bluuebunny/crossref_metadata_2025 huggingface dataset:
When to Resume Bariatric Surgery after COVID-19 Pandemic? – Results of Patients’ and Surgeons’ Survey.
Authors: Dudek Aicja , Dudek Alicja , Wysocki Michał , Walędziak Maciej , Szeliga Jacek , Proczko-Stepaniak Monika , Pedziwiatr Michał , Major Piotr
Published: July 2020

BackgroundCOVID-19 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state.MethodsThe study was conducted in two groups: Group 1 – bariatric patients; Group 2 – bariatric surgeons. Two online surveys were distributed.Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p<0.001) and contact with COVID+/quarantined persons (p<0.001) had impact on the response to resumption of bariatric procedures.ConclusionsPatients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.
Comparing Charlson and Elixhauser comorbidity indices with different weightings to predict in-hospital mortality: an analysis of national inpatient data
Authors: Sharma Narayan , Schwendimann René , Endrich Olga , Ausserhofer Dietmar , Simon Michael
Published: July 2020

Background When chronic conditions are associated with outcomes such as mortality, comorbidity measures are essential both to describe patient health status and to adjust for potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, as optimal comorbidity weightings remain undetermined. The present study aimed to derive a set of new population-based Elixhauser comorbidity weightings, then to validate and compare their mortality predictivity against those of the Charlson and Elixhauser-based van Walraven weightings estimates in a population-based cohort.Methods Retrospective analysis was conducted with routine Swiss general hospital (102 hospitals) data (2012–2017) for 6.09 million inpatient cases. To derive the population-based weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results for Part 1 alongside the established weighting systems used for Part 2. Charlson and van Walraven weightings were applied to Charlson and Elixhauser comorbidity indices. Generalized additive models were weighted and adjusted for age, gender and hospital types.Results Overall, the population-based weights’ c-statistic (0.867, 95% CI: 0.865–0.868) was consistently higher than Elixhauser-van Walraven’s (0.863, 95% CI: 0.862–0.864) and Charlson’s (0.850, 95% CI: 0.849–0.851) in the derivation and validation groups and net reclassification improvement of new weights offers improved predictive performance of 0.4% on the Elixhauser-van Walraven and 6.1% on the Charlson weightings.Conclusions All weightings were validated with the national dataset and the new population-based weightings model improved the prediction of in-hospital mortality. The newly derive weights support patient population-based analysis of health outcomes.
A Tripartite Analysis of Online Healthcare Platforms: Evidence from Spring Rain Doctor in China
Authors: Cao Xia , Zhang Lanting , Lv Dan , Li Weijia , Xing Zeyu
Published: July 2020

Background

Online healthcare platform (OHP) is a new form of medical treatment, which solves the problems of unbalanced distribution of medical resources and expensive medical treatment in China. Especially under the epidemic of COVID-19, OHP has greatly reduced the medical pressure of the hospital and the risk of cross infection.
Methods

This paper uses evolutionary game theory to analyze behavioral strategies and their dynamic evolution in the promotion of OHP, and then numerical simulations are carried out with the help of program compilation.
Results

The results demonstrate that: (1) both the stricter qualification inspection of doctors and the more investment in information protection promote the participation of doctors and the use of patients; (2) with a higher initial probability of doctors joining, the possibility for patients in using OHP and platforms to provide standardized online healthcare services becomes higher; (3) if the initial probability of patients using is higher, the possibility for doctors to participate OHP and platforms to provide standardized online healthcare services raises; (4) the trend of doctors joining the platform is affected by factors, such as registration cost, time cost, reputation loss and so on; (5) the tendency of patients in using online healthcare is mainly decided by the cost.
Conclusions

Based on theoretical analysis, this article takes the Spring Rain Doctor OHP as an example to verify the game results. Therefore, OHP should attach importance to the inspection of doctors and the protection of privacy information, and strengthen the publicity in remote places. At the same time OHP can promote the active participation of grassroots doctors, and set a reasonable evaluation mechanism, so as to popularize online medical treatment among patients further.
Epigenetic Immunomodulatory Effect of Eugenol and Astaxanthin on Doxorubicin Cytotoxicity in Hormonal Positive Breast Cancer Cells
Authors: Fouad Mariam A. , Sayed-Ahmed Mohamed M. , Huwait Etimad A. , Hafez Hafez F. , Osman Abdel-Mneim M.
Published: July 2020

Background: Hormonal receptor positive (HR+) breast cancer is the most commonly diagnosed molecular subtype of breast cancer; which showed good response to doxorubicin (DOX)-based chemotherapy. Eugenol (EUG) and astaxanthin (AST) are natural compounds with proved epigenetic and immunomodulatory effects in several cancer cell lines. This study has been initiated to improve the cytotoxic activity and reduce resistance of DOX through combination with EUG and AST in MCF7 cells.Methods: Cytotoxic activity of DOX alone and combined with either 1mM EUG or 40µM AST was performed using sulphorhodamine-B assay in MCF7 cells. Global histones acetylation and some immunological markers were investigated using ELISA, western blotting and quantitative RT-PCR techniques. Functional assay of multidrug resistance was performed using rhodamine 123 and Hoechst 3342 dyes. Flow cytometry with annexin V and propidium iodide were used to assess the change in cell cycle and apoptosis along with the expression of some differentiation, apoptosis and autophagy proteins. Results: DOX alone resulted in concentration-dependent cytotoxicity with IC50 of 0.5 μM. Both EUG and AST significantly increased DOX cytotoxicity which is manifested as a significant decrease in DOX IC50 from 0.5 μM to 0.088 μM with EUG and to 0.06 μM with AST. Combinations of DOX with 1mM EUG or 40 µM AST significantly increased the level of histones acetylation and histone acetyl transferase expression, while reduced the expression of aromatase and epidermal growth factor receptor (EGFR) when compared with 0.25 µM DOX alone. Also both combinations showed higher uptake of rhodamine but lower of Hoechst stains, along with increased the percentage of caspase 3, and decreased the expression of CK7 and LC3BI/II ratio. EUG combination induced IFγ but reduced TNFα causing shifting of cells from G2/M to S and G0/ G1 phases. Combination of DOX with EUG induced apoptosis through the higher BAX/ BCl2 ratio, while with AST was through the increase in caspase 8 expressions. Conclusion: EUG and AST potentiated the anticancer activity of DOX through epigenetic histones acetylation along with the immunonomodulation of different apoptotic approaches in MCF7 cells.
Expression of transduced Nucleolin promotes the clearance of accumulated alpha-synuclein
Authors: HO DONG HWAN , Nam Daleum , Jeong Soyeon , Seo Mi Kyoung , Park Sung Woo , Seol Wongi , Son Ilhong
Published: July 2020

Background

Alpha-synuclein (αSyn) is a major component of Lewy bodies, which are known to be a pathogenic marker of Parkinson’s disease (PD). The accumulation of αSyn is caused by dysfunctions in protein degradation machinery. The reinforcement of αSyn degradation is a potential therapeutic target of PD since accumulated αSyn is responsible for the pathogenesis of PD. Nucleolin (NCL) is essential for forming nucleolar structure. The function of NCL is correlated with oxidative stress-mediated cell death. A previous study demonstrated that NCL was reduced in PD brains, and overexpression of NCL alleviated rotenone-induced neural toxic effects. Knockdown of NCL had the opposite effect. These results suggest that the malfunctioning of NCL would exacerbate PD pathology. Thus, we hypothesized that the introduction of ectopic NCL could rescue the α-synucleinopathy in PD.
Methods

We tested whether ectopic expression of NCL facilitates the clearance of αSyn. The Ectopic expression of NCL was accomplished by the transfection of GFP or GFP-NCL in mouse embryonic fibroblasts (MEF) or transduction of green fluorescent protein (GFP) or GFP-NCL using lentivirus in rat primary cortical neuron. We also investigated whether the expression of GFP or GFP-NCL in mouse substantia nigra alleviates the PD pathology derived by αSyn aggregates.
Results

The expression of NCL enhanced the clearance of αSyn accumulation or aggregates in MEF and rat primary cortical neurons. The activity of autophagy-lysosome pathway was enhanced by NCL expression. The transduction of NCL in the substantia nigra, which was co-injected with αSyn fibrils, rescued PD manifestations.
Conclusions

The elevation of NCL levels may reflect a therapeutic strategy for α-synucleinopathy in PD.
A novel nomogram provides improved accuracy for predicting biochemical recurrence after radical prostatectomy
Authors: Xia Haizhui , Bi Hai , Yan Ye , Yang Bin , Ma Ruozhuo , He Wei , Zhu Xuehua , Zhang Zhiying , Zhang Yuting , Ma Lulin , Hou Xiaofei , Lu Jian
Published: July 2020

Background: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP), however, few of the previous prediction tools used serum prostate specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival. Methods: 337 patients who underwent RP were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCR-free survival at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analysis were performed to identify the advantage of the new nomogram in comparison with the CAPRA-S score. Results: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), since these variables were significantly associated with BCR in both univariate and multivariate analysis (p <0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, p =0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, p =0.001). Time-dependent ROC curves and decision curve analyses also demonstrated the advantages of the new nomogram.Conclusions: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCR-free survival after RP.
Mental health, attitudes, and behavior of healthcare workers amid Covid-19 pandemic
Authors: Kurt Ercan , Ovalı İbrahim Ethem , Tibilli Hakan , Gulacti Umut , Kaya Hakan , Koparal Mehtap , Lok Ugur , Canpolat Semih , Canpolat Esra Kurt , Doğan Fatih , Afsin Abdulmecit , Kafadar Safiye , Yucetas Şeyho Cem , Kafadar Hüseyin
Published: July 2020

Objective: To evaluate the mental Health and Psychosocial status, thoughts about the measures taken by the government, attitudes, and behaviors of HCWs facing the Covid-19 pandemic.Methods: A 56-question multiple-choice survey was performed by a one-to-one interview with the HCWs in 3 registered hospitals fighting the Covid-19 pandemic from 20 May to 10 June 2020. Mental health variables were assessed via the Patient Health Questionnaire-4 (PHQ-4) and the Turkish Beck Depression Scale to specify psychological manifestations. A scoring system was applied using a four-point Likert scale, from no points (“strongly disagree”) to three points (“strongly agree”) to determine the levels of anxiety and depression.Results: A total of 300 HCWs (45 physicians, 255 non-physician health care workers) enrolled in the survey. Only 0.8% of HCWs took psychological support from a therapist or psychiatrist. The most common concern about Covid-19 pandemic was that “the elderly and other risky population was being infected” (37.9%). 89.2% HCWs who felt the concern was that they had changed their thoughts with the information they got from television (P= 0.005, χ2= 20.271). Compared with non-physician HCWs, the physicians about the spreading of the Covid- 19 felt more the concern (%80 vs %47.1, p= 0.006 χ2=12.591) and physicians higher rate agreed that the number of tests being performed was sufficient enough. (53.3% vs. 41.2%, p=0.030, OR:0.29-0.35, χ2: 7.047), For all HCWs, the "feeling of being infected with Covid-19” item had the highest mean total score (2.60 ± 0.97). The mean score of “feeling nervous/anxious/on edge” item was 2.53±0.52 for physicians, and 2.26±0.86 for non-physician HCWs. Non-physicians HCWs had a higher mean score for “Feeling of increased body pain and agony” item than physicians (0.27±0.80 vs 0.76±1.23; mean dif= -0.50, 95% confidence interval=-1.002 to 0.006, p<0.05).Conclusions:The results of this survey study showed that the highest anxiety score for all healthcare professionals was the “feeling of being infected with covid-19”. Both physicians and non-physicians HCWs were feeling nervous/anxious/on edge largely according to anxiety scores.
Severe COVID-19 in cardiopath young pregnant without vertical transmission: a case report
Authors: França Ana Paula Figueiredo de Montalvão , Pereira Danielly do Vale , Rodrigues Elaine Valéria , Vieira Flávia Nunes , Machado Karine Santos , Nogueira Pedro Aleixo , Fonseca Ricardo Roberto de Souza , Machado Luiz Fernando Almeida
Published: July 2020

The authors have requested that this preprint be removed from Research Square.
Adaptive SIR model for propagation of SARS-CoV-2 in Brazil
Authors: Santos I. F. F. dos , Almeida G. M. A. , de Moura F. A. B. F.
Published: July 2020

We study the spreading of SARS-CoV-2 in Brazil based on official data available since March 22, 2020. The calculations are based on an adaptive susceptible-infected-removed (SIR) model featuring dynamical recuperation and propagation rates and can reproduce the number of confirmed cases over time with less than $5\%$ error. Furthermore, it is possible to predict the epidemic progression in the near future and we go on to estimate the time required to stabilize the virus propagation. The model is also proved to be accurate for analyzing the epidemic dynamics in other countries.
Are Danish vocational schools ready to implement ‘smoke-free school hours’? A qualitative study informed by the theory of organizational readiness for change
Authors: Hjort Anneke Vang , Schreuders Michael , Rasmussen Kathrine Højlund , Klinker Charlotte Demant
Published: July 2020

Background
Vocational education and training is a lower level of education and the smoking prevalence among Danish vocational students is high. The school tobacco policy regarding smoke-free school hours stipulates that students and staff are not allowed to smoke during school hours—inside or outside school premises—and it might be an effective intervention for reducing smoking in vocational schools. For school tobacco policies to be effective, they must be appropriately implemented. A primary predictor for successful implementation is organizational readiness for change. This study seeks to identify and understand the barriers to and facilitators for developing organizational readiness to implement smoke-free school hours in Danish vocational schools.
Methods
Semi-structured interviews and focus groups were carried out with managers and teachers (n = 22 participants) from six vocational schools. The interview guides were informed by ‘A theory of organizational readiness for change’ developed by Weiner, which was also used as a framework to analyze the data.
Results
We identified 13 facilitators and barriers. Nine factors acted as facilitators, including the following: believing that health promotion is a school role and duty; believing that society and workplaces are becoming more smoke-free, and believing that smoke-free school hours is a beneficial strategy to achieve fewer educational interruptions. Additional facilitators include establishing clear rules for sanctioning and enforcement; developing a joint understanding about smoke-free school hours; developing skills to deal with student responses to smoke-free school hours; establishing social alternatives to smoking; offering smoking cessation help and mandating smoke-free school hours by law. Four organizational norms, practices or discourses acted as barriers: Believing that smoke-free school hours violate personal freedom; believing that students have more important problems than smoking; believing that it is difficult to administer the level of enforcement; and believing that the enforcement of smoke-free school hours negatively influences student-teacher relations.
Discussion
Our results suggest that developing organizational readiness before adopting a comprehensive tobacco policy such as smoke-free school hours is important for successful implementation. Further research should investigate how to strengthen the facilitators for and counter the barriers to developing readiness for implementing smoke-free school hours.
Planning of Births and Childhood Undernutrition in Nepal: Evidence from a 2016 National Survey
Authors: Tiwari Ishwar , Acharya Kiran , Paudel Yuba Raj , Sapkota Bhim Prasad , Kafle Ramesh Babu
Published: July 2020

Background
Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aim to investigate the relationship between PoB and childhood undernutrition in the current study.
Methods
We used the Nepal Demographic Health Survey 2016 data, which is a nationally representative cross-sectional household survey. We used two common anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor of interest. Binary logistic regression with sampling weights was used to estimate adjusted odds ratios (OR) and 95% confidence intervals to examine the association between the PoB and childhood undernutrition.
Results
The overall prevalence of stunting was 35.8%, and underweight was 27.1% in under-five children in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of interval between birth and subsequent birth (IBBSB). The association between the birth order of children and the prevalence of undernutrition had strong statistical significance (p < 0.001). Mother’s age at marriage (p = 0.001), underweight mother (p < 0.001), mother’s education (p < 0.001), father’s education (p < 0.001), wealth quintile (p < 0.001), no exposure to mass media (p < 0.001), children’s age (p < 0.001), area of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12–24 months of interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting as compared to those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4–0.9).
Conclusion
The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12–24 months after marriage was found to be associated with reduced odds of childhood stunting. To mitigate childhood undernutrition, Nepal’s government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.
Food from the Campus: Understanding Africa’s Transition to Sustainable Urban FoodSecurity during the Covid-19 Pandemic
Authors: Barau Aliyu , Jibrin Jibrin Mohammed , Badamasi Murtala Muhammad , Mustapha Amina
Published: July 2020

This paper takes a critical look at the 20-hectares research/demonstration farm at Bayero University Kano’s Centre for Dryland Agriculture (CDA) in Kano, Nigeria. The paper examines how knowledge-based mode farm driven by scientific, ethical, and technological innovations contributes to ensuring some level of food security during the COVID-19 pandemic. The main research question driving the current study is: in what ways can universities demonstration farms support urban food security during pandemics? The study circumvented lockdown restriction challenges by deploying elevator pitch approach, walk-in interviews, document analysis, and covert observation to elicit the needed data for the study. The CDA farm produced several tons of variety of vegetables using its clean energy and locally recyclable water sources to secure food needs of some urban households during the lockdown. The ability of the farm to effectively embrace sustainable farming system suggests that transitioning to bioeconomy based food security is achievable and affordable in developing countries. Essentially, the paper recommends the need for universities to take a leading role and responsibility in promoting the principles of bioeconomy in agriculture through engagement and collaborations with municipalities and planned and unplanned urban communities in Africa’s fast urbanising cities.
Prediction of Therapeutic Efficacy of Gabapentin by Hull Airway Reflux Questionnaire in Chronic Refractory Cough
Authors: Zhang Mengru , CHEN Qiang , DONG Ran , YU Li , AI Zisheng , XU Xianghuai , QIU Zhongmin
Published: July 2020

BackgroundGabapentin is recommended for the treatment of chronic refractory cough. This study aims to identify its therapeutic predictors in a prospective clinical study.Methods179 patients with chronic refractory cough were treated with gabapentin. Prior to the therapy, all patients were assessed by Hull Airway Reflux Questionnaire (HARQ) and inhaled capsaicin test. When the treatment ended and cough resolution was confirmed, a stepwise logistic regression analysis was performed to identify the therapeutic predictors for gabapentin and to establish the prediction equation. ResultsGabapentin treatment achieved a therapeutic success rate of 66.5%. HARQ scores were significantly higher in responders than non-responders to gabapentin (29.79 ± 9.58 vs 21.95 ± 7.83, t = -3.685, P = 0.000), which were positively related to the therapeutic efficacy of gabapentin (r = 0.433, P < 0.01). The optimal cutoff point of 21.5 in HARQ presented with a moderate ability to predict gabapentin efficacy, with a sensitivity of 84.6% and specificity of 63.6%. Multiple logistic regression identified items of “A tickle in your throat, or a lump in your throat” (OR= 7.927, P=0.005), “Cough when you get out of bed in the morning” (OR=7.016, P=0.045) and “Cough with eating” (OR=6.689, P=0.011) as independent predictors. The established logistic regression equation predicted ³ 80% of the treatment success rate of gabapentin, which was verified by consequent preliminary revalidating study in 59 patients.ConclusionsHARQ may be useful to screen patients with chronic refractory cough most likely responsive to gabapentin, and help improve the therapeutic success. Trial registrationhttp://www.chictr.org/; No.: ChiCTR-ONC-13003123
Dose Response of a Novel Exogenous Ketone Supplement on Physiological, Perceptual, and Performance Parameters
Authors: Prins Philip , D’Agostino Dominic P. , Rogers Christopher Q. , Ault Dana L. , Welton Gary L. , Jones Dalton W. , Henson Samuel R. , Rothfuss Tyler J. , Aiken Kylie G. , Hose Jantzen L. , England Emilia L. , Atwell Adam D. , Buxton Jeffrey D. , Koutnik Andrew P.
Published: July 2020

Background: Interest into the health, disease, and performance impact of exogenous ketone bodies has rapidly expanded due to their multifaceted physiological and signaling properties but limiting our understanding is the isolated analyses of individual types and dose/dosing protocols.Methods: Thirteen recreational male distance runners (24.8±9.6y, 72.5±8.3kg, VO2max 60.1±5.4ml/kg/min) participated in this randomized, double-blind, crossover design study. The first two sessions consisted of a 5-km running time trial (TT) familiarization and a VO2max test. During subsequent trials, subjects were randomly assigned to one (KS1:22.1g) or two (KS2:44.2g) doses of beta-hydroxybutyrate (βHB) and medium chain triglycerides (MCTs) or flavor matched placebo (PLA). Blood R-βHB, glucose, and lactate concentrations were measured at baseline (0-min), post-supplement (30 & 60mins), post-exercise (+0min, +15mins). Time, HR, RPE, affect, RER, VO2, VCO2, and VE were measured during exercise. Cognitive performance was evaluated prior to and post-exercise.Results: KS significantly increased R-βHB, with more potent and prolonged elevations in KS2, illustrating an administrative and dosing effect. R-βHB was significantly decreased in KS1 compared to KS2 illustrating a dosing and exercise interaction effect. Blood glucose elevated post-exercise but was unchanged across groups. Blood lactate significantly increased post-exercise but was augmented by KS administration. Gaseous exchange, respiration, heart rate, affect, RPE, and exercise performance was unaltered with KS administration. However, clear responders and none-responders were indicated. KS2 significantly augmented cognitive function in pre-exercise conditions, while exercise increased cognitive performance for KS1 and PLA to pre-exercise KS2 levels. Conclusion: Novel βHB+MCT formulation had a dosing effect on R-βHB and cognitive performance, an administrative response on blood lactate, while not influencing gaseous exchange, respiration, heart rate, affect, RPE, and exercise performance.
Financial Accountability Mechanisms In Local Governments In Uganda: A Case of Kabale District Local Government
Authors: Eton Marus , Arinaitwe Perpetua , MosesAgaba  , Turyehabwa Abanis , Ogwel Bernard Patrick , Mwosi Fabian
Published: July 2020

The paper presents financial accountability mechanisms in local governments, with reference to Kabale district local government. A cross-sectional research design, which used both quantitative and qualitative approaches to collect and analyze data, was adopted. Both simple random and purposive sampling techniques were used to select 117 respondents from 174 subjects. Questionnaires and personal interviews were used to collect data from respondents. Frequencies and percentages were used to analyze quantitative data while direct quotes from interviews conducted among key informants formed the basis for qualitative analysis. Quantitative analysis was aided by software for document analysis (SPSS V 20.0). In descending order of perception, service delivery was found to be the most commonly used financial accountability mechanism, followed by financial reporting, expenditure control and budget. The paper therefore, concluded that service delivery is the most used mechanism of financial accountability, though the district’s local budget seemed unclear on reflecting the priorities of the local people. This paper recommended that the local government should ensure that the district’s budget demonstrates community preference; salaries and wages should be paid in accordance with the district’s approved budget; expenditures on development should always be as per the approved budget, and the mode of financial reporting, particularly on liabilities should be standardized. Due to the scope of this paper, which could not quantitatively relate financial accountability and service delivery, there is need for a comprehensive study on the effect of financial accountability and service delivery in Kabale district local government
Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study
Authors: Mosch* Lina , Poncette* Akira-Sebastian , Spies Claudia , Weber-Carstens Steffen , Schieler Monique , Krampe Henning , Balzer Felix
Published: July 2020

BackgroundIntensive care is lagging with digital transformation. It is essential to provide evidence and guidelines for integrating digital health technologies into the intensive care unit (ICU).We evaluated the implementation of a remote patient monitoring platform and derived an implementation framework proposal for digital health technology in an ICU.MethodsWe conducted this study from May 2018 to March 2020 during the implementation of a tablet-computer based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of seven semi-structured interviews with ICU clinical stakeholders and quantifiable questionnaire data. Results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results Inductive analysis of the interview transcripts revealed an insufficient implementation process because of a lack of staff engagement and little perceived benefits from the novel solution. The ICU was not considered the most suitable for remote patient monitoring, as the staff’s presence and monitoring coverage were high. We propose an implementation framework for digital technologies, including strategies to apply before and during implementation, targeting the implementation setting by involving all stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, taking into account the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects.Conclusions The ICU provides an exceptional setting for the introduction of digital health technology because it is a high-tech environment involving multiple professions and high-stress levels. Before implementation, the need for innovation and the ICU’s readiness to change should be assessed. During implementation, a clinical team should ensure transparent communication and continuous feedback. The establishment of an implementation unit is recommended to promote a sustainable implementation culture and to benefit from existing networks.Trial registrationClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173
Study on the coupling effect of controllable parameters on the dynamic characteristics of vehicle shift process throughout full life cycle of clutch
Authors: Wang Dongyang , Hu Minghui , Qin Datong
Published: July 2020

In this study, coupling effect of controllable parameters on the dynamic characteristics of vehicle shift process throughout full life cycle of wet clutch was studied. Firstly, an improved dynamic model of driveline was established with consideration of friction characteristics of clutch, time-varying mesh stiffness of gears, and torque-coupling effect. Then, dynamic characteristics of driveline during shift process were analyzed, and the model was validated with an experiment. Based on the model, the effect of frictional characteristics of clutch on the dynamic characteristics of driveline were analyzed, and to reduce the adverse effects caused by the degradation of frictional characteristics on the dynamic characteristics of driveline, a control strategy was proposed, which control the rising rate of on-coming clutch pressure and the maximum pressure coordinately. the influence of these two controllable parameters on the dynamic characteristics of driveline during shift process throughout the whole life of wet clutch life was analyzed. The results showed that side effect caused by the degradation of clutch frictional characteristics on the driveline during shift process can be attenuated by controlling the rising rate of on-coming clutch pressure and the maximum pressure coordinately.
Lactoferrin Suppresses LPS-Induced Expression of HMGB1, microRNA 155, 146, and TLR4/MyD88/NF-кB Pathway in RAW264.7 Cells
Authors: Nemati Maryam , Karimi Mohammad-Ali , Amiri Maryam , Nejabati Hamid Reza , Maroufi Nazila Fathi , Faridvand Yousef , Nouri Mohammad
Published: July 2020

Background: This current study evaluated the underlying mechanisms of LF against the inflammatory miRNAs, HMGB1 expression and TLR4-MyD88-NF-кB pathway in LPS-activated murine RAW264.7 cells. Methods: MTT assay was used to assess cell viability and the cell culture levels of the cytokines (TNF-α, IL-6) were evaluated by Enzyme-linked immunosorbent assay (ELISA). The expression of miRNAs was quantified by using qPCR and expression of HMGB1, TLR4, MyD88, and phosphorylated NF-κB (P-p65) were determined with Western blot and qPCR, respectively. Results: The results indicated that LF downregulates IL-6 and TNF-α expression. LF exhibited the degradation of P-p65 and reduced the production of HMGB1, TLR4, and MyD88 in LPS-induced inflammatory response. Importantly, in parallel with the suppression of cytokines and HMGB1-TLR4-MyD88-NF-кB pathway, LF could induce a decrease in inflammatory selected miRNAs, miR-155 and miR-146a expression. Conclusions: Altogether, these findings provide LF as a prominent anti-inflammatory agent could modulate HMGB1, microRNA-155, microRNA-146 and TLR4/MyD88/NF-кB pathway.
A Novel Sequential Treatment of Palbociclib Enhances the Effect of Cisplatin in RB-Proficient Triple-Negative Breast Cancer
Authors: Huang Yajing , Wu Hao , Li Xingrui
Published: July 2020

Background: Triple-negative breast cancer (TNBC) is a highly aggressive malignancy lack of sensitivity to chemo-, endocrine and targeted therapy. CDK4/6 inhibitors, combined with endocrine therapy, have been proven to be effective in postmenopausal women with HR-positive, HER2-negative advanced or metastatic breast cancer. So we investigated that whether CDK4/6 inhibitor palbociclib (PD) could enhance effects of cisplatin (CDDP) on TNBC.Methods: The effects of different drug regimens of PD and CDDP on MDA-MB-231 and RB-knockdown MDA-MB-231 (sh-MDA-MB-231) cells was assessed in vitro and vivo. Immunoblotting illustrated cyclin D1/RB/E2F axis signaling pathway.Results: PD induced G1 phase cell cycle arrest in MDA-MB-231 cell line. However, neither concomitant treatment with PD and CDDP nor immediately sequential treatment with CDDP before or after PD had an influence on cell apoptosis of MDA-MB-231 cells. We further investigated the effect of PD or CDDP withdrawal on the sequential treatment and found that PD used for 48h and then withdrawn for 48h followed by CDDP could significantly increase apoptosis, inhibit cell proliferation, cloning formation and mitotic progression of MDA-MB-231 cells, while in other regimens PD and CDDP represented additive or antagonistic response. PD preferential use synchronized tumor cell cycle which could increase DNA damage by CDDP as measured by γH2AX. These findings above were negative in sh-MDA-MB-231 cells, which indicated that PD enhances the sensitivity of TNBC cells to CDDP in a RB dependent manner. In vivo, this combination treatment inhibited tumor growth and Ki-67 expression compared with single drug treatments in MDA-MB-231 xenograft models. Western blotting analysis presented that PD enhanced sensitivity to CDDP through CDK4/6-cyclin D-RB-E2F pathway. Conclusions: This study indicates that the anti-tumor effect of PD-CDDP functions through CDK4/6-cyclin D1-RB-E2F pathway and the synchronization of cell cycle. PD-CDDP Our study provides a novel and potentially effective treatment for TNBC patients.
Viral Clearance After Early Corticosteroid Treatment In Patients With Moderate Or Severe Covid-19
Authors: Spagnuolo Vincenzo , Guffanti Monica , Galli Laura , Poli Andrea , Querini Patrizia Rovere , Ripa Marco , Clementi Massimo , Scarpellini Paolo , Lazzarin Adriano , Tresoldi Moreno , Dagna Lorenzo , Zangrillo Alberto , Ciceri Fabio , Castagna Antonella
Published: July 2020

The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients.Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs.The primary outcome was the time to nasopharyngeal swab negativization.A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization.Of 280 patients included, 59 (21.1%) patients were treated with steroids.Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p=0.023) or ≤100 mmHg (16.9% vs 12.7%; p=0.027), and length of hospitalization (20 vs 14 days; p<0.001).Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p=0.985).According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤70 years, a shorter duration of symptoms at admission, a baseline PaO2/FiO2 >200 mmHg, and a lymphocyte count at admission >1.0*109/L. SARS-CoV-2 clearance was not associated with corticosteroid use.Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with early use of corticosteroids
Evaluation of candidate models for the 13th generation International Geomagnetic Reference Field
Authors: Alken Patrick , Thebault Erwan , Beggan Ciaran , Aubert Julien , Baerenzung Julien , Brown William J. , Califf S. , Chulliat Arnaud , Cox G.A. , Finlay Christopher C. , Fournier Alexandre , Gillet Nicolas , Hammer Magnus D. , Holschneider Matthias , Hulot Gauthier , Korte Monika , Lesur Vincent , Livermore Philippe W. , Lowes Frank J. , Macmillan Susan , Nair Manoj , Olsen Nils , Ropp G. , Rother Martin , Schnepf Neesha , Stolle Claudia , Toh Hiroaki , Vervelidou Fotini , Vigneron Pierre , Wardinski Ingo
Published: July 2020

In December 2019, the 13th revision of the International Geomagnetic Reference Field (IGRF) was released by
the International Association of Geomagnetism and Aeronomy (IAGA) Division V Working Group V-MOD.
This revision comprises two new spherical harmonic main eld models for epochs 2015.0 (DGRF-2015) and
2020.0 (IGRF-2020) and a model of the predicted secular variation for the interval 2020.0 to 2025.0
(SV-2020-2025). The models were produced from candidates submitted by fteen international teams. These
teams were led by the British Geological Survey (UK), China Earthquake Administration (China), Universidad
Complutense de Madrid (Spain), University of Colorado Boulder (USA), Technical University of Denmark
(Denmark), GFZ German Research Centre for Geosciences (Germany), Institut de physique du globe de Paris
(France), Institut des Sciences de la Terre (France), Pushkov Institute of Terrestrial Magnetism, Ionosphere
and Radio Wave Propagation (Russia), Kyoto University (Japan), University of Leeds (UK), Max Planck
Institute for Solar System Research (Germany), NASA Goddard Space Flight Center (USA), University of
Potsdam (Germany), and Universite de Strasbourg (France). The candidate models were evaluated individually
and compared to all other candidates as well to the mean, median and a robust Huber-weighted model of all
candidates. These analyses were used to identify, for example, the variation between the Gauss coecients or
the geographical regions where the candidate models strongly di ered. The majority of candidates were
suciently close that the di erences can be explained primarily by individual modeling methodologies and data
selection strategies. None of the candidates were so di erent to warrant their exclusion from the nal IGRF-13.
The IAGA V-MOD task force thus voted for two approaches: the median of the Gauss coecients of the
candidates for the DGRF-2015 and IGRF-2020 models and the robust Huber-weighted model for the predictive
SV-2020-2025. In this paper, we document the evaluation of the candidate models and provide details of the
approach used to derive the nal IGRF-13 products.
Efficient Deep Learning Model for COVID-19 Detection in large CT images datasets: A cross-dataset analysis
Authors: Silva Pedro , Luz Eduardo , Silva Guilherme , Moreira Gladston , Silva Rodrigo , Lucio Diego , Menottu David
Published: July 2020

Early detection and diagnosis are critical factors to control the COVID-19 spreading. A number of deep learning-based methodologies have been recently proposed for COVID-19 screening in CT scans as a tool to automate and help with the diagnosis. To achieve these goals, in this work, we propose a slice voting-based approach extending the EfficientNet Family of deep artificial neural networks.We also design a specific data augmentation process and transfer learning for such task.Moreover, a cross-dataset study is performed into the two largest datasets to date. The proposed method presents comparable results to the state-of-the-art methods and the highest accuracy to date on both datasets (accuracy of 87.60\% for the COVID-CT dataset and accuracy of 98.99% for the SARS-CoV-2 CT-scan dataset). The cross-dataset analysis showed that the generalization power of deep learning models is far from acceptable for the task since accuracy drops from 87.68% to 56.16% on the best evaluation scenario.These results highlighted that the methods that aim at COVID-19 detection in CT-images have to improve significantly to be considered as a clinical option and larger and more diverse datasets are needed to evaluate the methods in a realistic scenario.
Increased Adiponectin Levels are Associated with Higher Radiographic Scores in the Knee Joint, but not in the Hand Joint: The Dong-gu Study
Authors: Xu Haimuzi , Kang Ji-Hyoun , Choi Sung-Eun , Park Dong-Jin , Kweon Sun-Seog , Lee Young-Hoon , Kim Hye-Yeon , Lee Jung-Kil , Shin Min-Ho , Lee Shin-Seok
Published: July 2020

Background: Several studies have evaluated the association between the serum adiponectin level and knee and hand osteoarthritis (OA); mixed results have been reported. We investigated the relationship between OA and the serum adiponectin level according to the radiographic features of knee and hand OA.Methods: A total of 2,402 subjects was recruited from the Dong-gu Study. Baseline characteristics were collected via a questionnaire, and X-rays of knee and hand joints were scored using a semi-quantitative grading system. The relationship between the serum adiponectin level and radiographic severity was evaluated by linear regression analysis.Results: Subjects in the higher serum adiponectin level tertiles were older and had a lower body mass index (BMI) than those in the lower tertiles. Regarding knee joint scores, the serum adiponectin level was positively associated with the total score (P < 0.001), osteophyte score (P = 0.003), and joint space narrowing (JSN) score (P < 0.001) after adjustment for age, gender, BMI, smoking, alcohol consumption, education, and physical activity. In terms of hand joint scores, no association was found between the serum adiponectin level and the total score, osteophyte score, JSN score, subchondral cyst score, sclerosis score, erosion score, or malalignment score after the above-mentioned adjustments.Conclusion: An increased serum adiponectin level was associated with a higher radiographic score in the knee joint, but not in the hand joint, suggesting the involvement of different pathophysiologic mechanisms in the development of OA between those joints.
Denosumab Alleviates Intervertebral Disc Degeneration Adjacent to a Lumbar Fusion by Inhibiting Endplate Osteochondral Remodeling and Vertebral Osteoporosis in Ovariectomized Rats
Authors: Sun Qi , Tian Fa-Ming , Liu Fang , Fang Jia-Kang , Hu Yun-Peng , Lian Qiang-Qiang , Zhou Zhuang , Zhang Liu
Published: July 2020

Background: Although adjacent segmental intervertebral disc degeneration (ASDD) is one of the most common complications after lumbar fusion, its exact mechanism remains unclear. As an antibody to RANKL, denosumab (Dmab) effectively reduces bone resorption and stimulates bone formation, which can increase bone mineral density (BMD) and improve osteoporosis. However, it has not been confirmed whether Dmab has a reversing or retarding effect on ASDD. Methods: Three-month-old female Sprague-Dawley rats that underwent L4–L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation four weeks after OVX surgery were given Dmab four weeks after PLF surgery (OVX+PLF+Dmab group). In addition, the following control groups were defined: Sham, OVX, PLF, and OVX+PLF (n=12 each).Then, manual palpation and X-ray were used to evaluate the state of lumbar fusion. The bone microstructure in the lumbar vertebra and endplate as well as the disc height index (DHI) of the L5/6 were evaluated by microcomputed tomography (μCT). The characteristic alterations of ASDD were identified via Safranin-O green staining staining. Osteoclasts were detected using tartrate-resistant acid phosphatase (TRAP) staining and the biomechanical properties of vertebra were evaluated. Aggrecan (Agg), metalloproteinase-13 (MMP-13), a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4) expression in the intervertebral disc were detected by immunohistochemistry and real-time polymerase chain reaction (RT-PCR) analysis.Results: Manual palpation showed clear evidence of the fused segment’s immobility. Compared to the OVX+PLF group, more new bone formation was observed by X-ray examination in the OVX+PLF+Dmab group. Dmab significantly alleviated ASDD by retaining disc height index (DHI), decreasing porosity of endplate, and increasing the biomechanical properties and BMD of vertebra. TRAP staining results showed a significantly decreased number after Dmab treatment, especially in subchondral bone and cartilaginous endplate. Moreover, the results of protein and mRNA expression in intervertebral disc (IVD) showed that Dmab not only inhibited matrix degradation by decreasing MMP-13 and ADAMTS-4 but also promoted matrix synthesis by increasing Agg. Conclusions: These results suggest that Dmab may be a novel therapeutic target for the treatment of ASDD.