bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution of prostheses position after primary total knee arthroplasty on dominant and non-dominant sides
Authors: Fengchao ZHAO , Lei LIU , Guochun Zha , Guanjie Yang , Shizhuang Xu , Li Zheng , Dadi Li
Published: March 2020

Background To investigate the changes of prosthesis position after primary total knee arthroplasty (TKA) on the dominant and non-dominant sides. Methods A retrospective analysis was made of 132 patients (148 knees) who underwent primary TKA from December 2016 to December 2018 in our hospital. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the position of the three right-handed surgeons. Total operation time, posterior distal femur angle (PDFA), posterior proximal tibia angle (PPTA), malposition rate of femoral prostheses in sagittal, postoperative hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) were compared between the two groups. Results The mean total operation time was in dominant group was 111.8(111.8±26.9) and in non-dominant group was 113.7(113.7±26.1) (P>0.05). Postoperative sagittal alignment, the mean PDFA was 90.2(90.2°±3.3°) in dominant group and 88.8(88.8°±3.6°) in non-dominant group (P<0.05). The mean PPTA was 84.8(84.8°±2.8°) in dominant group and 85.4(85.4°±3.7°) in non-dominant group (P>0.05). The incidence of malposition of sagittal femoral prosthesis in dominant group was 6/76 (7.9%) and that in non-dominant was 15/72 (20.8%). There was a significant difference between the two groups (χ2=5.083，P=0.024). Postoperative coronal alignment, the mean angle of components placement was 2.1°±4.2° for HKA, 88.7°±2.7° for mLDFA, 89.5°±2.7° for mMPTA in dominant group and 1.6°±4.1° for HKA, 89.0°±2.8° for mLDFA, 89.9°±2.7° for mMPTA in non-dominant group, respectively. There were no significant difference between the two groups (t=0.804 P=0.423, t=-0.564 P= 0.574, t=-1.011 P= 0.314). Conclusion Our study suggests that surgeon handedness is likely to be one of factors that affect the sagittal placement of femoral component. Orthopaedic surgeons should be aware of the potential problems and consider taking extra precautions to mitigate the risk before performing surgery.
Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection
Authors: Yu BaoZhan , Fu Jun , Chai Wei , Hao Libo , Chen Jiying
Published: March 2020

Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty (TJA). The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for the diagnosis of infection. The purpose of this study was to determine the accuracy of the NLR in the diagnosis of early PJI after total knee or hip joint arthroplasty.Methods: We retrospectively reviewed consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018. There were 20 cases diagnosed early PJI and 101 uninfected cases based on the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters (C-reactive protein, erythrocyte sedimentation rate, white blood-cell count, NLR, interleukin-6 levels) were compared between the two groups. Receiver operating characteristic curves were generated to determine the optimal cutoff values for each parameter. Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. Results: The CRP, ESR, WBC, NLR and IL-6 values were all elevated in the infected group compared to the uninfected group. The mean CRP (infected=59.06, uninfected=10.09), ESR (infected=35, uninfected=17), WBC(infected=7.95x109,uninfected=6.16x109), NLR (infected=4.89, uninfected=2.18), IL-6 (infected=40.68, uninfected=7.46). All values were significant difference between the two groups. The best test for the diagnosis of early PJI was IL-6 (AUC=81.4%; optimal cutoff value 8.07pg/ml) followed by the NLR (AUC =80.2%; optimal cutoff value 2.13), CRP (AUC =79.3%; optimal cutoff value 9.27mg/l), ESR (AUC =74.4%; optimal cutoff value 22mm/h) and WBC (AUC = 63.2%; optimal cutoff value 8.91x109). Conclusions: This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is an easy, cheap and convenient parameters to be calculated in daily practice without extra costs.
Determinants of breastfeeding practices in Ecuador: implications for localized applications of breastfeeding promotion and policies
Authors: Freire Wilma B. , Waters William F. , Roman Diana , Belmont Philippe , Wilkinson-Salamea Emily , Diaz Adrian , Palacios Ivan , Bucheli Enrique
Published: March 2020

Background Best practices in breastfeeding are often not followed in spite of appropriate levels of knowledge and positive attitudes regarding the many benefits of human milk. For a variety of reasons, particular, women do not initiate breastfeeding, suspend breastfeeding early, or initiate complementary feeding earlier than recommended. This paper analyzes breastfeeding patterns in three settings in Ecuador: a suburban parish near Quito, the nation’s capital, urban and rural parts of a province in the Amazonian lowlands, and the province of Galapagos. Methods We analyse data produced by surveys conducted in the three locations, each of which included mothers of infants between 0 and 24 months of age. The surveys collected demographic information and data based on breastfeeding indicators established by WHO. Results Significant differences were found in breastfeeding practices, particularly between the suburban parish near Quito and Galapagos, on one hand, and urban and rural parts of the Amazonian province, on the other. Conclusions Differences among population segments reflect specific opportunities and barriers to practices related to promoting optimal infant health and nutrition. Consequently, regional or local conditions that often are not apparent in national-level data should orient policies and promotion activities in specific populations.
Comparison of the clinicopathological characteristics and their impact on outcomes of resected colorectal liver metastases across time
Authors: Chen Lionel , Syn Nicholas L. , Goh Brian K. P. , Cheow Peng Chung , Raj Prema , Koh Yexin , Chung Alexander , Lee Ser Yee , Ooi London Lucien , Chan Chung Yip , Teo Jin Yao
Published: March 2020

Background: Resection of colorectal liver metastases (CLM) has been established as the standard of care. This study aims to compare the change in clinicopathological characteristics of patients who underwent curative resection of CLM across two time periods – 2000 to 2010 (T1) and 2011 to 2016 (T2) and evaluate the prognostic impact of these characteristics on survival outcomes. Methods: Patients who undergo liver resection for CLM at Singapore General Hospital from January 2000 to December 2016 were identified from a prospectively maintained database. The primary end point was overall survival. ResultsThere were 183/318 (57.5%) patients and 135 /318 (42.5%) patients in T1 and T2 respectively. There was a lower proportion of patients who had nodal metastases from primary colorectal cancer and clinical risk score (CRS) less than 3 in T2 when compared to T1. There was no difference in survival between both time periods (HR 0.850 95% CI 0.601 – 1.201 p = 0.357). Independent predictors of survival for the cohort were CEA levels ≥200ng/ml, primary tumour grade and lymph nodal status. Independent predictors of poor survival in T1 were poorly differentiated colorectal cancer and nodal metastases while in T2, independent predictors of poor survival were multiple liver metastases and nodal metastases.Conclusion: Nodal metastases from primary colorectal cancer is an independent predictor of poor survival across time for resectable CLM. Although there is no difference in survival between the two time periods, patients with multiple liver metastases should be carefully considered prior to surgery as it is also an independent predictor of overall survival.
Placing assistive technology and telecare in everyday practices of people with dementia and their caregivers: Findings from an embedded ethnography of a national dementia trial
Authors: Lariviere Matthew , Poland Fiona , Woolham John , Newman Stanton , Fox Chris
Published: March 2020

Background: Policy makers and care providers see assistive technology and telecare as potential products to support people with dementia to live independently and safely in their homes and communities. Little research has examined how people with dementia and their caregivers actually use these technologies. The study aimed to examine how and why people with dementia and their caregivers used assistive technology and telecare in their own homes. Methods: This study used an ethnographic design embedded within the NIHR-funded Assistive Technology and Telecare to maintain Independent Living At home for people with dementia (ATTILA) randomized controlled trial. We collected 208 hours of observational data on situated practices of ten people with dementia and their ten caregivers. We used this data to construct extended cases to explain how technologies supported people with dementia in home and community settings. Results: We identified three themes: placing technology in care, which illustrates how people with dementia and caregivers ‘fit’ technology into their homes and routines; replacing care with technology, which shows how caregivers replaced normal care practices with ones mediated through technologies; and technology displacing care and everyday life, which highlights how technologies disrupted the everyday lives of people with dementia. Discussion: This study exemplifies unintended and unanticipated consequences for assistive technology and telecare uptake in ‘real world’ community-based dementia care. It underlines the need to identify and map the context of technological provision over time within the changing lives of people with dementia and their caregivers.
Protective effects of DPP-4 inhibitor on podocyte injury in glomerular diseases
Authors: Kubo Ayano , Hidaka Teruo , Nakayama Maiko , Sasaki Yu , Takagi Miyuki , Suzuki Hitoshi , Suzuki Yusuke
Published: March 2020

Background Dipeptidyl peptidase-4 (DPP-4) is a serine protease that inhibits the degradation of glucagon-like peptide 1. DPP-4 inhibitors are used worldwide to treat type 2 diabetes mellitus and were recently shown to have pleiotropic effects such as anti-oxidant, anti-inflammatory, and anti-fibrotic actions. DPP-4 inhibitors improve albuminuria and renal injury including glomerular damage independent of its hypoglycemic effect. Although DPP-4 is mainly expressed in the kidney, the physiological function of DPP-4 remains unclear. Methods The localization of renal DPP-4 activity was determined in human renal biopsy specimens with glycyl-1-prolyl-4-methoxy-2-naphthylamide and the effects of a DPP-4 inhibitor were examined in human cultured podocyte. Results DPP-4 activity under normal conditions was observed in some Bowman's capsular epithelial cells and proximal tubules, but not in the glomerulus. DPP-4 activity was observed in crescent formation in anti-neutrophil myeloperoxidase cytoplasmic antigen antibody nephritis, nodular lesions in diabetic nephropathy, and some podocytes in focal segmental glomerulosclerosis. Notably, the DPP-4 inhibitor saxagliptin suppressed DPP-4 activity in podocytes and the proximal tubules. To assess the effect of DPP-4 inhibitor on podocytes, human cultured podocytes were injured by Adriamycin, which increased DPP-4 activity; this activity was dose-dependently suppressed by saxagliptin. Treatment with saxagliptin maintained the structure of synaptopodin and RhoA and improved the detachment of podocytes. Conclusions DPP-4 activity induces degradation of synaptopodin, resulting in destruction of the podocyte cytoskeleton. Saxagliptin may have pleiotropic effects to prevent podocyte injury.
Reconciling relationships with physical activity: A qualitative study of women’s postnatal physical activity decision-making
Authors: Liva Sarah , Hall Wendy , Oliffe John
Published: March 2020

Background: Challenges with engaging in postnatal physical activity can negatively affect the health of new mothers and their families. This study investigated women’s physical activity decision-making processes and strategies to support their physical activity as part of a healthy postpartum transition. Methods: Thirty healthy women with infants aged 2.5-12 months completed 3-day activity diaries and an individual interview. Using Glaser and Charmaz’s grounded theory methodology, the core category, reconciling relationships with physical activity, was derived, which explained women’s processes of postnatal physical activity decision-making. Results: Through reconciling relationships with physical activity, women discerned the types of physical activity they were comfortable pursuing at various points in the postpartum transition. Based on the meaning physical activity held for participants and their views about risks, supports, and resources, women gauged their capacity and the workability of their physical activity desires. Most women were uncertain of their capacity (physical, emotional) to return to physical activity and viewed the achievement of several or all of their desired physical activities as unworkable. Only a third fully pursued the desirable physical activities they viewed as important for their well-being. Women adjusted the strategies they used to achieve physical activity when their expectations of capacity and workability did not align with their experiences. Some women lacked access to resources or supportive messaging about postpartum physical activity and downgraded their physical activity pursuit after negative physical or childcare experiences. Conclusions: Women can benefit from discussions about physiological birth recovery and navigating community and peer resources to support physical activity access and the safe return to physical activity following birth.
Efficacy evaluation of the photodynamic therapy for oral lichen planus: a systematic review and meta-analysis
Authors: He Yuqing , Deng Jiaxin , Zhao Yi , Tao Huiqian , Dan Hongxia , Xu Hao , Chen Qianming
Published: March 2020

Background Photodynamic therapy (PDT) is a new option for oral lichen planus (OLP) management, while there are different opinions on the efficacy of PDT for OLP. To comprehensively assess the efficacy of PDT in the treatment of OLP, and compare it with steroid therapy . Methods A systematic review and meta-analysis was conducted to assess the curative effect of PDT, five electronic databases were searched, including PubMed, Web of Science (SCI), the Cochrane Library, Embase, and EBSCO, up to December 1, 2019. Random or fixed effects models for pooled estimates calculation were used and the Meta package of R software was applied. Results Pooled estimates revealed that lesion size decreased by 1.53 cm 2 (95%: 0.71-2.35) after PDT, while partial response (PR) reached 0.77 (95% CI: 0.65–0.85). The visual analog scale score was decreased 3.82 (95%CI:2.80-4.85), and the Thongprasom sign score was decreased 1.33 (95%CI:0.56-2.10) after PDT. Subgroup analyses revealed that the 5-Aminolevulinic acid (5-ALA) was more effective than methylene blue (MB), with the PR was 0.87 (95%:0.80-0.91). Topical use of 5-ALA can yield better response than gargling methylene blue. In terms of VAS, the diode laser showed better clinic partial response in treatment of OLP. But on changes of lesion size, the efficacy of semiconductor laser is higher than diode laser. And the similar efficacy of PDT with topical corticosteroids was confirmed by pooled estimates of five RCT trials with 139 lesions. Conclusion This systematic review indicates that PDT is an effective treatment modality in the management of OLP. Besides, PDT is as effective as topical corticosteroid in treating OLP and could be used for cases resistant to steroids or when steroids are contraindicated.
Twin-block appliance promotes condylar remodeling in patients with Class II malocclusion: a systematic review
Authors: Xu Jingchen , Xu Lin , Yin Yuanyuan , Yin Ke , Chen Song
Published: March 2020

Background: To evaluate the changes of condylar in patients with Class II malocclusion treated with Twin-block appliance. Methods: Six electronic databases, including PubMed, Embase, Cochrane library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and VIP Database were searched until October 15, 2019 without language restrictions. Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) reporting condylar changes produced by Twin-block appliance in Class II malocclusion patients were included. Literature filtering, data extraction, and methodological quality assessment were finished by two reviewers independently. Meta-analysis was performed with Review Manager (version5. 3; Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark). For continuous data, the mean difference and their 95% confidence intervals were used for statistical pooling. Results: Three studies with a total of 100 patients were included (1 RCT and 2 CCTs). The meta-analysis indicated a significant increase of condylar dimensions after Twin-block treatment in Class II malocclusion patients, including 0.91mm in height, 1.03mm in width, and 1.08mm in length. There were statistically significant increments in the superior and posterior joint spaces and no significant change in the anterior joint space. Conclusions: Twin-block appliance promotes the remodeling of condylar and stimulates forward and downward movement of condylar. Further high-quality studies with large samples and long-term evidence are still required to obtain more reliable conclusions. Keywords: Twin-block appliance; Class II malocclusion; Temporal Mandibular Joint; Systematic review; Meta-analysis
Examination of inter-rater and intra-rater reliability during retentive force measurement of different clasps using the developed small-sized retentive force measurement device
Authors: AKIYAMA Hitoshi , SAKAMOTO Maiko , AKAMA Ryoichi , TAKEI Jun
Published: March 2020

The purpose of the present study is to develop a small-sized retentive force measurement device that can easily measure the retentive force of a clasp used for a removable partial denture in daily clinical practice, and it is to examine the inter-rater and intra-rater reliability. A small-sized retentive force measurement device that can be easily measured in clinic has been developed. Using commercially available hard plaster cast, a skilled dental technician has made 10 types of cast clasps used in clinical practice using conventional techniques. There were 3 assessors who measured the retentive force of 10 types of cast clasps. In order to confirm the reliability, the intra-class correlation coefficients ICC (1,1) and ICC (1,3) of the 3 assessors were calculated, and the reliability within the assessor was examined. Further, the inter-class correlation coefficients ICC (3,1) and ICC (3,3) were calculated, and the reliability between the measurers was examined. The intra-class correlation coefficients of 3 assessors are as follows: assessor 1 has ICC (1,1) = 0.971, ICC (1,3) = 0.990, assessor 2 has ICC (1,1) = 0.967, ICC (1,3) = 0.989, assessor 3 has ICC (1,1) = 0.962, ICC (1,3) = 0.987. The inter-class correlation coefficients of 3 assessors are as follows: ICC (3,1) = 0.993, ICC (3,3) = 0.998. From the evaluation standard of the intraclass correlation coefficients of reliability value by ICC, it was evaluated as almost perfect and high reproducibility was confirmed. The developed small-sized retentive force measurement device has reproducibility within and between the assessors.
Tickborne disease awareness and protective practices among U.S. Forest Service employees from the Upper Midwest, USA
Authors: Schotthoefer Anna , Stinebaugh Kathryn , Martin Michael , Munoz-Zanzi Claudia
Published: March 2020

Background: People with occupations that require them to spend time working outdoors in suitable tick habitats are predicted to be at an increased risk for tick-borne diseases (TBDs). However, few studies have assessed the risks of outdoor employees.Methods: We conducted a cross-sectional survey to evaluate the exposure to ticks and tick-borne disease infections among U.S. Forest Service employees in a high TBD incidence region of northwestern Wisconsin, and to examine their knowledge, attitudes, and practices (KAPs) regarding TBDs to help guide future education and prevention programs. Chi-square contingency tables, calculations of odds ratios, and logistic regression models were used to identify associations among self-reported employee factors, and the proportion of correctly answered knowledge questions, their ranked concern for TBDs, practicing preventive behaviors, and willingness to pay for protective measures. Results: Ninety-five employees completed the survey. Nearly all respondents (97%) reported recent tick exposure and their knowledge of TBD was high (median score: 80% correct). Fifty-nine percent of respondents had high concern for TBDs, and there was high adherence to conducting body checks for ticks (83% reported always doing them), but only moderate use of tick repellents (24% reported always and 60% reported occasionally using). High concern (OR = 3.4 [1.33- 8.91]) and a history of TBD (OR = 4.66 [1.21 – 17.89]) were positively associated with high practice adherence. Respondents suggested they would be willing to pay for personal protective methods and get a hypothetical vaccine for Lyme disease, but not community-wide efforts to control ticks. Conclusions: Our study provides evidence that U.S. Forest Service employees in Wisconsin represent a high risk group for TBD, and despite relatively high TBD knowledge and engagement in tick protection activities, targeted prevention programs are still needed to reduce their risks for tick bites.
Biopsychosocial factors associated with opioid misuse in a 2017-2018 United States national survey: A comprehensive multivariate model
Authors: Ishino Francisco Alejandro Montiel , Gilreath Tamika , Salmeron Bonita , Williams Faustine
Published: March 2020

Background Few studies have comprehensively and contextually examined the relationship of variables associated with opioid misuse. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse in the United States by identifying the most salient predictors. Methods A multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N=85,580; weighted N=248,008,986). The outcome of opioid misuse was based on reported prescription pain reliever and/or heroin dependence or abuse. Biopsychosocial predictors of opioid misuse in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators. Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives). Results The comprehensive model found that criminality (adjusted odds ratio [AOR]=2.58, 95% confidence interval [CI]=1.98-3.37, p<0.001), self-reported health (i.e., excellent compared to fair/poor [AOR=3.71, 95%CI=2.19-6.29, p<0.001], good [AOR=3.43, 95%CI=2.20-5.34, p<0.001], and very good [AOR=2.75, 95%CI=1.90-3.98, p<0.001]), no private health insurance (AOR=2.12, 95%CI=1.55-2.89, p<0.001), serious psychological distress (AOR=2.12, 95%CI=1.55-2.89, p<0.001), suicidality (AOR=1.58, 95%CI=1.17-2.14, p=0.004), and other substance dependence or abuse were significant predictors of opioid misuse. Substances associated were nicotine (AOR=3.01, 95%CI=2.30-3.93, p<0.001), alcohol (AOR=1.40, 95%CI=1.02-1.92, p=0.038), marijuana (AOR=2.24, 95%CI=1.40-3.58, p=0.001), cocaine (AOR=3.92, 95%CI=2.14-7.17, p<0.001), methamphetamine (AOR=3.32, 95%CI=1.96-5.64, p<0.001), tranquilizers (AOR=16.72, 95%CI=9.75-28.65, p<0.001), and stimulants (AOR=2.45, 95%CI=1.03-5.87, p=0.044). Conclusions Biopsychosocial characteristics such as socioecological and health indicators, as well as other substance dependence or abuse were stronger predictors of opioid misuse than sociodemographic characteristics.
Gonococcal resistance can be viewed productively as part of a syndemic of antimicrobial resistance: an ecological analysis of 30 European countries
Authors: Kenyon Chris , Manoharan-Basil Sheeba S. , Dijck Christophe Van
Published: March 2020

Background

It is unclear how important bystander selection is in the genesis of antimicrobial resistance (AMR) in Neisseria gonorrhoeae .

Methods

We assessed bystander selection in a novel way. Mixed-effects linear regression was used to assess if country-level prevalence of gonococcal AMR in 30 European countries predicts homologous AMR in other bacteria. The data used was from the European Antimicrobial Resistance Surveillance Network.

Results

The prevalence of gonococcal ciprofloxacin resistance was found to be positively associated with AMR prevalence in E. coli (coef. 0.52; P=0.007), Acinetobacter spp . (coef. 0.13; P=0.044) and P. aeruginosa (coef. 0.36; P=0.020) but not K. pneumoniae .

Azithromycin resistance in N. gonorrhoeae was positively associated with macrolide resistance in S. pneumoniae (coef. 0.01; P=0.018). No association was found for cephalosporins.

Conclusions

Gonococcal AMR is linked to that in other bacteria. This finding is likely explained by high antimicrobial consumption in affected populations and provides additional motivation for strengthening antimicrobial stewardship programs.
Professional advice for primary healthcare workers in Ethiopia: a social network analysis
Authors: Sabot Kate , Blanchet Karl , Berhanu Della , Spicer Neil , Schellenberg Joanna
Published: March 2020

Background In an era of increasingly competitive funding, governments and donors will be looking for creative ways to extend and maximise resources. One such means can include building upon professional advice networks to more efficiently introduce, scale up, or change programmes and healthcare provider practices. This cross-sectional, mixed-methods, observational study compared professional advice networks of healthcare workers in eight primary healthcare units across four regions of Ethiopia. Primary healthcare units include a health centre and typically five satellite health posts.Methods 160 staff at eight primary healthcare units were interviewed using a structured tool. Quantitative data captured the frequency of healthcare worker advice seeking and giving on providing antenatal, childbirth, postnatal and newborn care. Network and actor-level metrics were calculated including density (ratio of ties between actors to all possible ties), centrality (number of ties incident to an actor), distance (average number of steps between actors) and size (number of actors within the network). Following quantitative network analyses, 20 qualitative interviews were conducted with network study participants from four primary healthcare units. Qualitative interviews aimed to interpret and explain network properties observed. Data were entered, analysed or visualised using Excel 6.0, UCINET 6.0, Netdraw, Adobe InDesign and MaxQDA10 software packages.Results The following average network level metrics were observed: density .26 (SD.11), degree centrality .45 (SD.08), distance 1.94 (SD.26), number of ties 95.63 (SD 35.46), size of network 20.25 (SD 3.65). Advice networks for antenatal or maternity care were more utilised than advice networks for post-natal or newborn care. Advice networks were typically limited to primary healthcare unit staff, but not necessarily to supervisors. In seeking advice, a colleague’s level of training and knowledge were valued over experience. Advice exchange primarily took place in person or over the phone rather than over email or online fora. There were few barriers to seeking advice.Conclusion Informal, inter-and intra-cadre advice networks existed. Fellow primary healthcare unit staff were preferred, particularly midwives, but networks were not limited to the primary healthcare unit. Additional research is needed to associate network properties with outcomes and pilot network interventions with central actors.
Traffic police officers’ use of first aid training at work: a qualitative content analysis of focus group discussions
Authors: Ndile Menti Lastone , Saveman Britt-Inger , Lukumay Gift G. , Mkoka Dickson A. , Outwater Anne H. , Backteman-Erlanson Susann
Published: March 2020

Background : The World Health Organisation (WHO) recommends involving lay people in prehospital care. Several training programmes have been implemented to build lay responder first aid skills. Findings show that most programmes significantly improved participants’ first aid skills. However, there is a gap in knowledge of what factors influence the use of these skills in real situations. The current study aimed to describe police officers’ views on and experiences of factors that facilitate or hinder their use of trained first aid skills at work.Methods Thirty-four police officers participated in five focus group discussions. A structured interview guide was used to collect data. Interviews were audio-recorded and transcribed verbatim. Data were analysed using qualitative content analysis.Results: We identified five categories of facilitators or hindrances. Training exposure was considered a facilitator; work situation and hospital atmosphere were considered hindrances; and the physical and social environments and the resources available for providing first aid could be either facilitators or hindrances.Conclusion: Practical exposure during training is perceived to improve police officers’ confidence in applying their first aid skills at work. However, contextual factors related to the working environment need to be addressed to promote this transfer of skills.
‘High schools High on life’: Development of an intervention to reduce excessive drinking in Danish high schools
Authors: Pisinger Veronica Sofie Clara , Hoffmann Sofie , Pålsson Lotte , Dalum Peter , Grønbæk Morten , Tolstrup Janne , Thygesen Lau Caspar , Krølner Rikke Fredenslund
Published: March 2020

The authors have requested that this preprint be removed from Research Square.
Combination of 99mTc-labeled PSMA-SPECT/CT and Diffusion-Weighted MRI in the prediction of early response after carbon ion therapy in prostate cancer: a prospective study
Authors: Li Ping , Liu Chang , Wu Shuang , Deng Lin , Zhang guangyuan , Cai Xin , Hu Silong , Cheng Jingyi , Xu Xiaoping , Wu Bin , Guo Xiaomao , Zhang Yingjian , Zhang Qing , Fu Shen
Published: March 2020

Background The purpose of this study was to assess the potential of 99mTc-labeled PSMA-SPECT/CT and Diffusion-Weighted Image (DWI) for predicting treatment response after carbon ion radiotherapy (CIRT) in prostate cancer. Methods We prospectively registered 26 patients with localized prostate cancer treated with CIRT. All patients underwent 99m Tc-labeled PSMA-SPECT/CT and multiparametric MRI before and after CIRT. The tumor/background ratio (TBR) and mean apparent diffusion coefficient (ADC mean ) were measured on the tumor and the percentage changes between 2 time points (ΔTBR and ΔADC mean ) were calculated. Patients were divided into two groups: good response and poor response according to clinical follow-up. Results The median follow up time was 38.3months. The TBR was significantly decreased ( p =0.001), while the ADC mean was significantly increased compared with the pretreatment value ( p <0.001). The ΔTBR and ΔADC mean were negatively correlated with each other ( p = 0.002). On ROC curve analysis for predicting treatment response, the area under the ROC curve (AUC) of ΔTBR (0.867) for predicting good response was higher than that of ΔADC mean (0.819). The AUC of combined with ΔTBR and ΔADC mean (0.895) was higher than that of either ΔADC mean or ΔTBR alone. The combined use of ΔTBR and ΔADC mean showed 91.4% sensitivity and 95.2% specificity. Conclusions Our preliminary data indicate that the changes of TBR and ADC mean maybe an early bio-marker for predicting prognosis after CIRT in localized prostate cancer patients. In addition, the ΔTBR was a more powerful prognostic factor than ΔADC mean in prostate cancer treated with CIRT.
From Invention to Industry from a social movement perspective: The emergence of the 3D Printing Industry
Authors: Lechner Christian , Pervaiz Abeer
Published: March 2020

In the entrepreneurship literature, the phenomenon of industry emergence has been largely investigated from an institutional perspective. Appropriate institutions would allow then a group of individual entrepreneurs (‘the heroes’) to create an industry through innovative ventures. New ventures create new industries and firm entry, survival and exit drive industry evolution. Our research, however, explores what creates the favorable set of circumstances for new ventures to emerge and focuses on the pre-emergence phase and we propose that the patterns of emergence resemble those of social movements. Through an actor perspective, this research highlights the existence of diverse actors, not necessarily entrepreneurs, who are necessary to trigger a collective action during the pre-emergence phase of industries. This research is also distinct from entrepreneurial ecosystems as its development already requires some successful entrepreneurial action. The 3D Printing industry was chosen as a single longitudinal case study, where the actors are the embedded units of analysis. The findings of the study lead to the identification of three aggregate dimensions; “Social Movement Composition”, Temporal Engagement” and “Coalitions Development”, that were prevalent during the pre-emergence phase of the 3D printing industry. Our propositions emphasize the importance of large collective action and the role of multiple actors in order to create the conditions for, first, firm emergence and the second, to the process of industry emergence.
Synovitis after Total Knee Arthroplasty: Possible Cause of Residual Postoperative Pain (Preliminary Study)
Authors: Sugimura Natsuki , Aso Koji , Izumi Masashi , Ikeuchi Masahiko
Published: March 2020

Purpose: The cause of residual pain after total knee arthroplasty (TKA) was unknown. Little attention has been given to postoperative synovitis as a cause of unexplained residual pain after TKA. Here we preliminarily investigated the relationship between synovitis after TKA and pain with ultrasonography. Methods: This study was conducted using convenient outpatient samples followed for TKA. Synovitis was accessed with ultrasonography. We originally made synovitis scores, which are a summation of the synovitis grade in the entire knee. Pain assessments including rest, moving pain visual analog scale (VAS) and WOMAC score and its subscale were evaluated. Correlations between synovitis scores or the maximum grade and pain assessments were analyzed. Pressure pain thresholds (PPTs) on synovitis were evaluated. Results: 46 knees in 37 patients (34 female, 3 male) were evaluated. Synovitis scores correlated with rest and moving VAS (r = 0.439; 0.355, p = 0.002, 0.016). PPTs on positive synovitis significantly decreased compared with grade zero (average PPTs (SD) on grade zero, one, two = 484(21), 255(13), 268(20) kPa; p < 0.001). Conclusion: Synovitis after TKA was associated with residual unexplained pain. Ultrasonography and synovitis scores should be available to evaluate synovitis after TKA.
Exploring the Efficacy of Transfer Learning in Mining Image-Based Software Artifacts
Authors: Best Natalie , Ott Jordan , Linstead Erik
Published: March 2020

Background Transfer learning allows us to train deep architectures requiring a large number of learned parameters, even if the amount of available data is limited, by leveraging existing models previously trained for another task. In previous attempts to classify image-based software artifacts in the absence of big data, it was noted that standard off-the-shelf deep architectures such as VGG-16 could not be utilized due to their large parameter space and therefore had to be replaced by customized architectures with fewer layers. This proves to be challenging to empirical software engineers who would like to make use of existing architectures without the need for customization. Findings Here we explore the applicability of transfer learning utilizing models pre-trained on non-software engineering data applied to the problem of classifying software UML diagrams. Our experimental results show training reacts positively to transfer learning as related to sample size, even though the pre-trained model was not exposed to training instances from the software domain. We contrast the transferred network with other networks to show its advantage on different sized training sets, which indicates that transfer learning is equally effective to custom deep architectures when large amounts of training data is not available. Conclusion Our findings suggest that transfer learning, even when based on models that do not contain software engineering artifacts, can provide a pathway for using off-the-shelf deep architectures without customization. This provides an alternative to practitioners who want to apply deep learning to image-based classification but to not have the expertise or comfort to define their own network architectures.
Sensory Processing Patterns affect Headache Severity among Adolescents with Migraine
Authors: Genizi Jacob , Halevy Ayelet , Schertz Mitchell , Osman Khaled , Assaf Nurit , Segal Idan , Sr Isaac , Kessel Aharon , Engel-Yeger Batya
Published: March 2020

Objective : To evaluate the relationship between pain catastrophizing level, sensory processing patterns, and headache severity among adolescents with episodic migraine. Background : Catastrophizing about pain is a critical variable in how we understand adjustment to pain and has a unique contribution in predicting pain intensity. Recent reports found that migraine is also related to enhanced sensory sensitivity. However, the relationship between pain severity, pain catastrophizing level and sensory sensitivity requires greater study especially among adolescents. Methods : Participants were 92 adolescents aged 13-18 years, 40 with episodic migraine and 52 healthy controls. The migraine patients were prospectively recruited from outpatient pediatric neurology clinics. All participants completed the Short Sensory Profile (SSP), and the Pain Catastrophizing Scale for children (PCS-ch). The migraine groups also completed the PedMIDAS, which measures Headache related disability. Results : Adolescents with migraine had significantly lower tendency to seek sensory input than healthy controls. Elevated rumination and helplessness correlated with higher migraine pain severity. Tendency to avoid sensory input predicted the migraine related disability level. They also significantly higher pain catastrophizing level than healthy controls, as seen in enhanced rumination (p ≤ 0.001) and helplessness (p ≤ 0.05). Conclusions : Sensory processing difficulties are common among adolescents with episodic migraine. Sensory avoidance may be related to pain experience, and pain catastrophizing and disability level.
808 nm-activable core@multishell upconverting nanoparticles with enhanced stability for efficient photodynamic therapy
Authors: Martinez Raquel , Polo Ester , Barbosa Silvia , Taboada Pablo , Pino Pablo del , Pelaz Beatriz
Published: March 2020

Background: The unique upconversion properties of rare-earth-doped nanoparticles offers exciting opportunities for biomedical applications, in which near-IR remote activation of biological processes is desired, including in vivo bioimaging, optogenetics, and light-based therapies. Tuning of upconversion in purposely designed core-shell nanoparticles gives access to biological windows in biological tissue. In recent years there have been several reports on NIR-excitable upconverting nanoparticles capable of working in biological mixtures and cellular settings. Unfortunately, most of these nanosystems are based on ytterbium's upconversion at 980 nm, concurrent with water's absorption within the first biological window. Thus, methods to produce robust upconverting nanoplatforms that can be efficiently excited with other than 980 nm NIR sources, such as 808 nm and 1064 nm, are required for biomedical applications. Results: Herein, we report a synthetic method to produce aqueous stable upconverting nanoparticles that can be activated with 808 nm excitation sources, thus avoiding unwanted heating processes due to water absorbance at 980 nm. Importantly, these nanoparticles, once transferred to an aqueous environment using an amphiphilic polymer, remain colloidally stable for long periods of time in relevant biological media, while keeping their photoluminescence properties. The selected polymer was covalently modified with two FDA-approved photosensitizers (Rose Bengal and Chlorin e6), which can be efficiently and simultaneously excited by the light emission of our upconverting nanoparticles. Thus, our polymer-functionalization strategy allows producing an 808 nm-activable photodynamic nanoplatform. These upconverting nanocomposites are preferentially stored in acidic lysosomal compartments, which does not negatively affect their performance as photodynamic agents. Upon 808 nm excitation, the production of reactive oxidative species (ROS) and their effect in mitochondrial integrity were demonstrated. Conclusions: In summary, we have demonstrated the feasibility of using photosensitizer-polymer-modified upconverting nanoplatforms that can be activated by 808 nm light excitation sources for application in photodynamic therapy. Our nanoplatforms remain photoactive after internalization by living cells, allowing for 808 nm-activated ROS generation. The versatility of our polymer-stabilization strategy promises a straightforward access to other derivatizations (for instance, by integrating other photosensitizers or homing ligands), which could synergistically operate as multifunctional photodynamic platforms nanoreactors for in vivo applications.
Distinct Type 2-high Inflammation Associated Molecular Phenotypes of Chronic Rhinosinusitis with Nasal Polyps with Comorbid Asthma
Authors: Wang Ming , Bu Xiangting , Luan Ge , Lin Liqing , Wang Yang , Jin Jianmin , Zhang Luo , Wang Chengshuo
Published: March 2020

Background Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and comorbid asthma have more severe disease and are difficult to treat. However, the phenotypes especially the molecular phenotypes of CRSwNP with comorbid asthma (CRSwNP+AS) are not clear. This study aimed to investigate the molecular phenotypes associated with CRSwNP+AS. Methods Nasal tissues from patients with CRSwNP+AS, CRSwNP-alone and control subjects were assessed with infiltrated inflammatory cells and concentrations of total IgE, and performed whole-transcriptome sequencing. Differentially expressed mRNAs (DE-mRNAs) and lncRNAs (DE-lncRNAs) and their associated pathways were analyzed. The correlations between type 2 cytokines and local eosinophils, tissue IgE, and transcriptome signatures were evaluated. Results More local eosinophils infiltration and higher levels of total IgE were found in nasal tissues from CRSwNP+AS than from CRSwNP-alone. RNA sequencing analysis identified 1988 common DE-mRNAs, and 176 common DE-lncRNAs shared by CRSwNP+AS versus control and CRSwNP-alone versus control. Weighted gene coexpression network analysis (WGCNA) identified LINC01146 as hub lncRNA dysregulated in both subtypes of CRSwNP. We identified 968 DE-mRNAs and 312 DE-lncRNAs between CRSwNP+AS and CRSwNP-alone. Both pathway enrichment analysis and WGCNA indicated that the phenotypic traits of CRSwNP+AS were mainly associated with higher activities of arachidonic acid metabolism, Th2 cytokines related pathway and fibrinolysis pathway, and oppositely lower activities of IL-17 signaling pathway. We further showed that the expression of Th2 cytokines, IL5 and IL13, were positively correlated with local eosinophils infiltration, tissue IgE level, and the expression of DE-mRNAs that related to arachidonic acid metabolism. Moreover, WGCNA identified HK3-006 as hub lncRNA in yellow module that most positively correlated with phenotypic traits of CRSwNP+AS. Conclusions Patients with CRSwNP+AS have distinct type 2-high inflammation and its associated transcriptome signatures in nasal tissues compared to patients with CRSwNP alone.
Clinical and Radiographic Characteristics, Management and Short-term Outcomes of Patients with COVID-19 in Wenzhou, China
Authors: Hong Liang , Ye Enling , Sun Gangqiang , Wang Xiaoyang , Zhang Shengguo , Wu Yanghe , Xie Xiangao , Xia Shichun , Zheng Xudong , Dong Ling , Cai Fujing , Lou Xixian , Zhao Renguo , Hu Yongqi , Ruan Zhanwei , Ding Jiguang , Sun Qingfeng
Published: March 2020

Background: Coronavirus disease 2019 (COVID-19) is an emerging viral disease. Here, we reported the clinical features, management, and short-term outcomes of COVID-19 patients in Wenzhou, an area outside Wuhan.Methods: Patients admitted to the Infectious Diseases Department of Ruian People's Hospital in Wenzhou, from January 21 to February 7, 2020, were recruited. Medical data on epidemiological history, demographics, clinical characteristics, laboratory tests, computerized tomography (CT) examination, treatment, and short-term outcomes were retrospectively reviewed. Blood biochemistry and routine tests were examined using standard methods and automatic machines. CT examination was performed again for several times during the hospitalization as necessary.Results: A total of 67 confirmed COVID-19 cases were diagnosed; 64 (95.4%) were common cases and three (4.5%) severe cases. The most common symptoms at admission were fever (86.6%), cough (77.6%), productive cough (52.2%), chest distress (17.9%), and sore throat (11.9%), followed by diarrhea (7.4%), headache (7.4%), shortness of breath (6.0%), dizziness (4.5%), muscular soreness (4.5%), and running nose (4.5%). Thirty patients (47.8%) had increased C-reactive protein levels. The CT radiographs at admission showed abnormal findings in 54 (80.6%) patients. The patients were treated mainly by oxygen therapy and antiviral drugs. By February 17, 2020, none of the 67 patients died and no infection occurred among medical staff in the department. Fifty-four (80.6%) patients were completely recovered and all others were improving.Conclusion: Cases in Wenzhou are mild, with good prognosis. Timely and appropriate screening, diagnosis, and treatment are the key to achieve the good outcomes.