bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome
Authors: Mirzaei Sahereh , Steffen Alana , Vuckovic Karen , Ryan Catherine , Bronas Ulf G , Zegre-Hemsey Jessica , DeVon Holli A
Published: September 2019

Background:

A decision to delay seeking treatment for symptoms of acute coronary syndrome increases the risk of serious complications, disability, and death.

Aims:

The purpose of this study was to determine if there was an association between gradual vs abrupt symptom onset and prehospital delay for patients with acute coronary syndrome and to examine the relationship between activities at symptom onset and gradual vs abrupt symptom onset.

Methods:

This was a secondary analysis of a large prospective multi-center study. Altogether, 474 patients presenting to the emergency department with symptoms of acute coronary syndrome were included in the study. Symptom characteristics, activity at symptom onset, and prehospital delay were measured with the ACS Patient Questionnaire.

Results:

Median prehospital delay time was four hours. Being uninsured (β=0.120, p=0.031) and having a gradual onset of symptoms (β=0.138, p=0.003) were associated with longer delay. A diagnosis of ST-elevation myocardial infarction (β=−0.205, p=0.001) and arrival by ambulance (β=−0.317, p<0.001) were associated with shorter delay. Delay times were shorter for patients who experienced an abrupt vs gradual symptom onset (2.57 h vs 8 h, p<0.001). Among men with an abrupt onset of symptoms and a ST-elevation myocardial infarction diagnosis, 54% reported that symptoms were triggered by exertion ( p=0.046).

Conclusion:

Patients should be counselled that a gradual onset of symptoms for potential acute coronary syndrome is an emergency and that they should call 911. Men with ischemic heart disease or with multiple risk factors should be cautioned that symptom onset following exertion may represent acute coronary syndrome.
The institutional context of financial fraud in a post-transition economy: The Quaestor scandal
Authors: Györy Csaba
Published: September 2019

The article will analyse the greatest Hungarian securities fraud to date: the Quaestor scandal. Quaestor was a holding of several companies, including one of Hungary’s biggest investment adviser and brokerage firms, which went into bankruptcy in early 2015. Later investigations uncovered a massive fraud with an estimated loss close to €500 million to investors, mainly caused by affiliated companies overselling their bonds many times over the limit set by the securities regulator. Using theoretical approaches from comparative political economy, economic sociology and organizational theory, the article will analyse how the institutional context of economic action on the financial markets was conductive to the fraud. Two major factors in particular will be emphasized: the political economy of finance, especially the underdeveloped nature of financial markets and the lack of a retail investor class; and the relative scarcity of capital.
Can Phishing Tank Survey Response Rates? Evidence from a Natural Experiment
Authors: Brenner Philip S.
Published: September 2019

In today’s survey climate, many individuals doubt the legitimacy of survey invitations. Phishing, an Internet-based fraud that tricks users into disclosing private information, has the potential to further erode the perceived legitimacy of e-mailed survey invitations and harm cooperation. However, no study has tested the effect of phishing on response rates. This article reports on a natural experiment examining phishing’s effect on survey response. University faculty and staff received an invitation to participate in an annual web survey on satisfaction with information technology (IT) services followed by a request to participate in a second “survey” ostensibly sent by another university department. However, the second survey invitation was a simulated phishing attack sent by the IT department. Analysis of response rates and the timing of responses from each of the last five years of the legitimate survey suggests that the phishing simulation dramatically reduced response compared to predictions based on previous years.
Image segmentation by improved minimum spanning tree with fractional differential and Canny detector
Authors: Lin Jianpu , Guo Tailiang , Yan Qun F , Wang Weixing
Published: September 2019

In this study, we propose an algorithm that uses an improved Minimum Spanning Tree algorithm and a modified Canny edge detector to segment images that contain a considerable amount of noises. First, we use our modified Canny operator to pre-process an image, and record the obtained object boundary information; then, we apply the improved Minimum Spanning Tree algorithm to associate the above information with boundary points in order to separate edges into two classes in the image, namely the inner and boundary regions. In particular, Minimum Spanning Tree algorithm is improved by using Fractional differential and combining the functions of the intra-regional and inter-regional differences with a function for edge weights. Based on the experimental results, compared with the other four exiting algorithms, the new algorithm has the higher accuracy and the better effect for noised image segmentation.
Mechanism, process and the wider context of economic geography
Authors: MacLeavy Julie
Published: September 2019

This commentary responds to Henry Wai-chung Yeung’s call to develop clearer causal explanations in geography through mechanism-based thinking. His suggested use of a critical realist framework to ground geographical research on economies is, on one level, appealing and may help to counteract taken-for-granted assumptions about socio-spatial conditions and the significance of economic structures for everyday lived experiences. However, the general lack of applied critical realist research means the distinction between ‘mechanism’ and ‘process’ is often difficult to define in analyses of specific empirical events or geographical episodes. Not only is there a need for methodological development but, I suggest, also for greater recognition of critical realism as a reflective practice. We need to consider the means by which scholars distinguish between contingent and necessary relations, identify structures and counterfactuals and infer how mechanisms work out in particular places. The critical realist goal of advancing transformative change through the provision of causal explanation relies upon inferences made on the basis of researcher experience. Hence, we need to recognise that research is always a political practice and be careful not to discount knowledge borne from other analytical approaches.
Tuberculosis screening in multiple sclerosis: effect of disease-modifying therapies and lymphopenia on the prevalence of indeterminate TB screening results in the clinical setting
Authors: Baldassari Laura E , Feng Jenny , Macaron Gabrielle , Planchon Sarah M , Alshehri Ebtesam , Moss Brandon P , Ontaneda Daniel , Willis Mary A
Published: September 2019

Background

Tuberculosis screening is recommended in multiple sclerosis patients starting certain disease-modifying therapies. Disease-modifying therapies may affect interferon-gamma release assay results.

Objective

To determine the effects of multiple sclerosis disease-modifying therapies on interferon-gamma release assay results.

Methods

Indeterminate interferon-gamma release assay results among multiple sclerosis patients were compared across disease-modifying therapies by Fisher’s exact test. Logistic regression evaluated the effects of lymphopenia on interferon-gamma release assay results.

Results

A total of 1058 patients underwent interferon-gamma release assay: 2.0% (21) positive, 6.1% (65) indeterminate, with 59.4% (628) on disease-modifying therapies. Results were significantly different across disease-modifying therapies ( P = 0.002). Absolute lymphocyte count less than 0.5 k/μL had 9.39 times (95% confidence interval 5.2–17.0) increased odds of indeterminate interferon-gamma release assay results.

Conclusions

Disease-modifying therapies affecting lymphocytes had a higher risk of indeterminate interferon-gamma release assay results.
Mechanisms and Uses of Dietary Therapy as a Treatment for Epilepsy: A Review
Authors: Sadeghifar Fatemeh , Penry Vanessa Baute
Published: September 2019

One-third of patients with epilepsy do not respond to antiepileptic drugs and may seek complementary and alternative treatment modalities. Dietary therapies such as the ketogenic diet (KD), the modified Atkins, the medium-chain triglyceride, and the low glycemic index diet have been successfully implemented in some forms of epilepsy and are growing in utilization. The KD is a high-fat, low-protein, low-carbohydrate diet that has been used for various conditions for over a century. Insights into the mechanism of action of these diets may provide more targeted interventions for patients with epilepsy. Knowledge of these mechanisms is growing and includes neuroprotective effects on oxidative stress, neuroinflammation, potassium channels in the brain, and mitochondrial function.
Chronic Pain Management Among Older Adults: A Scoping Review
Authors: Nawai Ampicha
Published: September 2019

Chronic pain is a significant problem for older adults. The effect of chronic pain on older people’s quality of life needs to be described and identified. For a decade, the Roy Adaptation Model has been used extensively to explain nursing phenomena and guide nursing research in several settings with several populations. The objective of this study was to use the Roy Adaptation Model to describe chronic pain and present a systematic scoping review of the literature about the middle-range theory of chronic pain among older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses model guided a scoping review search method. A literature search was undertaken using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Ovid, and ProQuest. The search terms were “chronic pain,” “pain management,” “older adult,” “Roy Adaptation Model,” and “a scope review.” The search included articles written in English published for the period of 2004–2017. All articles were synthesized using concepts of Roy’s Adaptation Model. Twenty-two studies were considered for the present review. Twenty-one articles were reports of quantitative studies, and one was a report of a qualitative study. Two outcome measures were found in this systematic scoping review. The primary outcomes reported in all articles were the reduction of pain due to interventions and an increase in coping with chronic pain. The secondary outcome measures reported in all studies were the improvement of physical function, quality of life, sleep disturbance, spiritual well-being, and psychological health related to pain management interventions among older adults. Many interventions of all studies reported improvement in chronic pain management among older adults. However, to improve chronic pain management, nurses need to understand about nursing theories, the context which instruments work, and develop empirical instruments based on the conceptual model.
Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants
Authors: Fraser Tyler W. , Kadakia Anish R. , Doty Jesse F.
Published: September 2019

Background:

Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform.

Methods:

Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24).

Results:

All radiographic parameters were statistically significantly improved from preoperative to postoperative ( P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site.

Conclusion:

This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship.

Level of Evidence:

Level IV, case series.
Diagnosis of asthma in children: the contribution of a detailed history and test results
Authors: de Jong Carmen C.M. , Pedersen Eva S.L. , Mozun Rebeca , Goutaki Myrofora , Trachsel Daniel , Barben Juerg , Kuehni Claudia E.
Published: September 2019

Introduction

There are few data on the usefulness of different tests to diagnose asthma in children.

Aim

We assessed the contribution of a detailed history and a variety of diagnostic tests for diagnosing asthma in children.

Methods

We studied children aged 6–16 years referred consecutively for evaluation of suspected asthma to two pulmonary outpatient clinics. Symptoms were assessed by parental questionnaire. The clinical evaluation included skin-prick tests, measurement of exhaled nitric oxide fraction (FeNO), spirometry, bronchodilator reversibility and bronchial provocation tests (BPT) by exercise, methacholine and mannitol. Asthma was diagnosed by the physicians at the end of the visit. We assessed diagnostic accuracy of symptoms and tests by calculating sensitivity, specificity, positive and negative predictive values and area under the curve (AUC).

Results

Of the 111 participants, 80 (72%) were diagnosed with asthma. The combined sensitivity and specificity was highest for reported frequent wheeze (more than three attacks per year) (sensitivity 0.44, specificity 0.90), awakening due to wheeze (0.41, 0.90) and wheeze triggered by pollen (0.46, 0.83) or by pets (0.29, 0.99). Of the diagnostic tests, the AUC was highest forFeNOmeasurement (0.80) and BPT by methacholine (0.81) or exercise (0.74), and lowest for forced expiratory volume in 1 s (FEV1) (0.62) and FEV1/forced vital capacity ratio (0.66), assessed by spirometry.

Conclusion

This study suggests that specific questions about triggers and severity of wheeze, measurement ofFeNOand BPT by methacholine or exercise contribute more to the diagnosis of asthma in school-aged children than spirometry, bronchodilator reversibility and skin-prick tests.
Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study
Authors: Ardura-Garcia Cristina , Arias Erick , Hurtado Paola , Bonnett Laura J. , Sandoval Carlos , Maldonado Augusto , Workman Lisa J. , Platts-Mills Thomas A.E. , Cooper Philip J. , Blakey John D.
Published: September 2019

Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.

We followed a cohort of 5–15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months’ follow-up.

We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79–0.96 per year), previous asthma diagnosis (2.2, 1.2–3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1–1.5), food triggers (2.0, 1.1–3.6) and eczema diagnosis (4.2, 1.02–17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50–0.95). Laboratory and lung function tests did not predict recurrence.

Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.
Antimicrobial use policy change in pre-weaned dairy calves and its impact on antimicrobial resistance in commensal Escherichia coli: a cross sectional and ecological study
Authors: Afema Josephine A. , Davis Margaret A. , Sischo William M.
Published: September 2019

Background

This study is based on data collected to investigate the relation of peri-parturient events (colostrum quality, passive transfer of immunity, calving difficulty) on calf health and antimicrobial use. A component of the study was to provide feedback to farm management to identify calves at risk for disease and promote antimicrobial stewardship. At the start of the study (May 2016), a combination of enrofloxacin, penicillin, and sulfamethoxazole was the first treatment given to clinically abnormal calves. Based on feedback and interaction between study investigators, farm management and consulting veterinarians, a new policy was implemented to reduce antimicrobial use in calves. In August, the first treatment was changed to a combination of ampicillin and sulfamethoxazole. In September, the first treatment was reduced to only sulfamethoxazole. We investigated the effects of these policy changes in antimicrobial use on resistance in commensalEscherichia coli.

Results

We enrolled 4301 calves at birth and documented antimicrobial use until weaning. Most calves (99.4%) received antimicrobials and 70.4% received a total of 2–4 treatments. Antimicrobial use was more intense in younger calves (≤ 28 days) relative to older calves. We isolated 544E. colifrom fecal samples obtained from 132 calves. We determined resistance to 12 antimicrobials and 85% of the isolates were resistant to at least 3 antimicrobial classes. We performed latent class analysis to identify underlying unique classes where isolates shared resistance patterns and selected a solution with 4 classes. The least resistant class had isolates that were mainly resistant to only tetracycline and sulfisoxazole. The other 3 classes comprised isolates with resistance to ampicillin, chloramphenicol, aminoglycosides, sulfonamides, tetracycline, in addition to either ceftiofur; or nalidixic acid; or ciprofloxacin plus nalidixic acid and ceftiofur. Overall,E colifrom younger calves and calves that received multiple treatments were more likely to have extensive resistance including resistance to fluoroquinolones and ceftiofur. In general, there was a declining trend in resistance to most antimicrobials during and after policy changes were implemented, except for ampicillin, ciprofloxacin, ceftiofur and gentamicin.

Conclusions

Information feedback to farms can influence farm managers to reduce antimicrobial use and this can change endemic farm resistance patterns.
Identifying policies and strategies for general practitioner retention in direct patient care in the United Kingdom: a RAND/UCLA appropriateness method panel study
Authors: Chilvers Rupa , Richards Suzanne H. , Fletcher Emily , Aylward Alex , Dean Sarah , Salisbury Chris , Campbell John
Published: September 2019

Background

The United Kingdom (UK) is experiencing a general practitioner (GP) workforce retention crisis. Research has focused on investigating why GPs intend to quit, but less is known about the acceptability and effectiveness of policies and strategies to improve GP retention. Using evidence from research and key stakeholder organisations, we generated a set of potential policies and strategies aimed at maximising GP retention and tested their appropriateness for implementation by systematically consulting with GPs.

Methods

28 GP Partners and GPs working in national stakeholder organisations from South West England and London were purposively sampled, and asked to take part in a RAND/UCLA Appropriateness Method panel. Panellists were asked to read an evidence briefing summary, and then complete an online survey on two occasions. During each round, participants rated the appropriateness of policies and strategies aimed at improving GP retention using a nine point scale (1 ‘extremely inappropriate’ to 9 ‘extremely appropriate’). Fifty-four potential policies and strategies (equating to 100 statements) were tested, focusing on factors influencing job satisfaction (e.g. well-being, workload, incentives and remuneration, flexible working, human resources systems). Ratings were analysed for panel consensus and categorised based on appropriateness (‘appropriate’, ‘uncertain’, ‘inappropriate’).

Results

12/28 GPs approached agreed to take part, 9/28 completed two rounds of the online survey between February and June 2018. Panellists identified 24/54 policy and strategy areas (41/100 statements) as ‘appropriate’. Examples included providing GP practices ‘at risk’ of experiencing GP shortages with a toolkit for managing recruitment and retention, and interventions to facilitate peer support to enhance health and wellbeing, or support portfolio careers. Strategies to limit GP workload, and manage patient demand were also endorsed.

Conclusions

The panel of experienced GPs identified a number of practical ways to improve GP retention through interventions that might enhance job satisfaction and work-life balance. Future research should evaluate the impact of implementing these recommendations.
Repeated high blood pressure at 6 and 11 years at the Pelotas 2004 birth cohort study
Authors: Guttier Marília Cruz , Barcelos Raquel Siqueira , Ferreira Rodrigo Wiltgen , Bortolotto Caroline Cardozo , Dartora William Jones , Schmidt Maria Inês , Matijasevich Alicia , Tovo-Rodrigues Luciana , Santos Iná S.
Published: September 2019

Background

We evaluated the prevalence and the factors associated with repeated high systolic (SBP) and diastolic blood pressure (DBP) at 6- and 11-year follow-ups of children from the Pelotas (Brazil) 2004 Birth Cohort.

Methods

All live births to mothers living in the urban area of Pelotas were enrolled in the cohort. Blood pressure (BP) values were transformed into Z-scores by sex, age, and height. High SBP and DBP were defined as repeated systolic and diastolic BP Z-scores on the ≥95th percentile at the two follow-ups. Prevalence (95% confidence interval) of repeated high SBP, DBP, and both (SDBP) were calculated. Associations with maternal and child characteristics were explored in crude and adjusted logistic regression analyses.

Results

A total of 3182 cohort participants were analyzed. Prevalence of repeated high SBP, DBP and SDBP was 1.7% (1.2–2.1%), 2.3% (1.8–2.9%) and 1.2% (0.9–1.6%), respectively. Repeated high SBP was associated with males, gestational diabetes mellitus (2.92; 1.13–7.58) and obesity at 11 years (2.44; 1.29–4.59); while repeated high DBP was associated with females, family history of hypertension from both sides (3.95; 1.59–9.85) and gestational age < 34 weeks (4.08; 1.52–10.96). Repeated high SDBP was not associated with any of the characteristics investigated.

Conclusion

Prevalence of repeated high SBP, DBP, and SDBP were within the expected distribution at the population level. Nonetheless, gestational diabetes mellitus, obesity, family history of hypertension, and prematurity increased the risk of repeated high blood pressure measured at two occasions 5 years apart.
Scaling up eConsult for access to specialists in primary healthcare across four Canadian provinces: study protocol of a multiple case study
Authors: Breton Mylaine , Smithman Mélanie Ann , Liddy Clare , Keely Erin , Farrell Gerard , Singer Alexander , Lamoureux-Lamarche Catherine , Dumas Pilon Maxine , Nabelsi Véronique , Gaboury Isabelle , Gagnon Marie-Pierre , Steele Gray Carolyn , Shaw Jay , Hudon Catherine , Aubrey-Bassler Kris , Gagnon Justin , Côté-Boileau Élizabeth , Bush Paula Louise
Published: September 2019

Background

Canada has been referred to as the land of ‘perpetual pilot projects’. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times – one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communication that allows primary care providers to electronically consult with specialists regarding their patients’ medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador.

Our aim is to understand and support the scale-up process of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-up process in each province; (2) understand the eConsult scale-up process in each province and compare across provinces; (3) identify policy issues and strategies to scaling up eConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling up eConsult.

Methods

We will conduct a qualitative multiple case study to investigate the scaling up of eConsult in four Canadian provinces using a grey literature review, key stakeholder interviews (10 interviews/province), non-participant observations, focus groups and deliberative dialogues. We will identify the main components of eConsult to be scaled up using logic models (obj. 1). Scaling up processes will be analysed using strategies adapted from process research (obj. 2). Policy issues and strategies to scale-up eConsult will be analysed thematically (obj. 3). Finally, a symposium will foster pan-Canadian learning on the process of scaling up eConsult (obj. 4).

Discussion

This study will likely increase learning and support evidence-based policy-making across participating provinces and may improve the capacity for a pan-Canadian scale-up of eConsult, including in provinces where eConsult has not yet been implemented. This work is essential to inform how similar innovations can reshape our health systems in the evolving information age.
Socio-cultural contextual factors that contribute to the uptake of a mobile health intervention to enhance maternal health care in rural Senegal
Authors: MacDonald Margaret E. , Diallo Gorgui Sene
Published: September 2019

Background

Although considerable progress has been made in reducing maternal mortality over the past 25 years in Senegal, the national maternal mortality ratio (MMR), at 315 deaths per 100,000 live births, is still unacceptably high. In recent years a mobile health (mHealth) intervention to enhance maternal health care has been introduced in rural and remote areas of the country. CommCare is an application that runs on cell phones distributed to community health workers known asmatroneswho enroll and track women throughout pregnancy, birth and the post-partum, offering health information, moral support, appointment reminders, and referrals to formal health care providers.

Methods

An ethnographic study of the CommCare intervention and the larger maternal health program into which it fits was conducted in order to identify key social and cultural contextual factors that contribute to the uptake and functioning of this mHealth intervention in Senegal. Ethnographic methods and semi-structured interviews were used with participants drawn from four categories: NGO field staff (n = 16), trained health care providers (including physicians, nurses, and midwives) (n = 19), community level health care providers (n = 13); and women belonging to a community intervention known as the Care Group (n = 14). Data were analyzed using interpretive analysis informed by critical medical anthropology theory.

Results

The study identified five socio-cultural factors that work in concert to encourage the uptake and use of CommCare: convening women in the community Care Group; a cultural mechanism for enabling pregnancy disclosure; constituting authoritative knowledge amongst women; harnessing the roles of older women; and adding value to community health worker roles. We argue that, while CommCare is a powerful tool of information, clinical support, surveillance, and data collection, it is also a social technology that connects and motivates people, transforming relationships in ways that can optimize its potential to improve maternal health care.

Conclusions

In Senegal, mHealth has the potential not only to bridge the gaps of distance and expertise, but to engage local people productively in the goal of enhancing maternal health care. Successful mHealth interventions do not work as ‘magic bullets’ but are part of ‘assemblages’ – people and things that are brought together to accomplish particular goals. Attention to the social and cultural elements of the global health assemblage within which CommCare functions is critically important to understand and develop this mHealth technology to its full potential.
Repeat HIV testing of individuals with discrepant HIV self-test results in Central Uganda
Authors: Kisa Rose , Matovu Joseph K. B. , Buregyeya Esther , Musoke William , Vrana-Diaz Caroline J. , Korte Jeffrey E. , Wanyenze Rhoda K.
Published: September 2019

Background

According to the user instructions from the manufacturer of OraQuick HIV self-test (HIVST) kits, individuals whose kits show one red band should be considered to be HIV-negative, no matter how weak the band is. However, recent reports show potential for a second false weak band after storage, thereby creating confusion in the interpretation of results. In this study, we re-tested individuals whose results were initially non-reactive but changed to weak reactive results to determine their true HIV status.

Methods

This study was nested within a large, cluster-randomized HIVST trial implemented among pregnant women attending antenatal care and their male partners in central Uganda between July 2016 and February 2017. Ninety-five initially HIV-negative respondents were enrolled into this study, including 52 whose kits developed a second weak band while in storage and 43 whose kits were interpreted as HIV-positive by interviewers at the next follow-up interview. Respondents were invited to return for repeat HIVST which was performed under the observation of a trained nurse counsellor. After HIVST, respondents underwent blood-based rapid HIV testing as per the national HIV testing algorithm (Determine (Abbot Laboratories), STAT-PAK (Chembio Diagnostic Systems Inc.) and Unigold (Trinity Biotech plc.) and dry blood spots were obtained for DNA/PCR testing. DNA/PCR was considered as the gold-standard HIV testing method.

Results

After repeat HIVST, 90 (94.7%) tested HIV-negative; 2 (2.1%) tested HIV-positive; and 3 (3.2%) had missing HIV test results. When respondents were subjected to blood-based rapid HIV testing, 97.9% (93/95) tested HIV-negative while 2.1% (2/95) tested HIV-positive. Finally, when the respondents were subjected to DNA/PCR, 99% (94/95) tested HIV-negative while 1.1% (1/95) tested HIV-positive.

Conclusions

Nearly all initially HIV-negative individuals whose HIVST kits developed a second weak band while in storage or were interpreted as HIV-positive by interviewers were found to be HIV-negative after confirmatory DNA/PCR HIV testing. These findings suggest a need for HIV-negative individuals whose HIVST results change to false positive while under storage or under other sub-optimal conditions to be provided with an option for repeat testing to determine their true HIV status.
ACLY facilitates colon cancer cell metastasis by CTNNB1
Authors: Wen Jun , Min Xuejie , Shen Mengqin , Hua Qian , Han Yuan , Zhao Li , Liu Liu , Huang Gang , Liu Jianjun , Zhao Xiaoping
Published: September 2019

Background

Colon cancer is the second leading cancer worldwide. Recurrent disease and chemotherapeutic drug resistance are very common in the advanced stage of colon cancer. ATP-citrate lyase (ACLY), the first-step rate-controlling enzyme in lipid synthesis, is elevated in colon cancer. However, it remains unclear about the exact role of ACLY in the development of colon cancer metastasis.

Methods

To evaluate the role of ACLY in colon cancer metastasis, we performed cell migration and invasion assays in two ACLY-deficient colon cancer cell lines. Colon cancer mouse model is used to examine ACLY’s effects on colon metastasis potentials in vivo. We analyzed the correlation between ACLY and CTNNB1 protein in 78 colon cancer patients by Pearson correlation. To finally explore the relationship of ACLY and CTNNB1, we used western blots, migration and invasion assays to confirm that ACLY may regulate metastasis by CTNNB1.

Results

Our data showed that the abilities of cell migration and invasion were attenuated in ACLY-deficient HCT116 and RKO cell lines. Furthermore, we describe the mechanism of ACLY in promoting colon cancer metastasis in vitro and in vivo. ACLY could stabilize CTNNB1 (beta-catenin 1) protein by interacting, and the complex might promote CTNNB1 translocation through cytoplasm to nucleus, subsequently promote the CTNNB1 transcriptional activity and migration and invasion abilities of colon cancer cells. Immunohistochemical analysis of 78 colon cancer patients showed that the high expression levels of ACLY and CTNNB1 protein was positively correlated with metastasis of colon cancer.

Conclusions

These results shed new light on the molecular mechanism underlying colon cancer metastasis, which might help in improving therapeutic efficacy.
Prevalence of the emerging novel Alongshan virus infection in sheep and cattle in Inner Mongolia, northeastern China
Authors: Wang Ze-Dong , Wang Wei , Wang Ni-Na , Qiu Kai , Zhang Xu , Tana Gegen , Liu Quan , Zhu Xing-Quan
Published: September 2019

Background

Alongshan virus (ALSV) is a novel discovered segmented flavivirus associated with human febrile illness in northeastern China. Ixodes persulcatus is considered as a candidate vector of ALSV in the endemic regions. However, the role of domesticated animals in the circulation and transmission of ALSV have not been investigated. To evaluate the prevalence of ALSV infections in domesticated animals, viral RNA and viral specific antibodies were detected in sheep and cattle in Hulunbuir of northeastern Inner Mongolia. The findings contribute to the understanding of the ecology and transmission of ALSV among different natural hosts.

Methods

A total of 480 animal serum samples were collected in Hulunbuir of northeastern China in May, 2017. Viral specific antibodies were tested by indirect enzyme-linked immunosorbent assay (ELISA) with a purified E. coli recombinant capsid protein (VP2) of ALSV (strain H3) and further detected by viral neutralization test (VNT). RNA in serum samples were extracted and detected for ALSV sequence by quantitative real-time RT-PCR. ALSV RNA positive samples were used for virus isolation.

Results

ALSV-specific antibodies were detected in 9.2% (22/240) of examined sheep and 4.6% (11/240) of examined cattle by ELISA, while lower serological positivity with 4.2% (10/240) for sheep and 1.7% (4/240) for cattle was confirmed by VNT. In contrast, the prevalence of ALSV RNA was much higher, ranging from 26.3% (63/240) in sheep to 27.5% (66/240) in cattle. The partial S1 (NS5-like) and S3 (NS3-like) segments of ALSVs in sheep and cattle shared high identities of more than 98% to the human and tick isolates in the studied regions.

Conclusions

These results suggest that the natural infection of ALSV can be found in sheep and cattle in the endemic regions.
Growth improvement of Lolium multiflorum Lam. induced by seed inoculation with fungus suspension of Xerocomus badius and Serendipita indica
Authors: Liu Binghua , Liu Xinghong , Liu Fangchun , Ma Hailin , Ma Bingyao , Zhang Wenxin , Peng Lin
Published: September 2019

In this study, a pot experiment was carried out in greenhouse to investigate the potentials of Xerocomus badius and Serendipita indica to penetrate and colonize roots of ryegrass (Lolium multiflorum Lam.) and to induce beneficial effects on seed germination and seedling growth. The results showed that X. badius and S. indica successfully colonized in the root system of L. multiflorum seedlings and the root colonization rate was 72.65% and 88.42%, respectively. By microscopy, the hyphae, chlamydospores and spores produced by S. indica were observed in roots cortex of L. multiflorum seedlings. In comparison with the non-inoculated seedlings, seedlings inoculated with X. badius and S. indica showed significant increase in growth parameters with plant height, basal diameter, biomass accumulation, relative growth rate, leaf relative water content and chlorophyll content. Also, we found that seedlings inoculated with S. indica exhibited a greater growth-promotion as compared with X. badius-inoculated seedlings. No significant influence of the two fungus application has been observed with respect to seed germination. It suggested that well establishments of mutualistic symbiosis between L. multiflorum and X. badius or S. indica were not so essential to seed germination but contributed highly to the survival and growth of the seedlings.
Relations of a planar domains bounded by hyperbolas with families of holomorphic functions
Authors: Kanas S. , Masih V. S. , Ebadian A.
Published: September 2019

We consider a family of analytic and normalized functions with the property that $zf'(z)/f(z)$
z

f
′

(
z
)
/
f
(
z
)
(or $1+zf''(z)/f'(z)$
1
+
z

f
″

(
z
)
/

f
′

(
z
)
) lies in a domain bounded by a right branch of a hyperbola $\rho =\rho (s)= ( 2 \cos \frac{\varphi }{s} )^{-s}$
ρ
=
ρ
(
s
)
=

(
2
cos

φ
s

)

−
s

, where $0< s\le 1$
0
<
s
≤
1
and $|\varphi |<(\pi s)/2$
|
φ
|
<
(
π
s
)
/
2
. A comprehensive characteristic of that families and relations with the well known families of univalent functions are presented. Some relevant examples are indicated.
Infrared chemical mapping of degradation products in cross-sections from paintings and painted objects
Authors: Henderson Eric J. , Helwig Kate , Read Stuart , Rosendahl Scott M.
Published: September 2019

Paintings and painted objects are quite susceptible to degradation, as paint layers are usually composed of complex mixtures of materials that can participate in chemical degradation processes. The identification of the constituent materials in paint (including binders, pigments, and fillers) and the degradation products within paint layers is of particular importance to ensuring the conservation of paintings, by providing important information both about their material history as well as their state of conservation. Metal fatty acid salts (metal soaps) are degradation products that can form in situ from interactions between inorganic pigments and free fatty acids in oil-based binding media, and can cause significant condition issues in paintings. Fourier transform infrared (FTIR) spectroscopy is one of the leading analytical techniques for the study of metal soaps. In this article, the materials analysis of several cross-sections from paintings and painted objects from works in Canadian collections is presented. Recent results on the use of external reflection FTIR (R-FTIR) spectroscopy to identify and map the distribution of paint components and metal soap degradation products is presented. In particular, zinc, lead, calcium, and copper fatty acid salts were all readily identified in paint cross-sections by R-FTIR spectroscopy, along with several pigments and the oil binding medium. The results shown here are among the first detailed examinations of these metal soaps in paint cross-sections using R-FTIR spectroscopy. The use of highly polished samples in which specular reflection is dominant allowed for spectral transformations to be applied to generate transmission/absorption-like spectra which facilitated identification of these species. The distribution of these species across the cross-sections was mapped by integrating characteristic absorption features in the R-FTIR spectra. Attenuated total internal reflection (ATR) FTIR spectroscopy was also performed on several samples, which provided additional compositional details at the interface of paint layers and degradation products.
The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review
Authors: Albergoni Andrea , Hettinga Florentina J. , La Torre Antonio , Bonato Matteo , Sartor Francesco
Published: September 2019

Background

The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue.

Methods

This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: “Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?”.

Results

The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1–12) and three low levels (56% week-12, 41% year-2, 14 year-3).

Conclusion

The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
Vemurafenib for Refractory Multisystem Langerhans Cell Histiocytosis in Children: An International Observational Study
Authors: Donadieu Jean , Larabi Islam Amine , Tardieu Mathilde , Visser Johannes , Hutter Caroline , Sieni Elena , Kabbara Nabil , Barkaoui Mohamed , Miron Jean , Chalard François , Milne Paul , Haroche Julien , Cohen Fleur , Hélias-Rodzewicz Zofia , Simon Nicolas , Jehanne Mathilde , Kolenova Alexandra , Pagnier Anne , Aladjidi Nathalie , Schneider Pascale , Plat Geneviève , Lutun Anne , Sonntagbauer Anne , Lehrnbecher Thomas , Ferster Alina , Efremova Viktoria , Ahlmann Martina , Blanc Laurence , Nicholson James , Lambilliote Anne , Boudiaf Houda , Lissat Andrej , Svojgr Karel , Bernard Fanette , Elitzur Sarah , Golan Michal , Evseev Dmitriy , Maschan Michael , Idbaih Ahmed , Slater Olga , Minkov Milen , Taly Valerie , Collin Matthew , Alvarez Jean-Claude , Emile Jean-François , Héritier Sébastien
Published: September 2019

PURPOSE

Off-label use of vemurafenib (VMF) to treat BRAFV600E mutation–positive, refractory, childhood Langerhans cell histiocytosis (LCH) was evaluated.

PATIENTS AND METHODS

Fifty-four patients from 12 countries took VMF 20 mg/kg/d. They were classified according to risk organ involvement: liver, spleen, and/or blood cytopenia. The main evaluation criteria were adverse events (Common Terminology Criteria for Adverse Events [version 4.3]) and therapeutic responses according to Disease Activity Score.

RESULTS

LCH extent was distributed as follows: 44 with positive and 10 with negative risk organ involvement. Median age at diagnosis was 0.9 years (range, 0.1 to 6.5 years). Median age at VMF initiation was 1.8 years (range, 0.18 to 14 years), with a median follow-up of 22 months (range, 4.3 to 57 months), whereas median treatment duration was 13.9 months (for 855 patient-months). At 8 weeks, 38 complete responses and 16 partial responses had been achieved, with the median Disease Activity Score decreasing from 7 at diagnosis to 0 ( P < .001). Skin rash, the most frequent adverse event, affected 74% of patients. No secondary skin cancer was observed. Therapeutic plasma VMF concentrations (range, 10 to 20 mg/L) seemed to be safe and effective. VMF discontinuation for 30 patients led to 24 LCH reactivations. The blood BRAFV600E allele load, assessed as circulating cell-free DNA, decreased after starting VMF but remained positive (median, 3.6% at diagnosis, and 1.6% during VMF treatment; P < .001) and was associated with a higher risk of reactivation at VMF discontinuation. None of the various empirical therapies (hematopoietic stem-cell transplantation, cladribine and cytarabine, anti-MEK agent, vinblastine, etc) used for maintenance could eradicate the BRAFV600E clone.

CONCLUSION

VMF seemed safe and effective in children with refractory BRAFV600E-positive LCH. Additional studies are needed to find effective maintenance therapy approaches.