TKA-PSI decreased blood loss with a small effect size corresponding to a 0.4 g/dl hemoglobin decrease (95%CI 0.18–0.88), but did not decrease transfusion rate (risk difference − 0.04, 95%CI -0.09–0.01). TKA-PSI did not reduce complication rates (risk difference 0.00, 95%CI − 0.01–0.01 in the composite outcome).

Conclusions

TKA-PSI does not improve patient-reported outcome measures, surgery time, and complication rates as compared to standard TKA. TKA-PSI decreases blood loss with a small effect, which is not enough to reduce transfusion rate.
The incidence and treatment trends of pediatric proximal humerus fractures
Authors: Hannonen Juuli , Hyvönen Hanna , Korhonen Linda , Serlo Willy , Sinikumpu Juha-Jaakko
Published: November 2019

Background

Proximal humerus fractures comprise approximately 2% of all pediatric fractures. In general, upper extremity fractures have increased in children. However, recent trends of proximal humerus fractures are not analyzed yet. The aim was to study the incidence and treatment trends of proximal humerus fractures in children.

Methods

All 300 children, aged < 16 years, who suffered from a proximal humerus fracture in the catchment area of Oulu University Hospital, Finland, between 2005 and 2015, were included. Radiographs were reviewed, and patients, injuries, treatments, and outcomes were comprehensively studied. Annual incidence was based on the child population at risk, which changed between 84.500 and 88.100 in the study time.

Results

The annual incidence of childhood proximal humerus fractures was mean 31.4/100,000 and no variation trend was found. The majority (92%) was treated nonoperatively, however, there was an increase of operative fixation from 0 to 16% during the study time (Difference 16, 95% CI 0.3 to 34.9%,P = 0.045). Bayonet displacement increased the risk of surgical fixation up to 16-fold (95% CI 4.8–51.4,P < 0.001) in a multivariate analysis when adjusted with other potential risk factors. Higher age was also associated with operative treatment (P = 0.002). The most usual recreational activities were horse riding, downhill skiing, snowboarding, and trampolining.

Conclusion

Contrary to most upper extremity fractures in children, proximal humerus fractures did not increase during the long study period. However, their operative treatment increased compared to nonoperative treatment, but the evidence supporting that trend remains unclear.
The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
Authors: Ivanecz Arpad , Plahuta Irena , Magdalenić Tomislav , Mencinger Matej , Peruš Iztok , Potrč Stojan , Krebs Bojan
Published: November 2019

Background

This study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR).

Methods

The DSS was validated in a cohort of 128 consecutive patients undergoing pure LLRs between 2008 and 2019 at a single tertiary referral center. The validated DSS includes four difficulty levels based on five risk factors (neoadjuvant chemotherapy, previous open liver resection, lesion type, lesion size and classification of resection). As established by the validated DSS, IOC was defined as excessive blood loss (> 775 mL), conversion to an open approach and unintentional damage to surrounding structures. Additionally, intra- and postoperative outcomes were compared according to the difficulty levels with usual statistic methods. The same five risk factors were used for validation done by linear and advanced nonlinear (artificial neural network) models. The study was supported by mathematical computations to obtain a mean risk curve predicting the probability of IOC for every difficulty score.

Results

The difficulty level of LLR was rated as low, moderate, high and extremely high in 36 (28.1%), 63 (49.2%), 27 (21.1%) and 2 (1.6%) patients, respectively. IOC was present in 23 (17.9%) patients. Blood loss of >775 mL occurred in 8 (6.2%) patients. Conversion to open approach was required in 18 (14.0%) patients. No patients suffered from unintentional damage to surrounding structures. Rates of IOC (0, 9.5, 55.5 and 100%) increased gradually with statistically significant value among difficulty levels (P < 0.001). The relations between the difficulty level, need for transfusion, operative time, hepatic pedicle clamping, and major postoperative morbidity were statistically significant (P < 0.05). Linear and nonlinear validation models showed a strong correlation (correlation coefficients 0.914 and 0.948, respectively) with the validated DSS. The Weibull cumulative distribution function was used for predicting the mean risk probability curve of IOC.

Conclusion

This external validation proved this DSS based on patient’s, tumor and surgical factors enables us to estimate the risk of intra- and postoperative complications. A surgeon should be aware of an increased risk of complications before starting with more complex procedures.
Engineering integrative vectors based on phage site-specific recombination mechanism for Lactococcus lactis
Authors: Koko Innanurdiani , Song Adelene Ai-Lian , Masarudin Mas Jaffri , Abdul Rahim Raha
Published: November 2019

Background

Site-specific integration system allows foreign DNA to be integrated into the specific site of the host genome, enabling stable expression of heterologous protein. In this study, integrative vectors for secretion and surface display of proteins were constructed based on a lactococcal phage TP901–1 integrating system.

Results

The constructed integration system comprises of a lactococcal promoter (PnisA or P170), phage attachment site (attP) from bacteriophage TP901–1, a signal peptide (USP45 or SPK1) for translocation of the target protein, and a PrtP344 anchor domain in the case of the integrative vectors for surface display. There were eight successfully constructed integrative vectors with each having a different combination of promoter and signal peptide; pS1, pS2, pS3 and pS4 for secretion, and pSD1, pSD2, pSD3 and pSD4 for surface display of desired protein. The integration of the vectors into the host genome was assisted by a helper vector harbouring the integrase gene. A nuclease gene was used as a reporter and was successfully integrated into the L. lactis genome and Nuc was secreted or displayed as expected. The signal peptide SPK1 was observed to be superior to USP45-LEISSTCDA fusion in the secretion of Nuc. As for the surface display integrative vector, all systems developed were comparable with the exception of the combination of P170 promoter with USP45 signal peptide which gave very low signals in whole cell ELISA.

Conclusion

The engineered synthetic integrative vectors have the potential to be used for secretion or surface display of heterologous protein production in lactococcal expression system for research or industrial purposes, especially in live vaccine delivery.
When user-centered design meets implementation science: integrating provider perspectives in the development of an intimate partner violence intervention for women treated in the United States’ largest integrated healthcare system
Authors: Danitz Sara B. , Stirman Shannon Wiltsey , Grillo Alessandra R. , Dichter Melissa E. , Driscoll Mary , Gerber Megan R. , Gregor Kristin , Hamilton Alison B. , Iverson Katherine M.
Published: November 2019

Background

Intimate partner violence (IPV) against women is a global health problem that is a substantial source of human suffering. Within the United States (US), women veterans are at high risk for experiencing IPV. There is an urgent need for feasible, acceptable, and patient-centered IPV counseling interventions for the growing number of women treated in the US’s largest integrated healthcare system, the Veterans Health Administration (VHA). Implementation science and user-centered-design (UCD) can play an important role in accelerating the research-to-practice pipeline. Recovering from IPV through Strengths and Empowerment (RISE) is a flexible, patient-centered, modular-based program that holds promise as a brief counseling intervention for women veterans treated in VHA. We utilized a UCD approach to develop and refine RISE (prior to formal effectiveness evaluations) by soliciting early feedback from the providers where the intervention will ultimately be implemented. The current study reports on the feedback from VHA providers that was used to tailor and refine RISE.

Method

We conducted and analyzed semi-structured, key-informant interviews with VHA providers working in clinics relevant to the delivery of IPV interventions (n = 23) at two large medical centers in the US. Participants’ mean age was 42.6 years (SD = 11.6), they were predominately female (91.3%) and from a variety of relevant disciplines (39.1% psychologists, 21.7% social workers, 17.4% physicians, 8.7% registered nurses, 4.3% psychiatrists, 4.3% licensed marriage and family therapists, 4.3% peer specialists). We conducted rapid content analysis using a hybrid inductive-deductive approach.

Results

Providers perceived RISE as highly acceptable and feasible, noting strengths including RISE’s structure, patient-centered agenda, and facilitation of provider comfort in addressing IPV. Researchers identified themes related to content and context modifications, including requests for additional safety check-ins, structure for goal-setting, and suggestions for how to develop and implement RISE-specific trainings.

Conclusions

These findings have guided refinements to RISE prior to formal effectiveness testing in VHA. We discuss implications for the use of UCD in intervention development and refinement for interventions addressing IPV and other trauma in health care settings globally.

Trial registration

ClinicalTrials.gov identifier: NCT03261700; Date of registration: 8/25/2017, date of enrollment of first participant in trial: 10/22/2018. Unique Protocol ID: IIR 16–062.
Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities
Authors: Krusz Emily , Hall Nina , Barrington Dani J. , Creamer Sandra , Anders Wendy , King Minnie , Martin Helen , Hennegan Julie
Published: November 2019

Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia.
Resident-led organizational initiatives to reduce burnout and improve wellness
Authors: Mari Sundus , Meyen Rachel , Kim Bo
Published: November 2019

Background

Professional burnout among medical trainees has been identified as a national concern in need of attention. A significant challenge for residency programs is designing and implementing effective strategies to promote resident wellness and reduce burnout. Emerging evidence highlights the importance of developing organizational changes targeting physician burnout.

Methods

To address this critical need, Harvard South Shore (HSS) Psychiatry Residency Training Program aimed to assess burnout among residents, identify areas for wellness-related growth, and implement strategies for organizational change to reduce burnout and increase wellness. We aligned closely to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines to systematically approach planning, conducting, and evaluating this quality improvement effort. We developed a wellness action team and assessed burnout using the Copenhagen Burnout Inventory (CBI). We also conducted a survey to investigate high opportunity areas for wellness-related growth and using this data we designed and implemented four organizational initiatives to (i) improve residents’ on-call experience, (ii) increase social activities, (iii) support preventative care, and (iv) promote wellness education. We then re-assessed burnout 1 year after implementation and performed two-sample t-tests to compare CBI scores. We additionally gathered and analyzed feedback from residents on the implemented organizational initiatives’ relevance to wellness and their well-being.

Results

There was an overall clinically meaningful reduction in burnout averaged among all residents that participated. Participants indicated that fitness-oriented activities were most likely to lead to change in wellness habits.

Conclusion

Our implemented wellness program was resident-led and involved continuous feedback from both residents and leadership. Given that there may be multiple factors that affect resident burnout, future studies involving a control group could help reveal whether our intervention contributed to the change in burnout scores we observed.
Correction to: Increased average number of medical publications per interviewee from 2009 to 2018: a study of 100 interviewees to an academic gastroenterology fellowship program
Authors: Imam Zaid , Cappell Mitchell S.
Published: November 2019

Following publication of the original article [1], due to miscommunication during proofing, the author notified us the bellow corrections. In this Correction, correct and incorrect versions are shown.
Reprogenetics, reproductive risks and cultural awareness: what may we learn from Israeli and Croatian medical students?
Authors: Bentwich Miriam Ethel , Mashiach-Eizenberg Michal , Borovečki Ana , Simonstein Frida
Published: November 2019

Background

Past studies emphasized the possible cultural influence on attitudes regarding reprogenetics and reproductive risks among medical students who are taken to be “future physicians.” These studies were crafted in order to enhance the knowledge and expand the boundaries of cultural competence. Yet such studies were focused on MS from relatively marginalized cultures, namely either from non-Western developing countries or minority groups in developed countries. The current study sheds light on possible cultural influences of the dominant culture on medical students in two developed countries, potentially with different dominant cultures regarding reprogenetics and reproductive risks: Israel and Croatia.

Methods

Quantitative-statistical analyses were employed, based on anonymous questionnaires completed by 150 first year medical students in Israel and Croatia. The questionnaires pertained to the knowledge and attitudes regarding genetics, reproduction and reproductive risks. These questionnaires were completed before the students were engaged in learning about these topics as part of the curriculum in their medical school.

Results

Substantial differences were revealed between the two groups of medical students. Israeli medical students were less tolerant regarding reproductive risks and more knowledgeable about genetics and reproductive risks than Croatian medical students. For example, while nearly all Israeli medical students (96%) disagreed with the idea that “Screening for reproductive risks in prospective parents is wrong,” less than 40% of their Croatian counterparts shared a similar stance. Similarly, all (100%) Israeli medical students correctly observed that “A carrier of a recessive genetic disease actually has the disease” was wrong, as opposed to only 82% of Croatian students.

Conclusions

By linking applicable theoretical literature to these findings, we suggest that they may reflect the hidden influence of the dominant culture in each country, disguised as part of the “culture of medicine.” Acknowledging and learning about such influence of the dominant culture, may be an important addition to the training of medical students in cultural competence, and specifically their cultural awareness. Such an acknowledgement may also pave the road to drawing the attention of existing physicians regarding a less known yet an important aspect of their cultural competence, insofar as the cultural awareness component is concerned.
Аn affordability of statins therapy - comparative analysis between Ukraine and Bulgaria
Authors: Tkachova Oksana , Iakovlieva Larysa , Mitkova Zornitsa , Manova Manoela , Savova Alexandra , Petrova Guenka
Published: November 2019

Background

The statins are а developing group of cardiovascular medicines, widely used for dyslipidemia. As a whole statins consumption leads to reduction in cardiovascular events and death, and improves the disease control. The main study issue considers the differences in an affordability to lipid lowering medicines in the countries with the highest morbidity and mortally rate within and outside EU. The affordability has been researched by exploring the price differences and average wages.

Methods

On total 7 international nonproprietary names and 19 dosage forms available on both markets are observed during 2013–2016. An average, minimum, and maximum retail prices per DDD, standard deviation (SD) has been calculated for all marketed dosage forms. A price ratio between the minimal and maximal price per DDD is estimated in order to evaluate their difference. Affordability of the treatment is determined as the number of working hours per month needed for patient to purchase medicines for a monthly therapy.

Results

Large variations of price per DDD, SD and the average price exist between different dosage forms in both countries. The highest value of a price ratio is observed for 5 mg rosuvastatin in Bulgaria and 10 mg rosuvastatin in Ukraine.

The number of working hours needed to cover monthly therapy has increased during 2013–2016 in Ukraine. The most affordable is treatment with a generic atorvastatin in Bulgaria and generic rosuvastatin in Ukraine. The most expensive rosuvastatin in Bulgaria and atorvastatin in Ukraine are found as the least affordable for a monthly therapy.

Conclusions

The decrease of prices for statins is not the only reason influencing patients’ affordability to therapy for statin therapy in Ukraine and Bulgaria. The difference in affordability in Ukraine and Bulgaria is affected mainly by the economic development in the country as well as wages variation.
Effects of health-information-based diabetes shared care program participation on preventable hospitalizations in Taiwan
Authors: Liang Yia-Wun , Chang Hsiao-Feng , Lin Yu-Hsiu
Published: November 2019

Background

Taiwan’s Diabetes Shared Care Program has been implemented since 2012, and the health information system plays a vital role in supporting most services of this program. However, little is known regarding the effectiveness of this information-based program. Therefore, this study investigated the effects of the participation of the Diabetes Shared Care Program on preventable hospitalizations.

Methods

This longitudinal study examined the data of health-care claims from 2011 to 2014 obtained from the diabetes mellitus health database. Patients with diabetes aged ≥18 years were included. Preventable hospitalizations were identified on the basis of prevention quality indicators developed for administrative data by the US Agency for Healthcare Research and Quality. A multilevel logistic regression was performed to examine the effects of the participation of the Diabetes Shared Care Program on preventable hospitalizations after adjustment for other variables. Analyses were conducted in late 2018.

Results

A medium level of participation (p = 0.05), age between 40 and 64 years(p < 0.0001), and absence of a catastrophic illness(p < 0.0001) were associated with a lower probability of having a preventable hospitalization. Male sex(p < 0.0001), age ≥ 65 years(p = 0.0203), low income level(p < 0.0001), living in the Southern division(p = 0.0106), and presence of many comorbidities(p < 0.0001) were associated with a higher probability of having a preventable hospitalization after adjustment for characteristics at the individual and county levels.

Conclusions

The health information system records patients’ medical history, monitors quality of care, schedules patient follow-ups, and reminds case managers to provide timely health education. This health-information-based Diabetes Shared Care Program is associated with better quality care of ambulatory, so it should be promoted on a broader scale.
Nurses striving to provide caregiver with excellent support and care at a distance: a qualitative study
Authors: Solli Hilde , Hvalvik Sigrun
Published: November 2019

Background

In Norway, changes in life expectancy have led to increased attention to older people who are ageing at home, by means of home care services, adapted technology and informal caregivers. The caring situation has become difficult for many caregivers. The use of telecare has now offered them the possibility to receive support at home. The purpose of this study was to explore how nurses provide support and care at a distance, using a web camera and a web forum in a closed telecare network for caregivers to persons suffering from stroke and dementia.

Methods

The study had an explorative design with a qualitative approach. The data sources consisted of interviews with nurses and excerpts from posts in a closed telecare network. Content analysis was used to analyse the text from the interviews and the text from the web forum.

Results

The main theme, “Balancing asymmetric and symmetric relationships” described nurses’ relationship with caregiver. Two categories, “Balancing personal and professional qualities” and “Balancing caregivers’ dependence versus independence” were identified. The first describing the tension in their dialogue, the second describing how nurses provided the caregivers with a sense of security as well as strengthening them to master their daily lives.

Conclusions

The nurses provided long distance support and care for the caregivers, by using computer-meditated communication. This communication was characterized by closeness as well as empathy. To strengthen the caregivers’ competence and independence, the nurses were easy accessible and provided virtual supervision and support. This study increases the knowledge about online dialogues and relationship between nurses and caregivers. It contributes to knowledge about balancing in the relationship, as well as knowledge about bridging the gap between technologies and nursing care as potential conflicting dimensions. Maintenance of ethical principles are therefore critical to be aware of.
Organizational change and the risk of sickness absence: a longitudinal multilevel analysis of organizational unit-level change in hospitals
Authors: Grønstad Anniken , Kjekshus Lars Erik , Tjerbo Trond , Bernstrøm Vilde Hoff
Published: November 2019

Background

Organizational change is often associated with reduced employee health and increased sickness absence. However, most studies in the field accentuate major organizational change and often do not distinguish between and compare types of change. The aim of this study was to examine the different relationships between six unit-level changes (upsizing, downsizing, merger, spin-off, outsourcing and insourcing) and sickness absence among hospital employees.

Methods

The study population included employees working in a large Norwegian hospital (n = 26,252). Data on unit-level changes and employee sickness absence were retrieved from objective hospital registers for the period January 2011 to December 2016. The odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee were estimated in a longitudinal multilevel random effects logistic regression model.

Results

Unit-level organizational change was associated with both increasing and decreasing odds of short-term sickness absence compared to stability, but the direction depended on the type and stages of change. The odds of long-term sickness absence significantly decreased in relation to unit-level upsizing and unit-level outsourcing.

Conclusions

The results from this study suggested that certain types of change, such as unit-level downsizing, may produce greater strain and concerns among employees, possibly contributing to an increased risk of sickness absence at certain stages of the change. By contrast, changes such as unit-level insourcing and unit-level upsizing were related to decreased odds of sickness absence, possibly due to positive change characteristics.
Ovol2, a zinc finger transcription factor, is dispensable for spermatogenesis in mice
Authors: Zhang Jin , Dong Juan , Qin Weibing , Cao Congcong , Wen Yujiao , Tang Yunge , Yuan Shuiqiao
Published: November 2019

Ovol2, a mouse homolog of Drosophila ovo, was identified as a zinc finger transcription factor predominantly expressed in testis. However, the function of Ovol2 in postnatal male germ cell development remains enigmatic. Here, we firstly examined the mRNA and protein levels of Ovol2 in developing mouse testes by RT-qPCR and western blot and found that both mRNA and protein of Ovol2 are continually expressed in postnatal developing testes from postnatal day 0 (P0) testes to adult testes (P56) and exhibits its higher level at adult testis. Further testicular immuno-staining revealed that OVOL2 is highly expressed in the spermatogonia, spermatocytes and round spermatids. Interestingly, our conditional ovol2 knockout mouse model show that loss of ovol2 in embryonic germ cells does not affect fecundity in mice. Our data also show that Ovol1 may have compensated for the loss of Ovol2 functions in germ cells. Overall, our data indicate that ovol2 is dispensable for germ cell development and spermatogenesis.
DeepSeedling: deep convolutional network and Kalman filter for plant seedling detection and counting in the field
Authors: Jiang Yu , Li Changying , Paterson Andrew H. , Robertson Jon S.
Published: November 2019

Background

Plant population density is an important factor for agricultural production systems due to its substantial influence on crop yield and quality. Traditionally, plant population density is estimated by using either field assessment or a germination-test-based approach. These approaches can be laborious and inaccurate. Recent advances in deep learning provide new tools to solve challenging computer vision tasks such as object detection, which can be used for detecting and counting plant seedlings in the field. The goal of this study was to develop a deep-learning-based approach to count plant seedlings in the field.

Results

Overall, the final detection model achieved F1 scores of 0.727 (at$$IOU_{all}$$IOUall) and 0.969 (at$$IOU_{0.5}$$IOU0.5) on the$$Seedling_{All}$$SeedlingAlltesting set in which images had large variations, indicating the efficacy of the Faster RCNN model with the Inception ResNet v2 feature extractor for seedling detection. Ablation experiments showed that training data complexity substantially affected model generalizability, transfer learning efficiency, and detection performance improvements due to increased training sample size. Generally, the seedling counts by the developed method were highly correlated ($$R^2$$R2= 0.98) with that found through human field assessment for 75 test videos collected in multiple locations during multiple years, indicating the accuracy of the developed approach. Further experiments showed that the counting accuracy was largely affected by the detection accuracy: the developed approach provided good counting performance for unknown datasets as long as detection models were well generalized to those datasets.

Conclusion

The developed deep-learning-based approach can accurately count plant seedlings in the field. Seedling detection models trained in this study and the annotated images can be used by the research community and the cotton industry to further the development of solutions for seedling detection and counting.
Comparative clinical evaluation of atlas and deep-learning-based auto-segmentation of organ structures in liver cancer
Authors: Ahn Sang Hee , Yeo Adam Unjin , Kim Kwang Hyeon , Kim Chankyu , Goh Youngmoon , Cho Shinhaeng , Lee Se Byeong , Lim Young Kyung , Kim Haksoo , Shin Dongho , Kim Taeyoon , Kim Tae Hyun , Youn Sang Hee , Oh Eun Sang , Jeong Jong Hwi
Published: November 2019

Background

Accurate and standardized descriptions of organs at risk (OARs) are essential in radiation therapy for treatment planning and evaluation. Traditionally, physicians have contoured patient images manually, which, is time-consuming and subject to inter-observer variability.

This study aims to a) investigate whether customized, deep-learning-based auto-segmentation could overcome the limitations of manual contouring and b) compare its performance against a typical, atlas-based auto-segmentation method organ structures in liver cancer.

Methods

On-contrast computer tomography image sets of 70 liver cancer patients were used, and four OARs (heart, liver, kidney, and stomach) were manually delineated by three experienced physicians as reference structures. Atlas and deep learning auto-segmentations were respectively performed with MIM Maestro 6.5 (MIM Software Inc., Cleveland, OH) and, with a deep convolution neural network (DCNN). The Hausdorff distance (HD) and, dice similarity coefficient (DSC), volume overlap error (VOE), and relative volume difference (RVD) were used to quantitatively evaluate the four different methods in the case of the reference set of the four OAR structures.

Results

The atlas-based method yielded the following average DSC and standard deviation values (SD) for the heart, liver, right kidney, left kidney, and stomach: 0.92 ± 0.04 (DSC ± SD), 0.93 ± 0.02, 0.86 ± 0.07, 0.85 ± 0.11, and 0.60 ± 0.13 respectively. The deep-learning-based method yielded corresponding values for the OARs of 0.94 ± 0.01, 0.93 ± 0.01, 0.88 ± 0.03, 0.86 ± 0.03, and 0.73 ± 0.09. The segmentation results show that the deep learning framework is superior to the atlas-based framwork except in the case of the liver. Specifically, in the case of the stomach, the DSC, VOE, and RVD showed a maximum difference of 21.67, 25.11, 28.80% respectively.

Conclusions

In this study, we demonstrated that a deep learning framework could be used more effectively and efficiently compared to atlas-based auto-segmentation for most OARs in human liver cancer. Extended use of the deep-learning-based framework is anticipated for auto-segmentations of other body sites.
Pretreatment of sweet sorghum straw and its enzymatic digestion: insight into the structural changes and visualization of hydrolysis process
Authors: Dong Miaoyin , Wang Shuyang , Xu Fuqiang , Wang Junkai , Yang Ning , Li Qiaoqiao , Chen Jihong , Li Wenjian
Published: November 2019

Background

The efficient utilization of lignocellulosic biomass for biofuel production has received increasing attention. Previous studies have investigated the pretreatment process of biomass, but the detailed enzymatic hydrolysis process of pretreated biomass remains largely unclear. Thus, this study investigated the pretreatment efficiency of dilute alkali, acid, hydrogen peroxide and its ultimate effects on enzymatic hydrolysis. Furthermore, to better understand the enzymatic digestion process of alkali-pretreated sweet sorghum straw (SSS), multimodal microscopy techniques were used to visualize the enzymatic hydrolysis process.

Result

After pretreatment with alkali, an enzymatic hydrolysis efficiency of 86.44% was obtained, which increased by 99.54% compared to the untreated straw (43.23%). The FTIR, XRD and SEM characterization revealed a sequence of microstructural changes occurring in plant cell walls after pretreatment, including the destruction of lignin–polysaccharide interactions, the increase of porosity and crystallinity, and reduction of recalcitrance. During the course of hydrolysis, the cellulase dissolved the cell walls in the same manner and the digestion firstly occurred from the middle of cell walls and then toward the cell wall corners. The CLSM coupled with fluorescent labeling demonstrated that the sclerenchyma cells and vascular bundles in natural SSS were highly lignified, which caused the nonproductive bindings of cellulase on lignin. However, the efficient delignification significantly increased the accessibility and digestibility of cellulase to biomass, thereby improving the saccharification efficiency.

Conclusion

This work will be helpful in investigating the biomass pretreatment and its structural characterization. In addition, the visualization results of the enzymatic hydrolysis process of pretreated lignocellulose could be used for guidance to explore the lignocellulosic biomass processing and large-scale biofuel production.
Incomer, a DD36E family of Tc1/mariner transposons newly discovered in animals
Authors: Sang Yatong , Gao Bo , Diaby Mohamed , Zong Wencheng , Chen Cai , Shen Dan , Wang Saisai , Wang Yali , Ivics Zoltán , Song Chengyi
Published: November 2019

Background

TheTc1/marinersuperfamily might represent the most diverse and widely distributed group of DNA transposons. Several families have been identified; however, exploring the diversity of this superfamily and updating its classification is still ongoing in the life sciences.

Results

Here we identified a new family ofTc1/marinertransposons, namedIncomer(IC), which is close to, but distinct from the known family DD34E/Tc1.ICshave a total length of about 1.2 kb, and harbor a single open reading frame encoding a ~ 346 amino acid transposase with a DD36E motif and flanked by short terminal inverted repeats (TIRs) (22–32 base pairs, bp). This family is absent from prokaryotes, and is mainly distributed among vertebrates (141 species of four classes), including Agnatha (one species of jawless fish), Actinopterygii (132 species of ray-finned fish), Amphibia (four species of frogs), and Mammalia (four species of bats), but have a restricted distribution in invertebrates (four species in Insecta and nine in Arachnida). AllICsin bats (Myotis lucifugus,Eptesicus fuscus,Myotis davidii, andMyotis brandtii) are present as truncated copies in these genomes, and most of them are flanked by relatively long TIRs (51–126 bp). High copy numbers of miniature inverted-repeat transposable elements (MITEs) derived fromICswere also identified in bat genomes. Phylogenetic analysis revealed thatICsare more closely related to DD34E/Tc1than to other families ofTc1/mariner(e.g., DD34D/marinerand DD × D/pogo), and can be classified into four distinct clusters. The host andICphylogenies and pairwise distance comparisons betweenRAG1genes and all consensus sequences ofICssupport the idea that multiple episodes of horizontal transfer (HT) ofICshave occurred in vertebrates. In addition, the discovery of intact transposases, perfect TIRs and target site duplications ofICssuggests that this family may still be active in Insecta, Arachnida, frogs, and fish.

Conclusions

Exploring the diversity ofTc1/marinertransposons and revealing their evolutionary profiles will help provide a better understanding of the evolution of DNA transposons and their impact on genomic evolution. Here, a newly discovered family (DD36E/Incomer) ofTc1/marinertransposons is described in animals. It displays a similar structural organization and close relationship with the known DD34E/Tc1elements, but has a relatively narrow distribution, indicating that DD36E/ICmight have originated from the DD34E/Tc1family. Our data also support the hypothesis of horizontal transfer ofICin vertebrates, even invading one lineage of mammals (bats). This study expands our understanding of the diversity ofTc1/marinertransposons and updates the classification of this superfamily.
File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study
Authors: Jones Cara L. , Deane Frank P. , Wolstencroft Keren , Zimmermann Adam
Published: November 2019

Background

Over the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework – the Collaborative Recovery Model could be sustained over time.

Method

The study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier.

Results

The file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the ‘Action Plan Review’ audit item.

Conclusions

A comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.
Electrically assisted cycling for individuals with type 2 diabetes mellitus: protocol for a pilot randomized controlled trial
Authors: Bourne Jessica E. , Page Angie , Leary Sam , Andrews Robert C. , England Clare , Cooper Ashley R.
Published: November 2019

Background

The global incidence of type 2 diabetes mellitus (T2DM) is increasing. Given the many complications associated with T2DM, effective management of the disease is crucial. Physical activity is considered to be a key component of T2DM management. However, people with T2DM are generally less physically active than individuals without T2DM and adherence to physical activity is often poor following completion of lifestyle interventions. As such, developing interventions that foster sustainable physical activity is of high priority. Electrically assisted bicycles (e-bikes) have been highlighted as a potential strategy for promoting physical activity in this population. E-bikes provide electrical assistance to the rider only when pedalling and could overcome commonly reported barriers to regular cycling. This paper describes the protocol of thePEDAL-2pilot randomized controlled trial, an e-cycling intervention aimed at increasing physical activity in individuals with T2DM.

Methods

A parallel-group two-arm randomized waitlist-controlled pilot trial will be conducted. Forty individuals with T2DM will be randomly assigned, in a 1:1 allocation ratio, to an e-cycling intervention or waitlist control. Recruitment and screening will close once 20 participants have been randomized to each study arm. The intervention will involve e-bike training with a certified cycle instructor and provision of an e-bike for 12 weeks. Data will be collected at baseline, during the intervention and immediately post-intervention using both quantitative and qualitative methods. In this trial, the primary interests are determination of effective recruitment strategies, recruitment and consent rates, adherence and retention and delivery and receipt of the intervention. The potential impact of the intervention on a range of clinical, physiological and behaviour outcomes will be assessed to examine intervention promise. Data analyses will be descriptive.

Discussion

This paper describes the protocol for thePEDAL-2pilot randomized controlled trial. Results from this trial will provide information on trial feasibility and identify the promise of e-cycling as a strategy to positively impact the health and behaviour of individuals with T2DM. If appropriate, this information can be used to design and deliver a fully powered definitive trial.

Trial registration

ISRCTN,ISRCTN67421464. Registered 03/01/2019.
Healthy Parent Carers peer-led group-based health promotion intervention for parent carers of disabled children: protocol for a feasibility study using a parallel group randomised controlled trial design
Authors: Bjornstad Gretchen , Wilkinson Kath , Cuffe-Fuller Beth , Fitzpatrick Katharine , Borek Aleksandra , Ukoumunne Obioha C. , Hawton Annie , Tarrant Mark , Berry Vashti , Lloyd Jenny , McDonald Annabel , Fredlund Mary , Rhodes Shelley , Logan Stuart , Morris Christopher
Published: November 2019

Background

Parent carers of disabled children are at increased risk of mental and physical health problems. They often experience challenges to maintaining good health which have implications for their well-being and their ability to care for their children. In response to these needs, researchers and parent carers developed the Healthy Parent Carers (HPC) programme. It is a peer-led, group-based intervention that promotes behaviours associated with health and well-being. The aims of this trial are to assess the acceptability of the HPC programme and the feasibility of its delivery in the community and to assess the feasibility and acceptability of the design of the definitive trial to evaluate the programme’s effectiveness and cost-effectiveness.

Methods

We will establish six research sites and train facilitators to deliver the manualised intervention. Parent carers of children with special educational needs and disabilities will be individually randomised, stratified by group delivery site, to either take part in a group programme and online resources (intervention) or to receive access to the online resources only (control). Measures of mental health; well-being; health-related quality of life; health behaviours; patient activation; protective factors such as resilience, social connections, and practical support; and use of health care, social care, and wider societal resources will be collected before randomisation (baseline), immediately post-intervention, and 6 months later. Recruitment of participants, adherence to the programme, and the dose received will be assessed. Group sessions will be audio-recorded to evaluate the fidelity of delivery and participant engagement. Participants’ and facilitators’ feedback on the programme content and delivery, their experience, and the acceptability of the outcome measures and trial design will be collected through feedback forms, interviews, and focus groups.

Discussion

This trial will assess whether the programme delivery and evaluative trial design are feasible, to inform whether to progress to a definitive randomised controlled trial to test the effectiveness and cost-effectiveness of the Healthy Parent Carers programme.

Trial registration

ISRCTN, ISRCTN151144652, registered on 25 October 2018; ClinicalTrials.gov, NCT03705221, registered on 15 October 2018.