bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Cervical Osteophyte Resection for Treatment of Dysphagia
Authors: Kolz Joshua M. , Alvi Mohammed A. , Bhatti Atiq R. , Tomov Marko N. , Bydon Mohamad , Sebastian Arjun S. , Elder Benjamin D. , Nassr Ahmad N. , Fogelson Jeremy L. , Currier Bradford L. , Freedman Brett A.
Published: March 2020

Study Design:

This was a retrospective cohort study.

Objectives:

When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia.

Methods:

Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%).

Results:

Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia ( P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication.

Conclusions:

Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.
The Sociological Imagination, Neoliberalism, and Higher Education
Authors: Rousseau Nathan
Published: March 2020

One of the main goals of sociology is to identify and evaluate institutional changes in society. The concept of the sociological imagination has gained wide use as a means of observing how personal issues are affected by social arrangements. This article critically examines how many contemporary sociologists, particularly in the area of teaching and learning, are using their sociological imaginations to observe and evaluate the changes taking place in higher education due to a paradigm shift that emphasizes occupational-professional programs at the expense of the arts and sciences. It is argued that this shift toward neoliberal principles is so pervasive that social scientists tend to think and speak in neoliberal terms even when expressing the importance of maintaining a sociological imagination. While some educators celebrate this trend in higher education, C. Wright Mills, the sociologist who coined the term, “sociological imagination,” believed (like John Dewey) that a well-rounded education is vital to preserving a democracy.
Israel and Lebanon: Relations Under Stress
Authors: Abadi Jacob
Published: March 2020

This article provides an analysis of the course of Israeli-Lebanese relations and its purpose is to shed light on the contacts between the Maronites in Lebanon and the State of Israel. It argues that the primary reason for the Maronites’ willingness to cooperate with the Jews was the fear that the rising tide of Arab nationalism in Lebanon would have adverse effects on their survival as a religious minority. Moreover, it demonstrates that these contacts laid the background for cooperation between the two communities which survived the vicissitudes of the Lebanese civil wars and still plays a role in Israeli foreign policy.
Building Capacity for Creativity: Rediscovering the Inner “Superhero” as a Mechanism for Developing a Creative Mindset for Entrepreneurial Problem-Solving
Authors: Fleck Emma , Asmuth Jennifer
Published: March 2020

This article delivers a series of activities which help participants to examine and stimulate their capacity for creativity to support entrepreneurial problem-solving. It provides a series of tools which enable entrepreneurship educators to support their students in a review, immersion and reflection of their creative capacity using the concept of childhood play, and specifically the superhero, to stimulate their imagination. Inspired by the creative mindset often found in young children, these activities help to build creative self-efficacy, challenging participants to exercise curiosity to go beyond their current resource limitations to solve problems by immersing them within a positive childhood experience. While students explore the concept of creativity and its fundamental role for entrepreneurial problem-solving, the workshop activity helps them to embody their own “superhero” and revisit their unconstrained, imaginative 5 year old selves through the use of pictures, costumes, masks, and icons. Finally, in reflecting upon the activities and acknowledging their own personal capacity for developing a creative process, participants are encouraged to use these skills for problem-solving both within the exercises of the class and throughout their entrepreneurial journey.
SAKK38/07 study: integration of baseline metabolic heterogeneity and metabolic tumor volume in DLBCL prognostic model
Authors: Ceriani Luca , Gritti Giuseppe , Cascione Luciano , Pirosa Maria Cristina , Polino Angela , Ruberto Teresa , Stathis Anastasios , Bruno Andrea , Moccia Alden A. , Giovanella Luca , Hayoz Stefanie , Schär Sämi , Dirnhofer Stefan , Rambaldi Alessandro , Martinelli Giovanni , Mamot Christoph , Zucca Emanuele
Published: March 2020

Several functional parameters from baseline (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography have been proposed as promising biomarkers of treatment efficacy in diffuse large B-cell lymphoma (DLBCL). We tested their ability to predict outcome in 2 cohorts of DLBCL patients receiving conventional immunochemotherapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [R-CHOP] regimen), either every 14 (R-CHOP14) or 21 days (R-CHOP21). Baseline PET analysis was performed in 141 patients with DLBCL treated with R-CHOP14 in the prospective SAKK38/07 study (NCT00544219) of the Swiss Group for Clinical Cancer Research (testing set). Reproducibility was examined in a validation set of 113 patients treated with R-CHOP21. In the SAKK38/07 cohort, progression-free survival (PFS) at 5 years was 83% for patients with low metabolic tumor volume (MTV) and 59% for those with high MTV (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.6-7.0; P = .0005), whereas overall survival (OS) was 91% and 64%, respectively (HR, 4.4; 95% CI, 1.9-10; P = .0001). MTV was the most powerful predictor of outcome also in the validation set. Elevated metabolic heterogeneity (MH) significantly predicted poorer outcomes in the subgroups of patients with elevated MTV. A model integrating MTV and MH identified high-risk patients with shorter PFS (testing set: HR, 5.6; 95% CI, 1.8-17; P < .0001; validation set: HR, 5.6; 95% CI, 1.7-18; P = .0002) and shorter OS (testing set: HR, 9.5; 95% CI, 1.7-52; P < .0001; validation set: HR, 7.6; 95% CI, 2.0-28; P = .0003). This finding was confirmed by an unsupervised regression tree analysis indicating that prognostic models based on MTV and MH may allow early identification of refractory patients who might benefit from treatment intensification. This trial was registered at www.clinicaltrials.gov as #NCT00544219.
Shared mechanisms of multimorbidity in COPD, atherosclerosis and type-2 diabetes: the neutrophil as a potential inflammatory target
Authors: Hughes Michael J. , McGettrick Helen M. , Sapey Elizabeth
Published: March 2020

Multimorbidity is increasingly common and current healthcare strategies are not always aligned to treat this complex burden of disease. COPD, type-2 diabetes mellitus (T2D) and cardiovascular disease, especially atherosclerosis, occur more frequently together than expected, even when risk factors such as smoking, obesity, inactivity and poverty are considered. This supports the possibility of unifying mechanisms that contribute to the pathogenesis or progression of each condition.

Neutrophilic inflammation is causally associated with COPD, and increasingly recognised in the pathogenesis of atherosclerosis and T2D, potentially forming an aetiological link between conditions. This link might reflect an overspill of inflammation from one affected organ into the systemic circulation, exposing all organs to an increased milieu of proinflammatory cytokines. Additionally, increasing evidence supports the involvement of other processes in chronic disease pathogenesis, such as cellular senescence or changes in cellular phenotypes.

This review explores the current scientific evidence for inflammation, cellular ageing and cellular processes, such as reactive oxygen species production and phenotypic changes in the pathogenesis of COPD, T2D and atherosclerosis; highlighting common mechanisms shared across these diseases. We identify emerging therapeutic approaches that target these areas, but also where more work is still required to improve our understanding of the underlying cellular biology in a multimorbid disease setting.
Impact of CFTR modulator use on outcomes in people with severe cystic fibrosis lung disease
Authors: Shteinberg Michal , Taylor-Cousar Jennifer L.
Published: March 2020

Drug compounds that augment the production and activity of the cystic fibrosis (CF) transmembrane regulator (CFTR) have revolutionised CF care. Many adults and some children with CF suffer advanced and severe lung disease or await lung transplantation. While the hope is that these drug compounds will prevent lung damage when started early in life, there is an ongoing need to care for people with advanced lung disease. The focus of this review is the accumulating data from clinical trials and case series regarding the benefits of CFTR modulator therapy in people with advanced pulmonary disease. We address the impact of treatment with ivacaftor, lumacaftor/ivacaftor, tezacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor on lung function, pulmonary exacerbations, nutrition and quality of life. Adverse events of the different CFTR modulators, as well as the potential for drug–drug interactions, are discussed.
Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis
Authors: Rahaghi Franck F. , Baughman Robert P. , Saketkoo Lesley Ann , Sweiss Nadera J. , Barney Joseph B. , Birring Surinder S. , Costabel Ulrich , Crouser Elliott D. , Drent Marjolein , Gerke Alicia K. , Grutters Jan C. , Hamzeh Nabeel Y. , Huizar Isham , Ennis James W. , Kalra Sanjay , Kullberg Susanna , Li Huiping , Lower Elyse E. , Maier Lisa A. , Mirsaeidi Mehdi , Müller-Quernheim Joachim , Carmona Porquera Eva M. , Samavati Lobelia , Valeyre Dominique , Scholand Mary Beth
Published: March 2020

Pulmonary sarcoidosis presents substantial management challenges, with limited evidence on effective therapies and phenotypes. In the absence of definitive evidence, expert consensus can supply clinically useful guidance in medicine. An international panel of 26 experts participated in a Delphi process to identify consensus on pharmacological management in sarcoidosis with the development of preliminary recommendations.

The modified Delphi process used three rounds. The first round focused on qualitative data collection with open-ended questions to ensure comprehensive inclusion of expert concepts. Rounds 2 and 3 applied quantitative assessments using an 11-point Likert scale to identify consensus.

Key consensus points included glucocorticoids as initial therapy for most patients, with non-biologics (immunomodulators), usually methotrexate, considered in severe or extrapulmonary disease requiring prolonged treatment, or as a steroid-sparing intervention in cases with high risk of steroid toxicity. Biologic therapies might be considered as additive therapy if non-biologics are insufficiently effective or are not tolerated with initial biologic therapy, usually with a tumour necrosis factor-α inhibitor, typically infliximab.

The Delphi methodology provided a platform to gain potentially valuable insight and interim guidance while awaiting evidenced-based contributions.
Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study
Authors: Rahaghi Franck F. , Sweiss Nadera J. , Saketkoo Lesley Ann , Scholand Mary Beth , Barney Joseph B. , Gerke Alicia K. , Lower Elyse E. , Mirsaeidi Mehdi , O'Hare Lanier , Rumbak Mark J. , Samavati Lobelia , Baughman Robert P.
Published: March 2020

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.

We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.

Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.

In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.
Standard machine learning approaches outperform deep representation learning on phenotype prediction from transcriptomics data
Authors: Smith Aaron M. , Walsh Jonathan R. , Long John , Davis Craig B. , Henstock Peter , Hodge Martin R. , Maciejewski Mateusz , Mu Xinmeng Jasmine , Ra Stephen , Zhao Shanrong , Ziemek Daniel , Fisher Charles K.
Published: March 2020

Background

The ability to confidently predict health outcomes from gene expression would catalyze a revolution in molecular diagnostics. Yet, the goal of developing actionable, robust, and reproducible predictive signatures of phenotypes such as clinical outcome has not been attained in almost any disease area. Here, we report a comprehensive analysis spanning prediction tasks from ulcerative colitis, atopic dermatitis, diabetes, to many cancer subtypes for a total of 24 binary and multiclass prediction problems and 26 survival analysis tasks. We systematically investigate the influence of gene subsets, normalization methods and prediction algorithms. Crucially, we also explore the novel use of deep representation learning methods on large transcriptomics compendia, such as GTEx and TCGA, to boost the performance of state-of-the-art methods. The resources and findings in this work should serve as both an up-to-date reference on attainable performance, and as a benchmarking resource for further research.

Results

Approaches that combine large numbers of genes outperformed single gene methods consistently and with a significant margin, but neither unsupervised nor semi-supervised representation learning techniques yielded consistent improvements in out-of-sample performance across datasets. Our findings suggest that usingl2-regularized regression methods applied to centered log-ratio transformed transcript abundances provide the best predictive analyses overall.

Conclusions

Transcriptomics-based phenotype prediction benefits from proper normalization techniques and state-of-the-art regularized regression approaches. In our view, breakthrough performance is likely contingent on factors which are independent of normalization and general modeling techniques; these factors might include reduction of systematic errors in sequencing data, incorporation of other data types such as single-cell sequencing and proteomics, and improved use of prior knowledge.
Multiple independent chromosomal fusions accompanied the radiation of the Antarctic teleost genus Trematomus (Notothenioidei:Nototheniidae)
Authors: Auvinet Juliette , Graça Paula , Dettai Agnès , Amores Angel , Postlethwait John H. , Detrich H. William , Ozouf-Costaz Catherine , Coriton Olivier , Higuet Dominique
Published: March 2020

Background

Chromosomal rearrangements are thought to be an important driving force underlying lineage diversification, but their link to speciation continues to be debated. Antarctic teleost fish of the family Nototheniidae (Notothenioidei) diversified in a changing environmental context, which led to ecological, morphological, and genetic differentiation among populations. In addition, extensive chromosomal repatterning accompanied species divergence in several clades. The most striking karyotypic changes involved the recent species radiation (about 10 My) of the genus Trematomus, with chromosomal pair numbers ranging between 29 and 12. These dramatic reductions in chromosome number resulted mostly from large-scale chromosome fusions. Multiple centric and/or tandem fusions have been hypothesized in at least seven of the twelve recognized Trematomus species. To reconstruct their evolutionary history, we employed comparative cytogenomics (BAC-FISH and chromosome painting) to reveal patterns of interspecific chromosomal orthologies across several notothenioid clades.

Results

We defined orthologous chromosomal segments of reference, termed Structural Units (SUs). SUs were identified in a total of 18 notothenioid species. We demonstrated for the first time that SUs were strongly conserved across every specimen examined, with chromosomal syntenies highlighting a paucity of intrachromosomal macro-rearrangements. Multiple independent fusions of these SUs were inferred in the Trematomus species, in contrast to the shared SU fusions in species of the sister lineage Notothenia.

Conclusions

The SU segments were defined units of chromosomal rearrangement in the entire family Nototheiidae, which diverged from the other notothenioid families 20 My ago. Some of the identified chromosomal syntenies within the SUs were even conserved in their closest relatives, the family Eleginopsidae. Comparing the timing of acquisition of the fusions in the closely related genera Notothenia and Trematomus of the nototheniid species family, we conclude that they exhibit distinct chromosomal evolutionary histories, which may be relevant to different speciation scenarios.
Diploid genome differentiation conferred by RNA sequencing-based survey of genome-wide polymorphisms throughout homoeologous loci in Triticum and Aegilops
Authors: Tanaka Sayaka , Yoshida Kentaro , Sato Kazuhiro , Takumi Shigeo
Published: March 2020

Background

Triticum and Aegilops diploid species have morphological and genetic diversity and are crucial genetic resources for wheat breeding. According to the chromosomal pairing-affinity of these species, their genome nomenclatures have been defined. However, evaluations of genome differentiation based on genome-wide nucleotide variations are still limited, especially in the three genomes of the genus Aegilops: Ae. caudata L. (CC genome), Ae. comosa Sibth. et Sm. (MM genome), and Ae. uniaristata Vis. (NN genome). To reveal the genome differentiation of these diploid species, we first performed RNA-seq-based polymorphic analyses for C, M, and N genomes, and then expanded the analysis to include the 12 diploid species of Triticum and Aegilops.

Results

Genetic divergence of the exon regions throughout the entire chromosomes in the M and N genomes was larger than that between A- and Am-genomes. Ae. caudata had the second highest genetic diversity following Ae. speltoides, the putative B genome donor of common wheat. In the phylogenetic trees derived from the nuclear and chloroplast genome-wide polymorphism data, the C, D, M, N, U, and S genome species were connected with short internal branches, suggesting that these diploid species emerged during a relatively short period in the evolutionary process. The highly consistent nuclear and chloroplast phylogenetic topologies indicated that nuclear and chloroplast genomes of the diploid Triticum and Aegilops species coevolved after their diversification into each genome, accounting for most of the genome differentiation among the diploid species.

Conclusions

RNA-sequencing-based analyses successfully evaluated genome differentiation among the diploid Triticum and Aegilops species and supported the chromosome-pairing-based genome nomenclature system, except for the position of Ae. speltoides. Phylogenomic and epigenetic analyses of intergenic and centromeric regions could be essential for clarifying the mechanisms behind this inconsistency.
Psychometric properties of the perceived stress scale in a community sample of Chinese
Authors: Huang Feifei , Wang Huijun , Wang Zhihong , Zhang Jiguo , Du Wenwen , Su Chang , Jia Xiaofang , Ouyang Yifei , Wang Yun , Li Li , Jiang Hongru , Zhang Bing
Published: March 2020

Background

The Perceived Stress Scale (PSS) is a globally used and self-report scale measuring perceived stress. Three versions of PSS (PSS-14, PSS-10 and PSS-4) are available which comprise 14, 10 and 4 items respectively. However, the Chinese version of the PSS has not yet been validated in a large community-based general population. The aims of this study were to evaluate the psychometric properties of the Chinese PSS in a large community-based general population and to compare the appropriateness of the three versions of PSS.

Methods

A total of 9507 adults with at least a junior high school education and completed PSS-14 from the China Health and Nutrition Survey were involved in this study. The internal consistency reliability of PSS was assessed using Cronbach’s alpha coefficient and confirmatory factor analysis was employed to test the construct validity. Modification index was used for model extension and the critical ratio was used for model restriction.

Results

The internal consistency coefficients were satisfactory for PSS-14 and PSS-10, but not for PSS-4. The corresponding Cronbach’s alpha were 0.830, 0.754 and 0.473 respectively. A 2-factor structure was confirmed for the PSS-14 and PSS-10, and all items’ standardized factor loadings exceeded 0.4 for either negative or positive factors. Given that item 12 loaded on both negative and positive factors for PSS-14 and the goodness of fit for PSS-14 was not acceptable, PSS-13 (PSS-14 excluding item 12) was studied. The construct validities of PSS-13 and PSS-10 were satisfactory, but the goodness of fit for PSS-10 were better than that for PSS-13.

Conclusions

PSS-13 (PSS-14 excluding item 12) and PSS-10 have satisfactory psychometric properties. PSS-10 are more applicable to measure the perceived stress than PSS-13 in a large community-based general population in China.
The effect of teaching puberty health concepts on the basis of a health belief model for improving perceived body image of female adolescents: a quasi-experimental study
Authors: Barkhordari-Sharifabad Maasoumeh , Vaziri-Yazdi Saeed , Barkhordari-Sharifabad Mansoureh
Published: March 2020

Background

As children approach adolescence, they focus increasingly on their appearance and physical attraction due to teenage body-image. Teaching the concepts of adolescent health changes an individual’s attitudes towards parts of the body. The health belief model (HBM) is one of the significant pedagogic models in health education. According to this model, the individual’s decision and motivation for adopting healthy behaviors depends on three separate categories “personal perception, adaptive behaviors, and probability of performing that action or behavior”. This study investigated the effect of teaching puberty health concepts on the basis of a HBM on perceived body image in female adolescents.

Methods

A quasi-experimental research design was used in the study. This study was conducted with 60 sixth grade girls in state elementary schools in Yazd, Iran, that were selected with cluster sampling method and assigned randomly into experimental and control groups. The experimental group were educated in the school during eight 45-min sessions based on the HBM, whereas the control group were educated using the traditional lecturing method. The data were collected with demographic and self-body image questionnaires completed before and after intervention. The data were analyzed with SPSS16 using analysis of covariance (ANCOVA).

Results

The mean age of the participants was 12.16 ± 0.74 years. The findings showed that “perceived body image” and “students’ self-attitude” improved significantly after intervention; yet, no significant difference was found between the subscales “attitudes towards weight” and “satisfaction with various parts of the body”.

Conclusion

The results of the study confirmed the efficacy and efficiency of teaching puberty health on the basis of the HBM on improving perceived body image in female adolescents.
The influence of pregnancy classes on the use of maternal health services in Indonesia
Authors: Azhar Khadijah , Dharmayanti Ika , Tjandrarini Dwi Hapsari , Hidayangsih Puti Sari
Published: March 2020

Background

Indonesia has developed the pregnancy class program for mothers in an effort to reduce the high maternal mortality rate. This study aims to understand the influence of pregnancy classes on mothers’ use of maternal and neonatal health services, which are known to improve pregnancy and delivery outcomes.

Methods

This study used data on members of households in communities in Indonesia, based on the 2016 National Health Indicators Survey (Sirkesnas), which covered 34 provinces and 264 districts/cities. The analysis focused on a sample of women ages 10–54 years who had ever been married and had given birth in the previous 3 years. The study analyzed three behaviors as outcome variables: whether a mother had adequate antenatal care, used a skilled birth attendant, and had a facility-based delivery. Logistic and multinomial logistic regression analysis was used to explore those relationships.

Results

29% of mothers utilized adequate antenatal care (a minimum of five antenatal care components and at least four antenatal care visits), 77% of mothers used skilled birth attendants for delivering their baby, and 76% of mothers used a health facility to give birth. Only 7% of mothers participated in the complete pregnancy class program. Mothers who completed participation in the pregnancy class program had 2.2 times higher odds of receiving adequate antenatal care [OR = 2.19; 95% CI: 1.62 to 2.97; P < 0.001]. Those who completed participation in the class had 2.7 times higher odds of using skilled birth attendants for delivery [OR = 2.69; 95% CI: 1.52 to 4.76; P < 0.001] and 2.8 times higher odds of giving birth in a health facility compared to a non-health facility [OR = 2.77; 95% CI: 1.56 to 4.91; P < 0.001].

Conclusions

Participation in pregnancy classes was positively associated with utilization of adequate antenatal care, skilled birth attendants, and delivery at health facility. Since participation in pregnancy classes in positively associated with maternal healthcare utilization, policy efforts should focus on improving implementation of the KIH program at the local level.
Diabetic foot care: knowledge and practice
Authors: Pourkazemi Aydin , Ghanbari Atefeh , Khojamli Monireh , Balo Heydarali , Hemmati Hossein , Jafaryparvar Zakiyeh , Motamed Behrang
Published: March 2020

Background

Diabetic foot ulcers (DFUs) are common problems in diabetes. One of the most important factors affecting the quality of diabetes care is knowledge and practice. The current study aimed at determining the knowledge and practice of patients with diabetes regarding the prevention and care of DFUs.

Methods

The current analytical, cross sectional study was conducted in Guilan Province (north of Iran) on 375 patients registered in the medical records as type 2 diabetes mellitus. Demographic characteristics, knowledge, and practice of participants were recorded in a questionnaire during face-to-face interviews conducted by the researcher. Descriptive and inferential statistics were performed using SPSS version18.

Results

The mean score of knowledge was 8.63 ± 2.5 out of 15, indicating that the majority of participants had a poor knowledge (84.8%). The mean practice score was 7.6 ± 2.5 out of 15, indicating that a half of them had poor performance (49.6%). There was a significant and direct correlation between knowledge and practice. Knowledge level, place of residence, marital status, and history of admission due to diabetic foot were predictors of practice score.

Conclusions

According to the low level of knowledge and practice in patients with diabetes regarding the prevention and care of DFUs, and considering the significant relationship of some demographics of patients with knowledge and practice scores, a targeted educational program is needed to promote knowledge of patients with diabetes.
Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study
Authors: Li Suellen , Odedina Stella , Agwai Imaria , Ojengbede Oladosu , Huo Dezheng , Olopade Olufunmilayo I.
Published: March 2020

Background

Previous research has revealed high rates of traditional medicine usage in Nigeria. Reports of widespread contamination of herbal medicine products and higher rates of noncompliance with Western medications among traditional medicine users have raised concerns about the safety of traditional medicine use. Few studies have explored how demographic factors predict rates of traditional medicine use in the general population.

Methods

We conducted interviews of 748 adult women recruited from the communities in the city of Ibadan, Nigeria from 2013 to 2015. A structured questionnaire was created to collect data on rates of traditional medicine use and demographic factors such as age, education, ethnicity, and occupation. Multivariate logistic regressions were run to examine factors related to traditional medicine use, and the effects were measured with odds ratios (OR) along with 95% confidence interval (95%CI).

Results

The overall proportion of traditional medicine use was 81.6%. Women from the Ibo and Hausa ethnic groups were significantly less likely to use traditional medicine than the majority Yoruba group (OR 0.25, 95%CI 0.10–0.63;, OR 0.43, 95%CI 0.24–0.76) respectively). In addition, educated women were less likely than their non-educated counterparts to have used traditional medicine, with the biggest effect seen in women with a secondary education (OR 0.42, 95%CI 0.21–0.85).

Conclusions

We found a high rate of traditional medicine usage, consistent with that found in prior research. A novel finding was the significance of ethnicity as a predictor for usage rates.
Implicit expression of uncertainty – suggestion of an empirically derived framework
Authors: Gärtner Julia , Berberat Pascal O. , Kadmon Martina , Harendza Sigrid
Published: March 2020

Background

Uncertainty occurs in physicians’ daily work in almost every clinical context and is also present in the clinical reasoning process. The way physicians communicate uncertainty in their thinking process during handoffs is crucial for patient safety because uncertainty has diverse effects on individuals involved in patient care. Dealing with uncertainty and expressing uncertainty are important processes in the development of professional identity of undergraduate medical students. Many studies focused on how to deal with uncertainty and whether uncertainty is explicitly expressed. Hardly any research has been done regarding implicit expression of uncertainty. Therefore, we studied the ways in which medical students in the role of beginning residents implicitly express uncertainty during simulated handoffs.

Methods

Sixty-seven advanced undergraduate medical students participated in a simulated first day of residency including a consultation hour, a patient management phase with interprofessional interaction, and a patient handoff. We transcribed the videographed handoffs verbatim and extracted language with respect to expression of uncertainty using a grounded theory approach. Text sequences expressing patient related information were analyzed and coded with respect to language aspects which implicitly modified plain information with respect to increasing or decreasing uncertainty. Concepts and categories were developed and discussed until saturation of all aspects was reached.

Results

We discovered a framework of implicit expressions of uncertainty regarding diagnostic and treatment-related decisions within four categories: “Statement”, “Assessment”, “Consideration”, and “Implication”. Each category was related to either the subcategory “Actions” or “Results” within the diagnostic or therapeutic decisions. Within each category and subcategory, we found a subset of expressions, which implicitly attenuated or strengthened plain information thereby increasing uncertainty or certainty, respectively. Language that implicitly attenuated plain information belonged to the categories questionable, incomplete, alterable, and unreliable while we could ascribe implicit strengtheners to the categories assertive, adequate, focused, and reliable.

Conclusions

Our suggested framework of implicit expression of uncertainty may help to raise the awareness for expression of uncertainty in the clinical reasoning process and provide support for making uncertainty explicit in the teaching process. This may lead to more transparent communication processes among health care professionals and eventually to improved patient safety.
Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review
Authors: Tomsic Ivonne , Heinze Nicole R. , Chaberny Iris F. , Krauth Christian , Schock Bettina , von Lengerke Thomas
Published: March 2020

Background

Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions.

Methods

Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions.

Results

Forty studies were included. Implementation interventions used most frequently (“top five”) were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3–5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant.

Conclusion

In SSI prevention in abdominal surgery, mostly standard bundles of implementation interventions are applied. While an effectiveness analysis of differences in SSI risk reduction by number and type of interventions did not render conclusive results, use of standard interventions such as audit and feedback, organizational culture, monitoring, reminders, and education at least does not seem to represent preventive malpractice. Further research should determine implementation interventions, or bundles thereof, which are most effective in promoting compliance with SSI-preventive measures in abdominal surgery.
Parental satisfaction with quality of neonatal care in different level hospitals: evidence from Vietnam
Authors: Nguyen An Thi Binh , Nguyen Ngan Thi Kim , Phan Phuc Huu , van Eeuwijk Peter , Fink Günther
Published: March 2020

Background

Most health systems provide the most specialized, and presumably also the highest quality of care at a central level. This study assessed parental satisfaction and its determinants in the context of neonatal care in a provincial as well as a national hospital of Vietnam.

Methods

In this cross-sectional quantitative study, parents of 340 preterm infants admitted to neonatal care units of a national and a provincial hospital in 2018 were interviewed using structured questionnaires. Unadjusted and adjusted linear regression models were used to assess the relationship between parental satisfaction and hospital rank.

Results

The mean parental satisfaction score was 3.74 at the provincial, and 3.56 at the national hospital. These satisfaction differences persisted when parent and child characteristics were adjusted for in multivariate analysis. Longer length of stay and worsening infant health status were associated with parents reporting lower levels of satisfaction with the quality of care being provided at the healthcare facility.

Conclusions

This study suggests that parents of preterm infants admitted in a provincial hospital were more satisfied with the quality of care received than those in a specialized national hospital. Length of stay and infant health status were the two most important determinants of level of parental satisfaction.
Assessment of left ventricular function in horses with aortic regurgitation by 2D speckle tracking
Authors: Decloedt A. , Ven S. , De Clercq D. , Rademakers F. , van Loon G.
Published: March 2020

Background

Aortic regurgitation (AR) may lead to left ventricular (LV) dilatation, cardiac arrhythmias and heart failure. Close follow-up of horses with AR is therefore paramount to detect onset of cardiac decompensation. The aim of this study was to examine whether two-dimensional speckle tracking (2DST) can be used to detect altered myocardial function in horses with chronic AR compared to control horses. Speckle tracking was performed on short axis and long axis images of the LV in 29 healthy Warmblood horses and 57 Warmblood horses with AR. Radial, circumferential and longitudinal strain, strain rate and displacement were measured for each segment separately and the average was calculated over all segments. Data generated from the apical segments were not included in the analysis.

Results

Radial (SR) and circumferential (SC) strain were significantly higher in horses with moderate AR (average SR 75.5 ± 24.3%, SC 19.3 ± 3.2%) but not in horses with severe AR (SR 65.5 ± 26.2%, SC 16.3 ± 3.5%), compared to control horses (SR 54.5 ± 18.0%, SC 16.8 ± 3.0%). Longitudinal strain did not show significant differences, but longitudinal displacement (DL) was larger in horses with moderate (average DL 29.5 ± 4.1 cm) and severe AR (DL 32.4 ± 6.1 cm) compared to control horses (DL 25.7 ± 4.0 cm), especially in the interventricular septum. Diastolic longitudinal strain rate was lower in early diastole in horses with severe AR (0.93 ± 0.18/s) compared to controls (1.13 ± 0.13/s).

Conclusions

2DST is able to detect altered myocardial motion in horses with AR, which showed significantly higher radial and circumferential strain. Further research is needed to determine whether these findings contribute to a more accurate diagnosis and prognosis in clinical cases.
Mesenchymal stromal cell-derived exosomes improve pulmonary hypertension through inhibition of pulmonary vascular remodeling
Authors: Zhang Shanshan , Liu Xiaoli , Ge Li Li , Li Kailin , Sun Yongchao , Wang Fang , Han Ying , Sun Chao , Wang Jue , Jiang Wen , Xin Qian , Xu Chaoyue , Chen Yuan , chen Ou , Zhang Zhaohua , Luan Yun
Published: March 2020

Background

Pulmonary hypertension (PH) is a life-threatening disease characterized by pulmonary vascular remodeling, right ventricular hypertrophy and failure. So far no effective treatment exists for this disease; hence, novel approaches are urgently needed. The aim of the present research was to observe the treatment effect of mesenchymal stromal cell derived exosomes and reveal the mechanism.

Methods

Monocrotaline (MCT)-induced PH in rats and hypoxia-induced cell damage model were established, respectively. Exosomes derived from the supernatant of human umbilical cord mesenchymal stem cells (MSC-exo) were injected into MCT-PH model rat or added into the cells cultured medium. Immunohistochemistry, quantitative real-time polymerase chain reaction (qRT-PCR) and western blot methods were used in vivo and vitro.

Results

The results showed that MSC-exo could significantly attenuate right ventricular (RV) hypertrophy and pulmonary vascular remodelling in MCT-PH rats. In the cell culture experiments, we found that MSC-exo could significantly inhibit hypoxia-induced pulmonary arterial endothelial cell (PAEC) apoptosis and pulmonary arterial smooth muscle cells (PASMC) proliferation. Furthermore, the pulmonary arterioles endothelial-to-mesenchymal transition (EndMT) was obviously suppressed. Moreover, the present study suggest that MSC-exo can significantly upregulate the expression of Wnt5a in MCT-PH rats and hypoxic pulmonary vascular cells. Furthermore, with Wnt5a gene silencing, the therapeutic effect of MSC-exo against hypoxia injury was restrained.

Conclusions

Synthetically, our data provide a strong evidence for the therapeutic of MSC-exo on PH, more importantly, we confirmed that the mechanism was associated with up-regulation of the expression of Wnt5a. These results offer a theoretical basis for clinical prevention and treatment of PH.
Production of drug metabolites by human FMO3 in Escherichia coli
Authors: Catucci Gianluca , Gilardi Gianfranco , Sadeghi Sheila J.
Published: March 2020

Background

In the course of drug discovery and development process, sufficient reference standards of drug metabolites are required, especially for preclinical/clinical or new therapeutic drugs. Whole-cell synthesis of drug metabolites is of great interest due to its low cost, low environmental impact and specificity of the enzymatic reaction compared to chemical synthesis. Here, Escherichia coli (E. coli) JM109 cells over-expressing the recombinant human FMO3 (flavin-containing monooxygenase isoform 3) were used for the conversions of clomiphene, dasatinib, GSK5182 and tozasertib to their corresponding N-oxide metabolites.

Results

The effects of NADPH regeneration, organic solvents as well as C-terminal truncations of human FMO3 were investigated. Under the optimized conditions, in excess of 200 mg/L of N-oxide metabolite of each of the four drugs could be produced by whole-cell catalysis within 24 h. Of these, more than 90% yield conversions were obtained for the N-oxidation of clomiphene and dasatinib. In addition, FMO3 shows high regio-selectivity in metabolizing GSK5182 where only the (Z) isomer is monooxygenated.

Conclusions

The study shows the successful use of human FMO3-based whole-cell as a biocatalyst for the efficient synthesis of drug metabolites including regio-selective reactions involving GSK5182, a new candidate against type 2 diabetes mellitus.
A four-DNA methylation signature as a novel prognostic biomarker for survival of patients with gastric cancer
Authors: Li Chunmei , Zheng Ya , Pu Ke , Zhao Da , Wang Yuping , Guan Quanlin , Zhou Yongning
Published: March 2020

Background

Gastric cancer (GC) is the fifth most frequently diagnosed cancer and the third leading cause of cancer-related mortality. Lack of prognostic indicators for patient survival hinders GC treatment and survival.

Methods and results

Methylation profile data of patients with GC obtained from The Cancer Genome Atlas (TCGA) database were analyzed to identify methylation sites as biomarkers for GC prognosis. The cohort was divided into training and validation sets. Univariate Cox, LASSO regression,and multivariate Cox analyses revealed a close correlation of a four-DNA methylation signature as a risk score model with the overall survival of patients with GC. The survival between high-risk and low-risk score patients with GC was significantly different. Analyses of receiver operating characteristics revealed a high prognostic accuracy of the four-DNA methylation signature in patients with GC. The subgroup analysis indicated that the accuracy included that for anatomical region, histologic grade, TNM stage, pathological stage, and sex. The GC prognosis based on the four-DNA methylation signature was more precise than that based on known biomarkers.

Conclusions

The four-DNA methylation signature could serve as a novel independent prognostic factor that could be an important tool to predict the prognostic outcome of GC patients. This potential must be verified in a large-scale population cohort study and through basic research studies.