bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic yield, safety and impact of transbronchial lung biopsy in mechanically ventilated, critically ill patients: a retrospective study
Authors: Ghiani Alessandro , Neurohr Claus
Published: October 2020

Background: Pulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative. Methods: Retrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients` medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on change in therapy. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method. Results: Forty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of the TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) being the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in only 40.5%, and there was no evidence of a survival benefit in those patients. Conclusions: Transbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histological result regarding treatment decisions in such patients.
Predicting Functional Performance via Classification of Lower Extremity Strength in Older Adults with Exergame-Collected Data
Authors: Becker Hagen , Garcia-Agundez Augusto , Müller Philipp Niklas , Tregel Thomas , Miede André , Göbel Stefan
Published: October 2020

Objective: The goal of this article is to present and to evaluate a sensor-based functional performance monitoring system. The system consists of an array of Wii Balance Boards (WBB) and an exergame that estimates whether the player can maintain physical independence, comparing the results with the 30 Second Chair-Stand Test (30CST). Methods: Sixteen participants recruited at a nursing home performed the 30CST and then played the exergame described here as often as desired during a period of two weeks. For each session, features related to walking and standing on the WBBs while playing the exergame were collected. Different classifier algorithms were used to predict the result of the 30CST on a binary basis as able or unable to maintain physical independence. Results: By using a Logistic Model Tree, we achieved a maximum accuracy of 91% when estimating whether player’s 30CST scores were over or under a threshold of 12 points, Our findings suggest that predicting age- and sex-adjusted cutoff scores is feasible. Conclusion: An array of WBBs seems to be a viable solution to estimate lower extremity strength and thereby functional performance in a non-invasive and continuous manner. This study provides proof of concept supporting the use of exergames to identify and monitor elderly subjects at risk of losing physical independence.
Modified Kocher-Langenbeck approach for the treatment of posterior wall or column acetabular fractures: The one-incision two-window method
Authors: Yang Tien-Yu , Huang Kuo-Chin
Published: October 2020

Abstract
The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach.
Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach.
Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients.
Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.
A patient satisfaction survey investigating pre- and post-operative information provision in lower limb surgery
Authors: Renna Maxwell Stanley , Metcalfe Andrew , Ellard David , Davies David
Published: October 2020

Background Planned lower limb surgery is common, with over 90,000 hip replacements, 95,000 knee replacements and 15,000 anterior cruciate ligament reconstructions performed in the UK each year. These procedures are primarily indicated to treat osteoarthritis, sporting injuries and trauma. Patient satisfaction is an important element of healthcare provision, which is usually measured by functional outcomes but influenced by other factors. Few studies have assessed patients’ views on the information given to them pertaining surgery and patients are infrequently consulted when designing leaflets and information packs, which can lead to confusion during the recovery period and poor long-term outcomes. Furthermore, previous studies have not directly asked patients what resources they would prefer, or which format would suit them best. This project aimed to assess if patients were satisfied with the information they received around their operations and to identify potential improvements.Methods Set in a National Health Service (NHS) run major trauma centre in the West Midlands, a multiple choice and free-text answer survey was administered to patients who used the orthopaedic service over the course of one month. Surveys were designed in Qualtrics and administered face-to-face on paper. Thematic content analysis was performed on the results. Results Eighty patients completed the survey, of which 88.8% of patients were satisfied with the information they received. Discussions with surgeons were the most useful resource and 53% of patients requested more internet resources. Post-operative patients were statistically more likely to be dissatisfied with information provision than pre-operative patients. Over 20% of study population requested more information on post-operative pain and recovery timelines. Conclusions Although patients were satisfied in general, areas for change were identified. Suggested resources take the form of webpages and mobile platforms. These resources could contain educational videos, patient experience blogs or interactive recovery timelines, to be of benefit to patients. These suggestions may enable NHS Trusts to “get into the digital age”, however, more research on patient satisfaction around information provision and the impact it has on recovery and decision making is needed.
The identification and determination of toxin genes of Vibrio strains causing hemorrhagic disease on red drum (Sciaenops ocellatus) using PCR method
Authors: Linh Nguyen Quang , Pham Yen Thi Hai , Nguyen Tram Duy Quynh
Published: October 2020

Data were collected from 30 strains of Vibrio and sampled on different organs (brain, hemorrhagic site and digestive tract) of Sciaenops ocellatus infection. The results showed that the nucleotide sequences 16S rRNA region are highly similar to those of V. alginolyticus, V. azureus, V. fluvialis, V. natriengens and V. orientalis, which were published on Genbank and other, ranging from 98.05 to 100 %. The digestive tract has the most common Vibrio strains (V. alginolyticus [16] V. azureus [7] and V. fluvialis). Thereout, 25 of 30 strains of Vibrio contained from 1 to 3 toxin genes, except for V. parahaemolyticus. Six parameters were used to measure the DNA polymorphism of 33 homologous DNA sequences in this Vibrio bacteria population. The results indicated that the number of separate polymorphic sites (S), the total number of mutant sites (Eta), the number of haplotype (h), the haplotype diversity (Hd), the average number of nucleotide differences (k), the nucleotide diversity (Pi) were 98 (S), 103 (Eta), 9 (h), 0.887 ± 0.032 (Hd), 25.789 (k) and 17.980x10-3 ± 0.003 (Pi), respectively (P < 0,05). The G+C contentover 1434 sites positions of nucleotide sequences accounted for 0.542. The phylogenetic tree showed that these strains are divided into six groups. As observed, the appearance of isolated Vibrio on 3 organs of fish (S. ocellatus) which are hemorrhagic include V. azureus (27,67 %), V. alginolyticus (50 %), V. orientalis (6,67 %) and V. fluvialis (16,67 %). Through this result, it is found that the diversity of Vibrio species that appeared on the red drum was used in the 16S rRNA region and the presence of toxin genes in these Vibrio species.
Morphology, genetic characterization and molecular phylogeny of pinworm Skrjabinema longicaudatum sp. n. (Oxyurida: Oxyuridae) from the endangered Tibetan antelope Pantholops hodgsonii (Abel) (Artiodactyla: Bovidae)
Authors: Cao Yi-Fan , Chen Hui-Xia , Li Yang , Zhou Dang-Wei , Chen Shi-Long , Li Liang
Published: October 2020

Background: The Tibetan antelope Pantholops hodgsonii (Abel) (Artiodactyla: Bovidae) is an endangered species of mammal endemic to the Qinghai-Tibetan Plateau. Parasites and parasitic diseases are considered to be important threats in the conservation of the Tibetan antelope. However, our present knowledge of the composition of the parasites of the Tibetan antelope remains limited. Methods: Large numbers of nematode parasites were collected from a dead Tibetan antelope. The morphology of these nematode specimens was observed using light and scanning electron microscopy. The nuclear and mitochondrial DNA sequences, i.e. small subunit ribosomal DNA (18S), large subunit ribosomal DNA (28S), internal transcribed spacer (ITS) and cytochrome c oxidase subunit 1 (cox1), were amplified and sequenced for molecular identification. Moreover, phylogenetic analyses were performed using maximum likelihood (ML) inference based on 28S and 18S + 28S + cox1 sequence data, respectively, in order to clarify the systematic status of these nematodes.Results: Integrated morphological and genetic evidence reveals these nematode specimens to be a new species of pinworm Skrjabinema longicaudatum (Oxyurida: Oxyuridae). There was no intraspecific nucleotide variation between different individuals of S. longicaudatum n. sp. in the partial 18S, 28S, ITS and cox1 sequences. However, a high level of nucleotide divergence was revealed between the new species and its congeners in 28S (8.36%) and ITS (20.3–23.7%) regions, respectively. Molecular phylogenetic results suggest that the genus Skrjabinema should belong to the subfamily Oxyurinae (Oxyuroidea: Oxyuridae), instead of the subfamily Syphaciidae or Skrjabinemiinae in the traditional classification, as it formed a sister relationship to the genus Oxyuris. Conclusions: A new species of pinworm Skrjabinema longicaudatum n. sp. (Oxyurida: Oxyuridae) is described. Skrjabinema longicaudatum n. sp. represents the first species of Oxyurida (pinworm) and the fourth nematode species reported from the Tibetan antelope. Our results contribute to the knowledge of the species diversity of parasites from the Tibetan antelope, and clarify the systematic position of the genus Skrjabinema.
Hemopneumothorax Detection Through the Process of Artificial Evolution - A Feasibility Study
Authors: Sommer Adir , Mark Noy , Gerasi Rafi , Avraham Linn Wagnert , Fan-Marko Ruth , Eisenkraft Arik , Nachman Dean
Published: October 2020

Background: Tension pneumothorax is one of the leading causes of preventable death on the battlefield. Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination. These techniques are not fully applicable in field conditions and on the battlefield, where situational and environmental factors may impair clinical capabilities. We aimed to assemble a device able to sample, analyze, and classify the unique acoustic signatures of pneumothorax and hemothorax. Methods: Tested on an ex-vivo porcine model, we have assembled a device consisting of two sensitive digital stethoscopes and sampled 12 seconds of mechanical ventilation breathing sounds over the animals’ thorax. The thoracic cavity was injected with increasing volumes of 200, 400, 600, 800, and 1000 ml of air and saline to simulate pneumothorax and hemothorax, respectively. The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution, a cutting-edge approach in the artificial intelligence discipline. Results: The algorithm was able to classify the signals according to their distinctive characteristics and to accurately predict, in up to 80% of cases, the presence of pneumothorax and hemothorax, starting from 400 ml, and regardless of background noise.Conclusions: We present a potential objective and rapid diagnosis modality that can overcome independent and subjective factors that may delay diagnosis and treatment of potentially lethal thoracic injuries, with emphasis on field conditions. A future diagnostic device could be embedded with the algorithm and provide real-time detection and monitoring of pneumothorax and hemothorax.
Low neoantigen expression and poor T cell priming underlie early immune escape in cancer
Authors: Westcott Peter , Sacks Nathan , Schenkel Jason , Smith Olivia , Zhang Daniel , Hauck Haley , Backlund Coralie , Beytagh Mary , Patten JJ , Eng George , Irvine Darrell , Yilmaz Ömer , Jacks Tyler
Published: October 2020

Immune evasion is a hallmark of cancer, and therapies that restore immune surveillance have proven highly effective in cancers with high tumor mutation burden (TMB) (e.g. microsatellite instable (MSI) colorectal cancer (CRC)). Whether low TMB cancers, which are largely refractory to immunotherapy, harbor T cell neoantigens capable of engaging adaptive immunity remains unclear. Here, we show that the majority of microsatellite stable (MSS) CRC harbors predicted high-affinity neoantigens despite low TMB. Unexpectedly, these neoantigens are broadly expressed at lower levels relative to those in MSI CRC, suggesting a potential role of antigen expression in tumor immune surveillance. To test this, we developed a versatile platform for functional interrogation of neoantigens with variable expression and applied it to novel preclinical colonoscopy-guided mouse models of CRC. While high expression of multiple high-affinity MHC-I-restricted neoantigens universally resulted in tumor rejection, low expression resulted in poor T cell priming and tumor progression. Strikingly, experimental or therapeutic rescue of priming rendered T cells fully capable of controlling tumors with low neoantigen expression. These findings underscore a critical role of neoantigen expression levels in immune evasion and suggest that poor expression or presentation may be a general feature of neoantigens acquired early in tumorigenesis. Finally, poorly expressed neoantigens, commonly excluded in tumor vaccine pipelines, may hold untapped therapeutic potential.
Assessment of the effectiveness of pain management among trauma patients in the emergency department
Authors: Wazzan Ahmad , Albeladi Yazeed Khalid , Altaifi Rozan Ibrahim , Alqahtani Mohammed Saeed , Bakheet Rayan Mahmoud
Published: October 2020

Background:In the emergency department (ED), pain is the most common complaint, especially among trauma patients. However, two-thirds of trauma patients are discharged from EDs with moderate to severe pain. Therefore, pain management is an important part of care in ED's trauma patients.Aim:To assess the effectiveness of pain management among trauma patients in the ED.Method:A retrospective cohort study that was conducted on adult trauma patients who attended the ED at King Abdulaziz medical city (KAMC) in Jeddah from the period (June 2016 to July 2018). The pain was measured twice, one before the intervention and one after intervention using a numeric pain scale. Data were collected from health information system (Best care®) and analyzed using SPSS version 24.Results:The Mean difference between pain scores before and after pain management was one on a numeric pain scale with a P-Value 0.001. Initial pain assessment occurred only in 69% of our population, while assessment after intervention happened in 71% of patients. Patients who received appropriate medication were 36.7%. 35% of patients received opioids as an initial drug of pain management; only 8.8% of patients had pain scores more than 7 initially. The median between the time of arrival and the time of Initial Assessment is 19 mins.Conclusion:Pain management in ED needs improvement. Timeliness of pain management should be addressed. Evaluation and re-evaluation of pain before and after the intervention is insufficient. Trauma Patients don't receive effective pain management in the ED.
MICRA-Net: MICRoscopy Analysis Neural Network to solve detection, classification, and segmentation from a single simple auxiliary task
Authors: Lavoie-Cardinal Flavie , Bilodeau Anthony , Delmas Constantin , Parent Martin , Koninck Paul De , Durand Audrey
Published: October 2020

High throughput quantitative analysis of microscopy images presents a challenge due to the complexity of the image content and the difficulty to retrieve precisely annotated datasets. In this paper we introduce a weakly-supervised MICRoscopy Analysis neural network (MICRA-Net) that can be trained on a simple main classification task using image-level annotations to solve multiple more complex auxiliary tasks, such as segmentation, detection, and enumeration. MICRA-Net relies on the latent information embedded within a trained model to achieve performances similar to state-of-the-art fully-supervised learning. This learnt information is extracted from the network using gradient class activation maps, which are combined to generate precise feature maps of the biological structures of interest. We demonstrate how MICRA-Net significantly alleviates the expert annotation process on various microscopy datasets and can be used for high-throughput quantitative analysis of microscopy images.
Mechanical Removal of Surface Residues on Graphene for TEM Characterizations
Authors: KIM Dong-Gyu , Lee Sol , Kim Kwanpyo
Published: October 2020

Contamination on two-dimensional (2D) crystal surfaces poses serious limitations on fundamental studies and applications of 2D crystals. Surface residues induce uncontrolled doping and charge carrier scattering in 2D crystals, and trapped residues in mechanically assembled 2D vertical heterostructures often hinder coupling between stacked layers. Developing a process that can reduce the surface residues on 2D crystals is important. In this study, we explored the use of atomic force microscopy (AFM) to remove surface residues from 2D crystals. Using various transmission electron microscopy (TEM) investigations, we confirmed that surface residues on graphene samples can be effectively removed via contact-mode AFM scanning. The mechanical cleaning process dramatically increases the residue-free areas, where high-resolution imaging of graphene layers can be obtained. We believe that our mechanical cleaning process can be utilized to prepare high-quality 2D crystal samples with minimum surface residues.
Interferon Gamma Release Assay After BCG Vaccination Among Newborns and Family Members Living in an Overcrowded Area in Jakarta, Indonesia
Authors: Tanoerahar Francisca Srioetami , Rooslamiati Indri , Kipuw Natalie , Hadiyanto  , Ali Soegianto , Sahiratmadja Edhyana
Published: October 2020

IntroductionActive tuberculosis (TB) patient is a potential source of Mycobacterium tuberculosis transmission in an overcrowded and poor area. Family members living in the same house may have been infected or latent tuberculosis infection (LTBI) may develop. The aim of the study was to explore LTBI among newborns and their family members living in an overcrowded area in Jakarta, Indonesia. MethodsA prospective analytical study was conducted among newborns from October 2016 to March 2017. Interferon gamma release assay (IGRA) was examined before BCG vaccination and after 12 weeks. In parallel, TB active case finding was performed among family members of the newborns.ResultsOf 135 newborns, only 117 (86.7%) came for BCG vaccination. Of 346 family members screened, 8 (2.3%) were detected as untreated active pulmonary TB, confirmed by positive sputum and/or MTB culture. Family members living in the same house with active TB individuals (p=0.011, OR 2.69) as well as being males (p = 0.025; OR 1.68) had a significant higher risk of having a positive IGRA. ConclusionsUntreated pulmonary TB infection in overcrowded areas infects the surrounding neighbors, resulting in latent TB infection. An active program for detecting pulmonary TB cases and preventive measures need to be taken seriously to contain the potential spreading of the infection.
A New Successive Forming Process for Large Modulus Gears
Authors: Lin Yao , Wu Tao , Wang Guangchun
Published: October 2020

A successive tooth forming process for producing large modulus spur gears (m＞2.5 mm) was firstly proposed in this paper to break the restrictions of large forming load and large equipment structure of traditional plastic forming. It contains the preforming stage and finishing stage. In the first stage, the die with a single-tooth preformed gear teeth one by one through several passes. In the second stage, the other die with multi-teeth refined the preformed teeth into required shape. The influence of total pressing depth and feed distribution in preforming stage on final forming quality was analyzed by numerical simulation and the reasonable process parameters had been presented. Gears without fold defects were well formed both in simulations and experiments, proving the feasibility of this method. The new process has advantages of smaller forming load and simpler tooling set, which shows a good potential for manufacturing large modulus spur gears.
“I Want to Get Better, But…”: Identifying the Perceptions and Experiences of People Who Inject Drugs With Respect to Evolving Hepatitis C Virus Treatments
Authors: Goodyear Trevor , Brown Helen , Browne Annette J. , Hoong Peter , Ti Lianping , Knight Rod
Published: October 2020

Background: The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018.Methods: Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n=56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Results: The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co40 morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with interferon-based treatment and uncertainty regarding treatment eligibility negatively, influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs 46 with other substance use related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. Conclusions: These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peerled care that responds to power differentials.
Self-reported Lifestyle Behaviours in Families With an Increased Risk for Type 2 Diabetes Across Six European Countries: the Feel4diabetes-study
Authors: Stappen Vicky Van , Cardon Greet , Iotova Violeta , Chakarova Nevena , Rurik Imre , Lindström Jaana , Kivelä Jemina , Luis Alberto Moreno , Mavrogrianni Christina , Manios Yannis , Ruben Brondeel
Published: October 2020

Background: The current study aimed to describe self-reported lifestyle behaviours by comparing them to current health guidelines in European Feel4Diabetes-families at risk for developing type 2 diabetes across six countries (Belgium, Finland, Spain, Greece, Hungary and Bulgaria). Methods: Parents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the FINDRISC-questionnaire, which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours of both adults and children were assessed by parental questionnaires. To investigate families’ lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries, multilevel regression analyses were conducted. Results: Most Feel4Diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the WHO, European or national authorities; less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in Feel4Diabetes-families at risk exist between the countries. Conclusions: Countries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.Trial registration: Name: Feel4Diabetes-study, trial registration number: 643708, data of registration 03/15/2015 (Retrospectively registered), URL: https://clinicaltrials.gov/ct2/show/NCT02393872?term=643708&draw=2&rank=1
Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria 
Authors: Braimoh Tiwadayo , Danat Isaac , Abubakar Mohammed , Ajeroh Obinna , Stanley Melinda , Wiwa Owens , Prescott Marta Rose , Lam Felix
Published: October 2020

Background: Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. However, it has been argued that initiatives that engage the private sector may worsen inequities due to their profit motive.Methods: Changes in disparities in the coverage of ORS and zinc treatments by socioeconomic strata and geographical location were assessed using data from cross-sectional baseline and endline surveys.Results: At baseline, 28% (95% CI: 22 - 35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52 - 58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P = 0.000) for the poorest and 17%-points (P = 0.000) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration index declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35 - 41%) compared to 29% (95%CI: 25 - 33%) in the urban.Conclusion: The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.
Phenological Traits, Litterfall Production, and Carbon Sequestration Rates of Major Three Species in the Sundarbans
Authors: Kamruzzaman Md. , Paul Sumonta Kumar
Published: October 2020

BackgroundAttempt to compare the phonological pattern of the three mangrove species: Heritiera fomes, Bruguiera sexangula, and Xylocapus mekongensis in the Sundarbans mangrove forest by observing the litterfall data over 3 years.ResultsAll these three species showed highest litterfall of leaves and stipules in summer and lowest in winter. In case of B. sexangula, it also showed its second peak of leaves litterfall in the rainy season. Branch litterfall for the three species was occurred all over the year without having a distinct seasonal pattern. Flowering was observed in February – June and March - May for H. fomes and X. mekomgensis, respectively. Fruiting was observed for H. fomes and X. mekongensis in between the month of March – May and April – June respectively. Peak of mature fruit or seed litterfall was observed in July and August for both H. fomes and X. mekongensis respectively. Litterfall of flower buds, flowers and propagule for B. sexangula was observed throughout the year and peak flower buds, flowers, and propagule litterfall was found in the month of January, March, and July respectively. Kendall’s coefficient of concordance showed that all the organs of litterfall were concordant during the study period. Autocorrelation coefficient revealed that all the parts of litterfall followed a clear annual cycle except branches. Mean total litterfall was calculated 1014.6±12.7 g m-2 year-1 for H. fomes, 1047.3±21.3 g m-2 year-1 for X. mekongensis and 1640.2±14.1 g m-2 year-1 for B. sexangula of which leaves litterfall contributed more than 50% of total litterfall for all the three species. H. fomes, B. sexangula and X. mekongensis none of them exhibit any correlation between stipules litterfall and reproductive organs litterfall.ConclusionThe findings may contribute to an understanding of vegetative and reproductive phenology, litterfall production, and carbon sequestration rate of the major mangrove species in Sundarbans mangrove forests, and also its role in global C budgets.
Microbial Community Structure and Composition is Associated With Host Species and Sex in Sigmodon Cotton Rats
Authors: Strickland Britton , Patel Mira , Shilts Meghan H. , Boone Helen H. , Kamali Arash , Zhang Wei , Stylos Daniel , Boukhvalova Marina S. , Rosas-Salazar Christian , Yooseph Shibu , Rajagopala Seesandra V. , Blanco Jorge C. G. , Das Suman Ranjan
Published: October 2020

Background: The cotton rat (genus Sigmodon) is an essential small animal model for the study of human infectious disease and viral therapeutic development. However, the impact of the host microbiome on infection outcomes has not been explored in this model, partly due to the lack of a comprehensive characterization of microbial communities across different cotton rat species. Understanding the dynamics of their microbiome could significantly help to better understand its role during when modeling viral infections in this small animal model.Results: We examined the bacterial communities of the gut and three external sites (skin, ear, and nose) of two inbred species of cotton rats commonly used in research (S. hispidus and S. fulviventer) by using 16S rRNA gene sequencing, constituting the first comprehensive catalog of the cotton rat microbiome. We showed that S. fulviventer maintained higher alpha diversity and richness than S. hispidus at external sites (skin, ear, nose), but there were no differentially abundant genera. However, S. fulviventer and S. hispidus had distinct fecal microbiomes composed of several significantly differentially abundant genera. Whole metagenomic shotgun sequencing of fecal samples identified species-level differences between S. hispidus and S. fulviventer, as well as different metabolic pathway functions as a result of differential host microbiome contributions. Furthermore, the microbiome composition of the external sites showed significant sex-based differences while fecal communities were not largely different. Conclusions: Our study shows that host genetic background potentially exerts homeostatic pressures, resulting in distinct microbiomes for two different inbred cotton rat species. Because of the numerous studies that have uncovered strong relationships between host microbiome, viral infection outcomes, and immune responses, our findings represent a strong contribution for understanding the impact of different microbial communities on viral pathogenesis. Furthermore, we provide novel cotton rat microbiome data as a springboard to uncover the full therapeutic potential of the microbiome against viral infections.
Strengthening of Masonry Rings With Composite Materials
Authors: Jasieńko Jerzy , Raszczuk Krzysztof , FRĄCKIEWICZ PIOTR , Kleszcz Kajetan , Bednarz Łukasz
Published: October 2020

The paper presents the results of experimental testing of six masonry rings built to technical scale and strengthened with CFRP strips and sheets and also with an FRCM system with PBO, glass, basalt and carbon fibres. The rings were subjected to tensile loads induced by four hydraulic jacks. The assumption is that the masonry rings are a representative simplification of domes, especially their structural support. Both single layered domes and ribbed domes are exposed to tensile stress in up to one third of their height.During the tests, the following information was collected: loads, displacements, strains of composites and failure modes. In some cases, an initial prestressing of reinforcements was carried out. Recommendations and limitations related to the use of the materials tested for reinforcing round, masonry structures under tensile stresses are discussed. The criterion for choosing the best solution was not only based on comparing the tensile strength of the reinforcement but also its stiffness. A strengthening efficiency index is proposed. The assessment of strengthening effectiveness was carried out, taking into account also heritage building conservation standards.
Anticoagulation Therapy Using Unfractionated Heparin at a Therapeutic Dose for Coronavirus Disease 2019 Patients With Severe Pneumonia: A Retrospective Historical Control Study
Authors: Takayama Wataru , Endo Akira , Otomo Yasuhiro
Published: October 2020

Introduction: Patients with severe coronavirus disease 2019 (COVID-19) pneumonia often have the complications of coagulopathy and thrombotic phenomena, which lead to high mortality. Whether administering systematic anticoagulant therapy is beneficial remains unclear. We report our experience using systemic anticoagulation with unfractionated heparin to treat severe COVID-19.Methods: We conducted a retrospective historical control study of severe COVID-19 patients requiring mechanical ventilation who received prophylactic-dose anticoagulation (April 1–May 20) or therapeutic-dose anticoagulation (May 21–August 20) in the intensive care unit (ICU) of the tertiary emergency critical care medical center in Japan. The primary endpoints were in-hospital mortality and anticoagulation therapy-related adverse events. The secondary endpoints included the administration of veno-venous extracorporeal membrane oxygenation (ECMO), ventilator-free days (VFD), ICU-free days, and the development of multiple organ dysfunction syndrome.Results: Twenty-one patients were in the prophylactic-dose group and 26 patients were in the therapeutic-dose group. Background characteristics between the groups were not significantly different, although the therapeutic-dose group had a lower in-hospital mortality rate [0 (0.0%) patients vs. 4 (19.0%) patients; p = 0.063] and significantly longer ICU-free days (median [interquartile range (IQR)]: 15 days [13-18] vs. 5 days [0-13]; p = 0.014). Hemorrhagic events did not occur during the study period. Compared to the prophylactic-dose group, the therapeutic-dose group tended to have a longer VFD, were not treated with ECMO, and did not experience multiple organ dysfunction syndrome; however, the difference was not statistically significant.Conclusions: Therapeutic-dose anticoagulation may be beneficial for patients with severe COVID-19 pneumonia requiring mechanical ventilation.
Dual antiplatelet therapy in patients with coronary artery disease after percutaneous coronary intervention with drug-eluting stents: A systematic review and network meta-analysis
Authors: Xu Yi , Shen Yimin , Zhao Pengfei , Han Yuanyuan , Jiang Jun
Published: October 2020

Background: This network meta-analysis was committed to evaluating the efficacy and safety of different dual antiplatelet therapies (DAPTs) after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs).Methods: Randomized controlled trials (RCTs) comparing two of the following DAPT strategies: long-term (>12 months) DAPT (L-DAPT), 12-months DAPT (DAPT 12Mo), short-term (≤6 months) DAPT followed by aspirin monotherapy (S-DAPT+ASA), short-term DAPT followed by a P2Y12 receptor inhibitor monotherapy (S-DAPT+P2Y12) were searched. Primary outcomes were all-cause mortality, cardiac death, myocardial infarction (MI), stroke, major bleeding, any bleeding, definite or probable stent thrombosis (ST). This Bayesian network meta-analysis was performed with the random-effects model.Results: Twenty-four RCTs (n=81,376) were included. L-DAPT increased the risk of major bleeding (OR 2.37, 95%CI 1.32-5.03 compared with S-DAPT+P2Y12) and any bleeding (OR 2.95, 95%CI 1.91-4.34 compared with S-DAPT+P2Y12). When compared with L-DAPT, DAPT 12Mo (OR 1.54, 95%CI 1.13-2.02) and DAPT+ASA (OR 1.67, 95%CI 1.22-2.19) were associated with higher rates of MI, but S-DAPT+P2Y12 obtained no statistical difference. The sensitivity analysis revealed that the risks of major bleeding and any bleeding further increased for ≥18 months of DAPT. In the subgroup analysis, short-term DAPT (S-DAPT) presented similar efficacy and safety to DAPT 12Mo for patients with the acute coronary syndrome (ACS), and lower risks of major bleeding and all-cause mortality were observed in S-DAPT+P2Y12 among patients with newer-generation DES.Conclusions: S-DAPT+P2Y12 presented superiority in patients with all clinical presentations, for a lower risk of bleeding and not associated with increased ischemic harm. Besides, prospective research between aspirin monotherapy and P2Y12 monotherapy was required.
Effects of Refractive Power on Quantification Using Ultra-Widefield Retinal Imaging
Authors: Lim Su-Ho , Jeong Seongyong , Ahn Jang Hwan , Hemert Jano van , Sagong Min
Published: October 2020

Background: Ultra-widefiled (UWF) retinal images include significant distortion when they are projected onto a two-dimensional surface for viewing. Therefore, many clinical studies that require quantitative analysis of fundus images have used stereographic projection algorithm, three-dimensional fundus image was mapped to a two-dimensional stereographic plane by projecting all relevant pixels onto a plane through the equator of the eye. However, even with this impressive algorithm, refractive error itself might affect the size and quality of images theoretically. The purpose of this study is to investigate the effects of refractive power on retinal area measurements (quantification) using UWF retinal imaging (Optos California; Dunfermline, Scotland, UK).Methods: A prospective, interventional study comprised 50 healthy eyes. UWF images were acquired first without the use of a soft contact lens (CL) and then repeated with six CLs (+9D, +6D, +3D, -3D, -6D, and -9D). Using stereographically projected UWF images, the optic disc was outlined by 15-17 points and quantified in metric units. We divided the subjects into three groups according to axial length: Groups A (22-24mm), B (24-26mm), and C (≥26mm). The primary outcome was percentage change before and after use of the CLs. Secondary outcome was proportion of subjects with magnification effects, maximal changes >10%. Results: The study population was 6, 28, and 16 eyes in each group. Overall changes for the measured area were not significantly different in the whole study population. Group C had a larger proportion of magnification effects compared to Groups A and B (50.0%, 0%, and 3.6%, P=0.020). Measured area with plus lenses was significantly higher in Group C (P<0.001). Conclusion: The use of CLs might affect quantification of eyes with long axial length when using UWF images. Ophthalmologists should consider refractive error when measuring area in long eyes.
Context Matters: Using A Case Study Approach to Understand Implementing A Patient Centred Rehabilitation Model for Persons With Cognitive Impairment
Authors: McGilton Katherine , Cumal Alexia , Corsi Dana , Gingrich Shaen , Zheng Nancy , Escrig-Pinol Astrid
Published: October 2020

Background: There is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation. Patient centred rehabilitation models exist, yet there is a lack of specific strategies for implementing these models into other contexts. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care.Methods: The study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals’ perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in this facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework. Results: Across the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure was a key aspect of the geographical domain, which was focused on the facility’s physical layout.Conclusions: The study identified key factors within the context that supported and hindered the implementation of the model of care in a new environment. This work suggests that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how these aspects interact and influence one another. The CICI Framework was a useful guide to understand which elements existed and which were still required for successful implementation of the model of care.