bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Effects of Vitamin D Supplementation in Obese Children During Integrated Weight-Loss Programme - A Double Blind Randomized Placebo-Controlled Trial
Authors: Brzeziński Michał , Jankowska Agnieszka , Słomińska-Frączek Magdalena , Metelska Paulina , Wiśniewski Piotr , Socha Piotr , Szlagatys-Sidorkiewicz Agnieszka
Published: April 2020

Background: Vitamin D was studied in regards to its possible impact on body mass reduction and metabolic changes in adults and children with obesity yet there were no studies assessing the impact of vitamin D supplementation during a weight management programme in children and adolescence. The aim of our study was to assess the influence of 26 weeks of vitamin D supplementation in overweight and obese children undergoing an integrated 12-months’ long weight loss programme on body mass reduction, body composition and bone mineral density. Methods: A double-blind randomized placebo-controlled trial. Vitamin D deficient patients ( <30 ng/ml level of vitamin D) aged 6-14, participating in multidisciplinary weight management programme were randomly allocated to receiving vitamin D (1200 IU) or placebo for the first 26 weeks of the intervention. Results: Out of the 152 qualified patients, 109 (72%) completed a full cycle of four visits scheduled in the programme. There were no difference in the level of BMI change. Although the reduction was greater in the vitamin D vs. placebo group (-4.28 ± 8.43 vs. -2.53 ±6.10) the difference was not statistically significant (p=0.319). Similarly the reduction in fat mass – assessed both using bioimpedance and DEXa was achieved, yet the differences between the groups were not statistically significant. Conclusions: Our study ads substantial results to support the thesis on no effect of vitamin D supplementation on body weight reduction in children and adolescents with vitamin D insufficiency undergoing a weight management programme. Trial registration no: NCT 02828228; trial registration date: 8 June 2016 registered in: ClinicalTrials.gov.
Phthalate Toxicity
Authors: Suresh Arjun , Jindal Tanu
Published: April 2020

Phthalates are esters of Pthalic acid, compounds mainly used as plasticisers. Phthalates are widely used chemicals which are of significant research interest as their exposure causes various consequences for human health. There are several categories of phthalates extensively used in many commercial productions with diverse uses, physicochemical properties and toxicological effects. This chapter discusses the toxicity of Phthalates and its potential risks to human health.
Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: A Prospective Cohort Study
Authors: Hassen Hamid Y. , Endris Bilal S. , Roro Meselech A. , Gebreyesus Seifu H. , Van Geertruyden Jean-Pierre
Published: April 2020

At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We conducted a prospective cohort study among 379 pregnant women in South Ethiopia. A step-wise multivariable analysis was done to develop the prediction model. To improve clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristics curve (AUC) and calibration plot. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The area under the receiver operating characteristics curve (AUC) of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis shows the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify those at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications and thus improving the overall maternal and child healthcare in low- and middle-income countries.
The Role of Endocannabinoid System in Sleep Deprivation-Induced Psychosis-Like Symptoms through Hampering Prepulse Inhibition; A Hypothesis
Authors: Nami Mohammad , Kamali Ali-Mohammad , Kazemiha Milad , kosagisharaf Rao , Derman Sabri
Published: April 2020

The interaction between endocannabinoid (eCB) system with in key brain structures such as hippocampus, amygdala and prefrontal cortex and sleep deprivation (SD)-induced psychosis has been less studied. The present hypothesis revolves around the question whether altered chemical dynamics within the eCB system with the resultant impact on cannabinoid receptors in key cortical hubs would impact SD-induced psychosis-like symptoms. Having this investigated research is expected to pave the path towards identifying newer drug targets namely for schizophrenia.
Rice Productivity Growth During Nine Years in Badung Regency, Bali Province
Authors: Krisnandika Anak Agung Keswari , Wijaya I Made Anom Sutrisna , Ambarawati I Gusti Agung Ayu , Adi Anak Agung Ayu Mirah , Tamura Eisaku , Hongo Chiharu
Published: April 2020

The trend of rice productivity and its stability in Badung Regency are presented in this study. The area is a tourism-based economy without leaving the role of rice production to feed the people.  Time series data were collected from five sub districts covering 53 villages during 2008-2016 due to the completeness of the data. Variability of the data was observed from the coefficient of variance (C.V.) to decide rice productivity stability. This study also observed correlation between rainfall and rice productivity in the area. Result of the study shows that rice productivity trend in Badung Regency tend to decline during nine years of observation especially in 2014-2016. Three sub-districts had stable condition, while two sub-districts in tourism area contributed to the decline of this matter. Analysis using bi-plot revealed that there is no significant correlation between rainfall in sub-district and rice productivity, implying that water is available throughout the year.  In terms of stability, majority of villages (69.81%) had stable condition of rice productivity ranging from middle and high category. Other 30.19% villages were categorized as unstable ranging from low to high productivity. This condition showed that Badung Regency were able to maintain stability of rice productivity during nine years of observation. Implication of this study is to pay more attention to two sub districts in tourism area to improve their rice productivity such as implementation of good agricultural practices.
Influence of Government Policy on Highland Agriculture Development in Enrekang Regency, South Sulawesi, Indonesia
Authors: Summase Idris , Ali M. Saleh S. , Salman Darmawan , Rukmana Didi
Published: April 2020

Upland agriculture faces threats in the ecological crisis that will affect the sustainability of highland communities. The process lasts quite long because of external and internal influences, leading to ecological exploitation. Agricultural development, is closely related to the influence of government policy. Research focuses on discussing aspects of policy influence on the development of upland agriculture. The research is a qualitative study, using an inductive approach, the case of ethnic thorn communities in Enrekang Regency. The results of the study indicate that the three main policies that influence the development of upland agriculture are: 1). Political policy and government system, 2). Rural development policies and infrastructure, 3). Decentralization or regional autonomy, 4). Economic policies, especially investment and markets. The conclusion is that the development of agriculture is economically progressing in the shadow of the ecological crisis, drought, flooding and impact on humanitarian crisis, because it needs arrangements in land management and the application of technology for agricultural development.
Molecular Identification of Endophytic Fungi from Local Rice and Growth Test on Several Types of Culture Media
Authors: Syamsia Syamsia , Idhan Abubakar , Patappari Amanda , Noerfitryani Noerfitryani , Rahmi Rahmi , Rahim Iradhatullah
Published: April 2020

Local rice is rice that has been cultivated for generations by the community and commonly cultivated without using chemical inputs. Endophytic fungi are fungi that live in the plant tissue and does not cause disease symptoms in the host plants. This study aimed to molecular identifying isolates of MDTA and MDTB endophytic fungi which have been isolated from the local Pulu Mandoti rice plant tissue and growth test on the four types of culture media those were synthetic PDA, natural PDA, MPA, and MEA. The fungi DNA isolation using DNesay Kit. DNA sequencing analysis using the mega BLAST program showed that the MDTB fungus has similarities to Podoscypha bolleana strain 32034 no accession JQ675334 and Podoscypha bolleana strain 32032 no accession JQ675332, whereas the MDTA fungus has similarities to Coprinopsis cinerea A2S3-5 isolate and Coprinopsis cinerea strain CNRMA / F 07-32. The best culture media and sporulation of endophytic fungi is MPA media. This research is the first study to molecular identifying with endophytic fungi from local rice and viability test on the four types of culture media. The results of this study contribute to the diversity of local rice endophytic fungi in Sulawesi.
Food Safety Problems in China: Based on the Illegally Waste Cooking Oil
Authors: Chuangbin Chen , Haisong Nie
Published: April 2020

The illegal oil (coming from the waste cooking oil and animals’ fat, etc.) is being processed as daily edible oil by a series of processing programs in China. It contains enormous toxic carcinogenic substances such as aflatoxin, dioxins, and polychlorinated biphenyls (PCBs), etc. In China, 22 million tons of cooking oil is approximately consumed each year, however, 2-3 million tons (account for 10%) of the illegal oil is circulated back to the daily market finally. This research aims to analyze four parts among the illegal oil. It combines the Chinese food safety legal loophole with the treatments of other developed countries to solve China’s illegal oil problem. What’s more, carrying out a field survey is conducted to understand the source of the illegal oil and have a clear understanding of consumers’ usage. Next, the main reason for the spread of the illegal oil which is from the street stalls and restaurants is revealed. The new technique is also used to transform the illegal oil into biodiesel fuel (BDF), however, the material (the illegal oil) cannot be easily obtained due to many barriers and challenges in China. Based on the field survey results, setting up a specific feedback mechanism for restaurants/hotels and the other policy implications are proposed to China’s governments for solving the illegal oil issue in China.
Production Risk of Seaweed Cultivation in South Sulawesi: Comparison between Cobb-Douglas and Just-Pope Production Function
Authors: Kasim Nur Alam , Megawati Megawati , Arifah Arifah , Hidayati Wiwiek
Published: April 2020

Fluctuation in production on farm of seaweed Eucheuma cottonii could be affected by climate, pests and diseases, input factors, management and socio-economic conditions of farmers. The objectives of this study were (1) analyzed determinants of productivity, (2) analyzed the factors that affected the risk of production, and (3) analyzed the factors that affected productivity after considering the risk of production. The samples used in this study were 210 seaweed farmers selected by using proportional random sampling method. Multiple linear regression model with Cobb-Douglas and Just-Pope production functions were used to analyze the data. The results showed that (1) Productivity of seaweed E. cottonii positively influenced by number of seeds, bond distance of seeds and labor; (2) area of lots, seeds and bond distance of seeds negatively effected the risk of production; and (3) area of lots, seeds, bond distance of seeds, labor, and experience of farmers positively effected the productivity after considering of risks whereas age of farmers affected negatively. Values of regression coefficient had significant affected the productivity of seaweed E.cottonii (Cobb-Douglas model) tended to decline after considering the risk of production (Just-Pope model). This implies that in analyzing seaweed productivity, it needs to consider the risks in the model.
Prices of Agricultural Products and Poverty: How Strongly are the Two Linked?
Authors: Arsyad Muhammad
Published: April 2020

Prices of agricultural products and poverty relationship are the two types of standing issue to solve. This paper tries to argue that price of agricultural products (hereafter, agricultural price) and poverty are strongly related. We employed Correlation (intermediate step) and Path (final step) in the analysis procedure. The results show that, first, the association degree between agricultural input (note as well, that price is crucial factor to get input) with poverty approaching 70%, indicating that agricultural input is good-fit in explaining poverty.  Second, the higher the frequency of getting agricultural extension, and price information for various inputs (and output) in agriculture, the higher the crop productions (agricultural sector, in broad sense) will be gained.  This indicates these two variables (inputs-outputs prices) can also be expected to be important instruments in increasing smallholders’ income and in turn help them living above poverty line.  Farmers household income is strongly affected by prevailing market price. Agricultural price is functioning as intermediate part of income calculation. It is clear that price of agricultural products has a strong linkage with rural poverty alleviation in the country.
Análisis de rendimiento en extracción del código de cadena VCC realizado en el lenguaje de programación Java
Authors: Pinilla-Garzón Carlos Alfonso , Barahona-Rodríguez Cesar Yesid
Published: April 2020

Las imágenes digitales ofrecen características que se pueden obtener computacionalmente. En este trabajo se hace especial énfasis en la obtención del contorno de la imagen y el perímetro, características estas propias de una imagen. La metodología seleccionada para este propósito es la técnica VCC de los códigos de cadena, con la que se extrae el contorno, y la extracción del perímetro mediante la suma del número de celdas en el borde acorde con la conectividad. Para el análisis del rendimiento del algoritmo se toma como variable de medición el tiempo de la extracción de la cadena, con el objetivo de compararla con escenarios de prueba y llevar a cabo un análisis del algoritmo. A fin de probar el rendimiento del código se puso a prueba por medio de mediciones del tiempo computacional en el que tardaban en extraer el código de la cadena VCC, y al realizar las pruebas el descriptor demostró ser lo suficientemente rápido para la recolección de 25, 50 y 100 imágenes. El tiempo obtenido es significativamente diminuto para el ser humano, y se concluye que el algoritmo que implementa el código de cadena VCC es lo suficientemente eficaz al extraer una cantidad límite de imágenes digitales.
Caracterización de señales de EEG relacionadas a potenciales evocados visuales en estado estacionario
Authors: Blanco-Díaz Cristian Felipe , Ruiz-Olaya Andrés Felipe
Published: April 2020

Uno de los paradigmas más utilizados en la literatura para la implementación de un sistema EEG BCI son los potenciales evocados visuales en estado estacionario, estos normalmente surgen en la corteza occipital del cerebro. Para poder visualizar, extraer y clasificar estos, se requieren una serie de etapas. La metodología del estudio se dividió en las fases iniciales en el diseño de un sistema BCI: adquisición, preprocesamiento, extracción y clasificación. En este estudio, se realizó una caracterización de estos potenciales desde la adquisición utilizando el equipo g. Nautilus con el estándar 10-20 de la Universidad Antonio Nariño hasta la clasificación de los datos utilizando los métodos matemáticos CCA y SED en diferentes ventanas de tiempo. Así pues, puesto que en la implementación de un sistema BCI en tiempo real se espera que el tiempo de clasificación sea lo más corto posible para la ejecución rápida de un comando, este tipo de estudios permiten identificar cuáles métodos son los más válidos en la clasificación de estos datos, así como algunas variables a tener en cuenta. Los resultados permiten identificar, entonces, una mejor efectividad en la clasificación de datos con CCA que con SED, además del comportamiento del sistema según las ventanas de tiempo.
Feasibility of a Twitter campaign to promote HPV vaccine uptake among racially/ethnically diverse young adult women living in public housing
Authors: Allen Jennifer , Hollander Justin , Gualtieri Lisa , Falconi Tania M. Alarcon , Savir Stephanie , Agénor Madina
Published: April 2020

Objectives This study assessed the feasibility of implementing a one-month Twitter campaign to promote knowledge about the human papillomavirus (HPV) vaccine among low-income women living in public housing. Methods We recruited a convenience sample (n=35) of women ages 18-26 years who resided in public housing in Massachusetts. We assessed the feasibility and acceptability of the campaign. Online assessed changes in HPV knowledge, attitudes, and vaccine intentions before and after the campaign. Results Most believed that Twitter was an acceptable educational strategy and remained engaged with the campaign throughout the intervention. There were no changes in HPV knowledge, perceived benefits of or barriers to vaccination, decision self-efficacy, or vaccine intentions. Perceived risk for cervical cancer decreased after the campaign. Conclusions The one-month educational campaign was feasible and acceptable but did not result in measurable changes perhaps due to high vaccine awareness and uptake before the intervention. Practice Implications Twitter may be a feasible and acceptable method for promoting knowledge about the HPV vaccine, but more research is needed to understand how best to reach low-income women with low levels of vaccine uptake.
C/EBP-β and SIRT1 regulate IL-18 expression in the proliferative phase endometrium of patients with polycystic ovary syndrome (PCOS)
Authors: Long Xiaoyu , Wang Honghao , Zhu Xiaohui , Li Rong , Yang Yan , Qiao Jie
Published: April 2020

Background：Previous studies have shown that patients with polycystic ovary syndrome (PCOS) tend to suffer from low-grade chronic inflammation. Besides, our previous studies have confirmed that IL-18 is highly expressed in the serum and endometrium of patients with PCOS. Nevertheless, the mechanism underlying IL-18 elevation remains unclear. The aim of this study was to explore the signaling pathways that lead to the up-regulation of IL-18 in the endometrium of PCOS patients. Materials and Methods: By using the TF-Search tool, we predicted that C/EBP-β might be a transcription factor of IL-18, and deacetylase SIRT1 might be involved in its regulation. Consequently, SIRT1 and C/EBP-β in proliferative endometrium of PCOS patients and control groups were analyzed using immunohistochemistry, real-time quantitative PCR and Western Blot; the diagnosis of PCOS was based on the 2003 Rotterdam ESHRE/ASRM criteria. The interaction between C/EBP-β and IL-18 was verified by double luciferase assay. Results: The gene and protein levels of SIRT1 and C/EBP-β in proliferative endometrium of PCOS patients were significantly higher compared to the control group. Immunohistochemical experiments confirmed that SIRT1 was mainly expressed in the endometrial nucleus, while C/EBP-β was mainly expressed in the endometrial nucleus and cytoplasm. The interaction between C/EBP-β and IL-18 was confirmed by double luciferase assay. Conclusion: SIRT1 and C/EBP-β are highly expressed in the endometrium of PCOS patients, and may participate in the regulation of IL-18. These results further our understanding of the role of C/EBP-β in PCOS and may be used as a basis for the development of targeted therapies for this disease.
24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017
Authors: Revegue Marc Harris Dassi Tchoupa , Takassi Elom , Eboua François Tanoh , Desmonde Sophie , Amoussou-Bouah Ursula Belinda , Bakai Tchaa Abalo , Jesson Julie , Dahourou Désiré Lucien , Malateste Karen , Raynaud Jean-Philippe , Arrivé Elise , Leroy Valériane
Published: April 2020

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including timely disclosure of their HIV-serostatus that was explored in the West-African COHADO cohort. We assessed the 24-month outcomes in COHADO, among APHIV in relation to the disclosure of their own HIV-serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. A favorable 24-month outcome was defined when combining being retained in care, without progression to WHO-AIDS stage, with CD4 cell count > baseline CD4 (± 10%) and with virological suppression (viral load [VL] <50 copies/mL). We investigated correlates of APHIV favorable 24-month outcome using multivariate logistic regression. Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); only 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01). Adjusted on sex, age, a 24-month favorable outcome was not associated with HIV-disclosure status but was significantly higher for APHIV living in Lomé compared to those living Abidjan (adjusted odds ratio =4.41, 95%CI:2.29-8.50). Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed accross countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.
Prognostic value of pretreatment platelet counts in lung cancer: a systematic review and meta-analysis
Authors: Yuan Yuan , Zhong Hai , Ye Liang , Li Qian , Fang rong su , Gu Wei , Qian Ying Ying
Published: April 2020

Background : The prognostic value of elevated pretreatment platelet counts remains controversial in lung cancer patients. We performed the present meta-analysis to determine its precise role in these patients. Methods: We employed a multiple search strategy in the PubMed, EMBASE and Cochrane Library databases to identify eligible studies. Disease-free survival (DFS)/progression-free survival (PFS)/time to progression (TTP) and overall survival (OS) were used as outcomes with hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity among the studies and publication bias were also evaluated. Results : A total of 40 studies including 16696 lung cancer patients were eligible for the analysis. Overall, the pooled analysis showed that compared with normal platelet counts, elevated pretreatment platelet counts were associated with poorer OS (HR= 1.54, 95% CI: 1.37-1.72, P<0.001) and poorer DFS/PFS/TTP (HR=1.62, 95% CI: 1.33-1.98, P<0.001) in patients with lung cancer. In subgroup analyses, elevated pretreatment platelet counts were also associated with poorer OS and DFS/PFS/TTP in most subgroups. There was no evidence of publication bias. Conclusions : This meta-analysis revealed that elevated pretreatment platelet counts were an independent predictor of OS and DFS/PFS/TTP in lung cancer patients. Large-scale prospective studies and a validation study are warranted.
The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods
Authors: Parsons Richard Whaddon , Liew Danny , Neville A Munro , Audehm Ralph G , Haikerwal Deepak , Piazza Peter , Lim Kevin , Sindone Andrew P
Published: April 2020

Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF.Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals.Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were aged 18 years and above. Of these patients 16,930 were classified as having ‘definite HF’, 4873 as having ‘probable HF’ and 36,517 as having ‘possible HF’. A further 40,992 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify ‘definite’ HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify ‘probable HF’ patients. The majority of ‘possible’ HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign.Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.
Prognosis of patients with acute exacerbation of combined pulmonary fibrosis and emphysema: A retrospective single-center study
Authors: Ikuyama Yuichi , Ushiki Atsuhito , Kosaka Makoto , Akahane jumpei , Mukai Yuichi , Araki Taisuke , Kitaguchi Yoshiaki , Tateishi Kazunari , Urushihata Kazuhisa , Yasuo Masanori , Yamamoto Hiroshi , Hanaoka Masayuki
Published: April 2020

Background: Previous analyses of combined pulmonary fibrosis and emphysema (CPFE) cohorts have provided conflicting data on the survival of patients with CPFE. Therefore, the aim of this study was to investigate the clinical prognosis of acute exacerbations (AE) of CPFE.Methods: We retrospectively reviewed the medical records of patients who had been treated at the Shinshu University Hospital (Matsumoto, Japan) between 2003 and 2017. We identified 21 patients with AE of CPFE and 41 patients with AE of idiopathic pulmonary fibrosis (IPF) and estimated their prognoses using the Kaplan–Meier method.Results: Treatment content and respiratory management were not significantly different between the two groups before and after exacerbation. At the time of AE, the median serum Krebs von den Lungen-6 level was significantly lower in the CPFE group (Krebs von den Lungen-6: 966 U/µL; white blood cell count: 8810 /µL) than that in the IPF group (Krebs von den Lungen-6: 2130 U/µL, p < 0.001; white blood cells: 10809/µL, p = 0.0096). The baseline Gender-Age-Physiology scores were not significantly different between the two groups (CPFE, 4.5 points; IPF, 4.7 points; p = 0.58). Kaplan–Meier curves revealed that the survival time after AE for patients with CPFE was longer than that for patients with IPF (p < 0.001, log-rank test).Conclusions: Survival prognoses after AE were significantly better for patients with CPFE than that for those with IPF. Our findings may improve the medical treatment and respiratory management of patients with AE-CPFE.
Intermittent Kangaroo Mother Care and the Practice of Breastfeeding Late Preterm Infants: Results from Four Hospitals in Different Provinces of China
Authors: Zhang Bo , Duan Zhiying , Zhao Yingxi , Williams Sarah , Wall Stephen , Huang Limin , Zhang Xiaoqin , Wu Wenli , Yue Jieya , Zhang Lin , Liu Jun , Zhao Gengli
Published: April 2020

Background China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. Methods Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the “KMC group”, those who did not were enrolled in the “No KMC group”. Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. Results Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 hours before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR=2.15 (1.53-3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR=1.61 (1.15-2.25)), be exclusive breast milk feeding at follow-up (OR=2.55 (1.81-3.61)), and use breastfeeding method at follow-up (OR=2.09 (1.44-3.02)). Conclusions Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.
Measurement properties of the Musculoskeletal Health Questionnaire (MSK-HQ): a between country comparison
Authors: Christiansen David Høyrup , McCray Gareth , Winding Trine Nøhr , Andersen Johan Hviid , Nielsen Kent Jacob , Karstens Sven , Hill Jonathan C
Published: April 2020

Background: The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages.Objective: The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain. Methods: MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n=153) and UK (n=166) cohorts. Results: The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients’ own judgment at 3 months exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8-10 points and 26% for the DK cohort and 6-8 points and 29% for the UK cohort.Conclusions: The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.
A Novel Method for Identifying a Parsimonious and Accurate Predictive Model for Multiple Clinical Outcomes
Authors: Diaz-Ramirez Ledif Grisell , Lee Sei J. , Smith Alexander K. , Gan Siqi , Boscardin Walter John
Published: April 2020

Background: Most methods for developing clinical prognostic models focus on identifying parsimonious and accurate models to predict a single outcome; however, patients and providers often want to predict multiple outcomes simultaneously. For example, older adults are often interested in predicting nursing home admission as well as mortality. We propose and evaluate a novel predictor selection method for multiple outcomes.Methods: Our proposed method selected the best subset of common predictors based on the minimum average normalized Bayesian Information Criterion (BIC) across outcomes: the Best Average BIC (baBIC) model. We compared the predictive accuracy (Harrell’s C-statistic) and parsimony (number of predictors) of the baBIC model with a subset of common predictors obtained from the union of optimal models for each outcome (Union model). We used example data from the Health and Retirement Study (HRS) to demonstrate our method and conducted a simulation study to investigate performance considering correlated and uncorrelated outcomes.Results: In the example data, the average Harrell’s C-statistics across outcomes of the baBIC and Union models were comparable (0.657 vs. 0.662 respectively). Despite the similar discrimination, the baBIC model was more parsimonious than the Union model (15 vs. 23 predictors respectively). Likewise, in two simulation scenarios with correlated and uncorrelated outcomes, the mean C-statistic across outcomes of the baBIC and Union models were very similar, and the baBIC model had on average fewer predictors. In the simulations, the baBIC method performed well by identifying the correct predictors most of the time and excluding the incorrect predictors in the majority of the simulations.Conclusions: Our method identified a common subset of variables to predict multiple clinical outcomes with superior parsimony and comparable accuracy to current methods.
Effects of a 12-week workplace counseling program on physical activity and low back pain: a pilot randomized controlled study
Authors: Shimo Kazuhiro , Hasegawa Mami , Mizutani Seiko , Hasegawa Tomomi , Ushida Takahiro
Published: April 2020

Background: Physical activity (PA) is essential in the management and rehabilitation of low back pain (LBP). However, it is not clear that PA interventions in the workplace can improve LBP. This study aimed to investigate the effects of workplace counseling on PA levels, and LBP and physical function among workers.Methods: We recruited 37 people with 12 weeks of LBP who worked as office staff or machinery mechanic in a manufacturing company in Aichi, Japan. Participants were randomly assigned to the intervention group (n = 20) or control group (n = 17). All participants of both groups were affixed with waist-worn accelerometers to monitor PA. The intervention group also received a program of face-to-face counseling with a physical therapist or nurse once a week for 12 weeks to reassure and encourage participants to maintain a high level of PA. PA, LBP severity and physical function were assessed at baseline, 3 and 6 months.Results: Baseline characteristics were similar in both groups. PA was significantly higher in the intervention group than in the control group at 3 and 6 months. In the intervention group, PA and physical function significantly increased at 3 and 6 months from baseline, and LBP severity at 6 months improved significantly from baseline. We calculated the effect size of the PA workplace counseling and found that it had a medium-to-large effect on PA, LBP severity and physical function.Conclusions: Our data suggest that workplace PA intervention can increase PA and improve LBP among workers.Trial registration: UMIN-CTR Clinical Trial UMIN000038864 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044321). Registered 12 December 2019, retrospectively registered.
Appraising Efficiency of OpSite as Coolant in Drilling of Bone
Authors: Effatparvar Mohammad Reza , Jamshidi Nima , Mosavar Alireza
Published: April 2020

Background: During drilling of bone, which is common in clinical surgeries, heat generation increases local temperature in the drilling site. Transmission of excessive heat to the surrounding bone tissue can cause thermal osteonecrosis. Consequently, it may lead to failure of implants and fixation screws or delay in healing process. Using cooling is a method for limiting temperature elevation. Materials and Methods: In this study, through comparing 3 conditions of drilling without cooling, external cooling with normal saline, and external cooling with OpSite spray, the efficiency of OpSite as coolant is studied. In this regard, 2 drill bit diameters, 3 drilling speeds, and 3 drilling feed-rates are considered as drilling variables in the experiments. Results: For the whole experiments, while cooling with normal saline resulted in lower maximum temperatures than without cooling condition, OpSite had even better results and limited the temperature elevation during drilling of bone efficiently.Conclusion: OpSite spray, which has lower infection risks than normal saline on one hand and lower maximum temperature rise with all combinations of drilling parameters on the other hand, can be considered in clinical surgeries for cooling applications.
Identifying genetic variants and pathways associated with extreme levels of fetal hemoglobin in Sickle Cell Disease in Tanzania.
Authors: Nkya Siana , Mwita Liberata , Mgaya Josephine , Kumburu Happiness , Zwetselaar Marco van , Menzel Stephan , Mazandu Gaston Kuzamunu , Sangeda Raphael Z. , Chimusa Emile R. , Makani Julie
Published: April 2020

Background: Sickle cell disease (SCD) is a blood disorder caused by a point mutation on the beta globin gene resulting in the synthesis of abnormal hemoglobin. Fetal hemoglobin (HbF) reduces disease severity, but the levels vary from one individual to another. Most research has focused on common variants which differ across populations and hence do not fully account for HbF variation. Methods: We investigated rare and common genetic variants that influence HbF levels in 14 SCD patients to elucidate variants and pathways in SCD patients with extreme HbF levels (≥7.7% for high HbF) and (≤2.5% for low HbF) in Tanzania. We performed targeted next generation sequencing (Illumina_Miseq) covering exonic and other significant fetal hemoglobin-associated loci, including BCL11A, MYB, HOXA9, HBB, HBG1, HBG2, CHD4, KLF1, MBD3, ZBTB7A and PGLYRP1.Results: Results revealed a range of genetic variants, including bi-allelic and multi-allelic SNPs, frameshift insertions and deletions, some of which have functional importance. Notably, there were significantly more deletions in individuals with high HbF levels (11% vs 0.9%). We identified deletions with high HbF levels and frameshift insertions in individuals with low HbF. CHD4 and MBD3 genes, interacting in the same sub-network, were identified to have a significant number of pathogenic or non-synonymous mutations in individuals with low HbF levels, suggesting an important role of epigenetic pathways in the regulation of HbF synthesis. Conclusions: This study provides new insights in selecting essential variants and identifying potential biological pathways associated with extreme HbF levels in SCD using multiple genomic variants associated with HbF in SCD.
Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year
Authors: Wang Zixin , Mo Phoenix K.H. , Ip Mary , Fang Yuan , Lau Joseph T.F.
Published: April 2020

Background Sexualized drug use (SDU) refers to use of any psychoactive substance before/during sexual intercourse. Chemsex is a subset of SDU, which is defined as the use of some specific psychoactive substances (methamphetamine, mephedrone, γ-hydroxybutyrate, ketamine and cocaine) before/during sexual intercourse. SDU and chemsex are prevalent among gay, bisexual and other men who have sex with men (GBMSM). This study investigated uptake and willingness to use pre-exposure prophylaxis (PrEP) among a sample of GBMSM in Hong Kong with experience of SDU in the past year. Methods A total of 600 GBMSM were recruited by convenient sampling through outreaching in gay venues, online recruitment and peer referral. Participants completed a cross-sectional anonymous telephone interview. This study was based on a subsample of 580 GBMSM self-reported as HIV negative/unknown sero-status. Results: Of the participants, 82 (14.1%) and 37 (6.4%) had experience of SDU and chemsex in the past year. The prevalence of PrEP uptake was 4.0% among all participants and 14.6% among those with experience of SDU in the past year. Among MSM with experience of SDU in the past year who were not on PrEP (n=70), 67.1% were willing to use daily oral PrEP in the next six months. Multivariate logistic regression models showed that positive attitudes toward PrEP (AOR: 2.37, 95%CI: 1.47, 3.82), perceived support from significant others to use PrEP (AOR: 9.67, 95%CI: 2.95, 31.71), and perceived behavioral control of using PrEP (AOR: 19.68, 95%CI: 5.44, 71.26) were significantly associated with higher willingness to use PrEP. Conclusion: GBMSM with experience of recent SDU are potentially good candidates of PrEP implementation. This group of GBMSM reported high prevalence of uptake and willingness to use PrEP. Perceptions related to PrEP based on the Theory of Planned Behavior were significantly associated with willingness to use PrEP.
A randomized pilot study to evaluate graft versus fistula vascular access strategy in older patients with advanced kidney disease: results of a feasibility study
Authors: Murea Mariana , Geary Randolph L , Houston Denise K , Edwards Matthew S , Robinson Todd W , Davis Ross P , Hurie Justin B , Williams Timothy K , Velazquez-Ramirez Gabriela , Bagwell Benjamin , Tuttle Audrey B , Moossavi Shahriar , Rocco Michael V , Freedman Barry I , Williamson Jeff D , Chen Haiying , Divers Jasmin
Published: April 2020

Background. Although older adults encompass almost half of patients with advanced chronic kidney disease, it remains unclear which long-term hemodialysis vascular access type, arteriovenous fistula or arteriovenous graft, is optimal with respect to effectiveness and patient satisfaction. Clinical outcomes based on the initial AV access type have not been evaluated in randomized controlled trials. This pilot study tested the feasibility of randomizing older adults with advanced kidney disease to initial arteriovenous fistula versus graft vascular access surgery.Methods: Patients 65 years or older with pre-dialysis chronic kidney disease or incident end-stage kidney disease and no prior arteriovenous vascular access intervention were randomized in a 1:1 ratio to undergo surgical placement of a fistula or a graft after providing informed consent. Trial feasibility was evaluated as (i) recruitment of ≥70% of eligible participants, (ii) ≥50% to 70% of participants undergo placement of index arteriovenous access within 90 to 180 days of enrollment, respectively, (iii) ≥80% adherence to study-related assessments, and (iv) ≥70% of participants who underwent index arteriovenous access placement will have a follow-up duration of ≥12 months after index surgery date.Results: Between September 2018 and October 2019, 81% (44/54) of eligible participants consented and were enrolled in the study; 11 had pre-dialysis chronic kidney disease and 33 had incident or prevalent end-stage kidney disease. After randomization, 100% (21/21) assigned to arteriovenous fistula surgery and 78% (18/23) assigned to arteriovenous graft surgery underwent index arteriovenous access placement within a median (1st, 3rd quartile) of 5.0 (1.0, 14.0) days and 13.0 (5.0, 44.3) days, respectively, after referral to vascular surgery. The completion rates for study-specific assessments ranged between 40.0 and 88.6%. At median follow-up of 215.0 days, 5 participants expired, 7 completed 12 months of follow-up, and 29 are actively being followed. Assessments of grip strength, functional independence and vascular access satisfaction were completed by >85% of patients who reached pre-specified post-operative assessment time point.Conclusions: Results from this study reveal it is feasible to enroll and randomize older adults with advanced kidney disease to one of two different arteriovenous vascular access placement surgeries. The study can progress with minor protocol adjustments to a multisite clinical trial.Trial registration: Clinical Trials ID: NCT03545113. Registered June 4, 2018.