bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of individual creativity, psychological capital, and leadership autonomy support on hospital employees’ innovative behaviour
Authors: Slåtten Terje , Mutonyi Barbara Rebecca , Lien Gudbrand
Published: October 2020

Background: There is growing interest in and focus on healthcare services research to identify factors associated with innovation in healthcare organizations. However, previous innovation research has concentrated primarily on the organizational level. In contrast, this study focuses on innovation by individual employees. The specific aim is to examine factors with potential impact on individual employee innovation in hospital organizations. Thus, the study significantly deepens and broadens previous research on innovation in the domain of health services.Methods: A conceptual model was developed and tested on a sample of hospital employees (n=1008). Partial least-squares structural equation modelling (PLS-SEM) was used to analyse the data with SmartPLS 3 software in two steps involving a measurement model and a structural model. Mediation analysis was used to test the proposed indirect effects.Results: Hospital employees’ individual innovative behaviour is directly and positively associated with individual creativity (b = 0.440), psychological capital (b = 0.34) and leadership autonomy support (b = 0.07). The relationships between leadership autonomy support, psychological capital and individual innovative behaviour are all mediated by employees’ creativity. Psychological capital mediates the relationship between leadership autonomy support and individual innovative behaviour. Overall, the proposed model explains 50% of the variance in hospital employees’ innovative behaviour.Conclusions: This study reveals a complex pattern of links between innovative behaviour and leadership autonomy support, employees’ creativity and employees’ psychological capital. However, the findings indicate that leadership autonomy support has an influential and multifaceted impact on hospital employees’ innovative behaviour.
A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes
Authors: Al-Turaihi Hassan , Elizabeth Blears , Kavin Sugumar , Ganesh Deshmukh
Published: October 2020

Background:Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods:A retrospective review of patients with CF who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were calculated using statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of recurrence.Conclusion:EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and a valid treatment option for CFs.
CD4 T-cell immune stimulation of HER2+ breast cancer cells alters response to trastuzumab in vitro
Authors: Song Patrick , Mansur Amer , Dugger Kari J. , Davis Tessa R. , Howard Grant , Yankeelov Thomas E. , Sorace Anna G.
Published: October 2020

Introduction: The HER2+ tumor immune microenvironment is composed of macrophages, natural killer cells, and tumor infiltrating lymphocytes, which produce pro-inflammatory cytokines. Determining the effect of T-cells on HER2+ cancer cells during therapy could guide immunogenic therapies that trigger antibody-dependent cellular cytotoxicity. This study utilized longitudinal in vitro time-resolved microscopy to measure T-cell influence on trastuzumab in HER2+ breast cancer.Methods: Fluorescently-labeled breast cancer cells (BT474, SKBR3, MDA-MB-453, and MDA-MB-231) were co-cultured with CD4+ T-cells (Jurkat cell line) and longitudinally imaged to quantify cancer cell viability when treated with or without trastuzumab (10, 25, 50 and 100 mg/mL). The presence and timing of T-cell co-culturing was manipulated to determine immune stimulation of trastuzumab-treated HER2+ breast cancer. HER2 and TNF-a expression were evaluated with western blot and ELISA, respectively. Significance was calculated using a two-tailed parametric t-test.Results: The viability of HER2+ cancer cells significantly decreased when exposed to 25 mg/mL trastuzumab and T-cells, compared to cancer cells exposed to trastuzumab without T-cells (p = 0.01). The presence of T-cells significantly increased TNF-a expression in trastuzumab-treated cancer cells (p = 0.02). Conversely, cancer cells treated with TNF-a and trastuzumab had a similar decrease in viability as trastuzumab-treated cancer cells co-cultured with T-cells (p = 0.32).Conclusions: The presence of T-cells significantly increases the efficacy of targeted therapies and suggests trastuzumab may trigger immune mediated cytotoxicity. Increased TNF-a receptor expression suggest cytokines may interact with trastuzumab to create a state of enhanced response to therapy in HER2+ breast cancer, which has potential to reducing tumor burden.
Patterns of informal family care during acute hospitalization of older adults from different ethno-cultural groups in Israel.
Authors: Shulyaev Ksenya , Gur-Yaish Nurit , Shadmi Efrat , Zisberg Anna
Published: October 2020

Introduction Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting is insufficiently researched.Objectives Our study explore potential differences between ethno-cultural groups in the amount and kind of informal support they provide for older adults during hospitalization.Methods This research is a secondary data analysis of two cohort studies conducted in Israeli hospitals. Hospitalized older adults are divided into three groups: Israeli-born and veteran immigrant Jews, Arabs, and Jewish immigrants from the Former Soviet Union (FSU). Duration of caregiver visit, presence in hospital during night hours, type of support (using the Informal Caregiving for Hospitalized Older Adults scale) are assessed during hospitalization. Results are controlled by background parameters including functional Modified Barthel Index (MBI) and cognitive Short Portable Mental Status Questionnaire (SPMSQ) status, chronic morbidity (Charlson), and demographic characteristics.Results Informal caregivers of “FSU immigrants” stay fewer hours during the day in both cohorts, and provide less supervision of medical care in Study 2, than caregivers in the two other groups. Findings from Study 1 also suggest that informal caregivers of “Arab” older adults are more likely to stay during the night than caregivers in the two other groups.Conclusions Ethno-cultural groups differ in their patterns of caregiving of older adults during hospitalization. Health care professionals should be aware of these patterns and the cultural norms that are related to caregiving practices for better cooperation between informal and formal caregivers of older adults.
The implications of clinical risk factors, CAR index, and compositional changes of immune cells on hyperprogressive disease in non-small cell lung cancer patients receiving immunotherapy
Authors: Kim Seo Ree , Chun Sang hoon , Kim Joo ri , Kim Sang-Yeob , Seo Jun young , Jung Chan Kwon , Gil Bo-Mi , Kim Jeong-Oh , Ko Yoon Ho , Woo In Sook , Shim Byoung Yong , Hong Sook-Hee , Kang Jin-Hyoung
Published: October 2020

Background: Immune checkpoint blockades (ICBs) are characterized by a durable clinical response and better tolerability in patients with a variety of advanced solid tumors. However, we not infrequently encounter patients with hyperprogressive disease (HPD) exhibiting paradoxically accelerated tumor growth with poor clinical outcomes. This study aimed to investigate implications of clinical factors and immune cell composition on different tumor responses to immunotherapy in patients with non-small cell lung cancer (NSCLC).Methods: This study evaluated 231 NSCLC patients receiving ICBs between January 2014 and May 2018. HPD was defined as a >2-fold tumor growth kinetics ratio during ICB therapy and time-to-treatment failure of ≤ 2 months. We analyzed clinical data, imaging studies, periodic serologic indexes, and immune cell compositions in tumors and stromata using multiplex immunohistochemistry.Results: Of 231 NSCLC patients, PR/CR and SD were observed in 50 (21.6%) and 79 (34.2%) patients, respectively and 26 (11.3%) patients met the criteria for HPD. Median overall survival in poor response groups (HPD and non-HPD PD) was extremely shorter than region disease-controlled group (SD and PR/CR) (5.5 and 6.1 months vs. 16.2 and 18.3 months, respectively, P= 0.000). In multivariate analysis, HPD were significantly associated with heavy smoker (p=0.0072), PD-L1 expression ≤1% (0.0355), and number of metastatic site ≥3 (0.0297). Among the serologic indexes including NLR, PLR, CAR, and LDH, only CAR had constantly significant correlations with HPD at the beginning of prior treatment, immunotherapy, and at the 1st tumor assessment. The number of CD4+ effector T cells and CD8+ cytotoxic T cells, and CD8+/PD-1+ tumor-infiltrating lymphocytes (TIL) tended to be smaller, especially in stromata of HPD group. More M2-type macrophages expressing CD14, CD68 and CD163 in the stromal area and markedly fewer CD56+ NK cells in the intratumoral area were observed in HPD group.Conclusions: Our study suggests that not only clinical factors including heavy smoker, very low PD-L1 expression, multiple metastases, and CAR index, but also fewer CD8+/PD-1+ TIL and more M2 macrophages in the tumor microenvironment are significantly associated with the occurrence of HPD in the patients with advanced/metastatic NSCLC receiving immunotherapy.
Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis
Authors: Wang Yuan-Chen , Pan Jun , Liu Ya-Wei , Sun Feng-Yuan , Qian Yang-Yang , Jiang Xi , Zou Wen-Bin , Xia Ji , Jiang Bin , Ru Nan , Zhu Jia-Hui , Linghu En-Qiang , Li Zhao-Shen , Liao Zhuan
Published: October 2020

Backgrounds and Aims: A full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades. Methods: Systematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses. Results: In total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI], 0.59%-0.89%), 0.75% (95% CI, 0.43%-1.13%), 0.00% (95% CI, 0.00%-0.00%), 0.94% (95% CI, 0.65%-1.28%), 0.67% (95% CI, 0.32%-1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (-0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time ( P = .0006 and P < .0001). Conclusions: VCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).
Safety and efficacy of a novel cephalomedullary nail in femoral shaft fractures: a retrospective observational cohort in 33 patients
Authors: De Leon Jorge Clint , Tye Cooper Benjamin , Breinholt Connor Scott , Dang Khang H , Karia Ravi A.
Published: October 2020

Background: Despite advances in femoral shaft fracture fixation, the nonunion rate remains relatively high; and there is limited data on the efficacy and failure rate of specific implants. A novel cephalomedullary nail that provides the ability to treat femur shaft fractures in isolation, with associated ipsilateral femur injuries, and provides various options for proximal and distal fixation exists on the market; but little is available on the safety and efficacy of this implant. The aim of this study is to evaluate the early failure rate of this cephalomedullary nail, while comparing the nonunion rate to what is currently presented in the literature. This study is the first of its kind in evaluation of a specific implant for treatment of femoral shaft fractures and ipsilateral pathology.Methods: Patients over 18 years of age, with traumatic femur shaft fractures, treated with this novel cephalomedullary nail and available for a minimum of 3-month follow-up were included for analysis. Retrospective chart review for this retrospective observational cohort study was performed. Demographic data, injury details, AO/OTA fracture classification, and implant details were recorded for each patient. Primary outcome measured was implant failures (screw or nail breakage). Secondary outcomes measured included malunion, nonunion, deep infection, post-operative complications, and need for reoperation. We hypothesize that the union and failure rate will be similar to that reported in the literature for femur shaft fractures.Results: Of the 33 patients included for analysis, 1 patient went on to non-union. There were no cases of implant failure. The single nonunion was a high-energy mechanism, open fracture, and higher level AO/OTA classification. The remaining 32 reached radiographic union at 3 months. Conclusion: The nonunion rate of this novel cephalomedullary nail is comparable to what is reported in the literature. This nail is a safe and effective implant to treat femoral shaft fractures with a variety of ipsilateral femoral shaft injuries and reliably leads fracture union. Further studies are needed analyzing implant failure and comparing specific implants.
Construction of a high density genetic map and QTL mapping of PEG-induced drought tolerance at the early seedling stage in sesame using whole genome re-sequencing
Authors: Liang Junchao , Ye Yanying , Yan Xiaowen , Yan Tingxian , Rao Yueliang , Zhou Hongying , Sun Jian , Le Meiwang
Published: October 2020

BackgroundImprovement in sesame (Sesamum indicum L.) drought tolerance at seedling stage is important for yield stability. Genetic approaches combing with conventional breeding is the most effective way to develop drought-tolerant cultivars. So far, only a few studies have been reported to reveal gene/ quantitative trait loci (QTL) controlling drought tolerance in sesame. To identify the genomic regions associated with drought tolerance, we constructed a high-density genetic map using a recombinant inbred line (RIL) population through whole genome re-sequencing (WGRS) technique. QTLs contributing to three seedling traits were identified under both non-stress and water stress conditions.ResultsThree drought tolerance related traits and their relative values (the ratio of value under stress to value under control condition), including seedling weight (SW), shoot length (SL) and root length (RL), were evaluated under control and PEG-induced osmotic conditions at seedling stage in a RIL population derived from cross of Zhushanbai (ZSB) and Jinhuangma (JHM). Significant variation and high broad sense heritability were observed for all traits except SW under stress condition in the population. With this population, a high-density linkage map with 1354 bin markers was constructed through WGRS strategy. Composite interval mapping analysis was performed for all the traits as well as their relative phenotypic data. A total of 34 QTLs were detected for these traits under both conditions and their relative values, and 13 stable QTLs associated with seven traits were revealed in two independent experiments, explaining on average, 4.95-16.26% of phenotypic variation for each QTL. Four of them contributed more than 10% of phenotypic variation. One region on chromosome 12 contained two major QTLs related to RL under osmotic condition and relative RL. Seven candidate genes underlying major QTLs for drought tolerance were identified according to gene descriptions and variations between parents.ConclusionThe current study reports the first QTL mapping of drought tolerance related traits through a RIL population and first QTL detection of root related trait (root length) in sesame. These findings will provide new genetic resources for molecular improvement of drought tolerance and candidate gene identification in sesame.
Strength and Size of Phosphorus-Rich Patches Determine the Foraging Strategy of Neyraudia reynaudiana
Authors: Cai Liping , Wang Yuzhen , Tigabu Mulualem , Hou Xiaolong , Wu Pengfei , Zhou Chuifan , Ma Xiangqing , Cai Liping
Published: October 2020

Background: Under natural conditions, soil nutrients are heterogeneously distributed, and plants have developed adaptation strategies, such as root morphological plasticity and/or physiological plasticity, to efficiently forage patchily distributed nutrient. Most previous studies examined either patch strength or patch size separately and focused mainly on root morphological plasticity, thus the effects of both patch strength and size on morphological and physiological plasticity are not well understood. In this study, we examined the foraging strategy of Neyraudia reynaudiana (Kunth) Keng ex Hithc, a pioneer grass colonizing degraded sites, with respect to patch strength and size in heterogeneously distributed phosphorus (P), and how foraging patchily distributed P affects total plant biomass. Plants were grown in sand-culture pots divided into ½, ¼, 1/6 compartments and full size and supplied with 0 + 0/30, 0 + 7.5/30 and 7.5 + 0/30 mg P/kg dry soil as KH2PO4 or 0 + 15/15, 0 + 18.5/ 18.5, 7.5 + 15/15 mg kg−1 in the homogenous treatment. The first amount was the P concentration in the central region, and that the second amount was the P concentration in the outer parts of the pot.Results: After 3 months of growth under experimental conditions, significantly (p < 0.05) high root elongation, root surface area, root volume and average root diameter was observed in large patches with high patch strength. Roots absorbed significantly more P in P-replete than P-deficient patches. Whole plant biomass was significantly higher in larger patches with high patch strength than small patches and homogeneous P distribution.Conclusion: The result demonstrates that root morphological and physiological plasticity are important adaptive strategies for foraging patchily distributed P and the former is largely determined by patch strength and size. The results also establish that foraging patchily distributed P resulted in increased total plant biomass compared to homogeneous P distribution.
Effect of APOE ε4 genotype on amyloid-β and tau accumulation in Alzheimer’s disease
Authors: Baek Min Seok , Cho Hanna , Lee Hye Sun , Lee Jae Hoon , Ryu Young Hoon , Lyoo Chul Hyoung
Published: October 2020

Background: To assess the effects of apolipoprotein E (ApoE) ε4 genotype on amyloid-β (Aβ) and tau burden and their longitudinal changes in Alzheimer’s disease (AD) spectrum.Methods: Among 272 individuals who underwent PET scans (18F-florbetaben for Aβ and 18F-flortaucipir for tau) and ApoE genotyping, 187 individuals completed 2-year follow-up PET scans. After correcting for the partial-volume effect, we compared the standardized uptake value ratio (SUVR) for Aβ and tau burden between the ε4+ and ε4- groups. By using a linear mixed-effect model, we measured changes in SUVR in the ApoE ε4+ and ε4- groups.Results: The ε4+ group showed greater baseline Aβ burden in the diffuse cortical regions and greater tau burden in the lateral, and medial temporal, cingulate, and insula cortices. Tau accumulation rate was higher in the parietal, occipital, lateral, and medial temporal cortices in the ε4+ group. In Aβ+ individuals, baseline tau burden was greater in the medial temporal cortex, while Aβ burden was conversely greater in the ε4- group. Tau accumulation rate was higher in the ε4+ group in a small region in the lateral temporal cortex. The effect of ApoE ε4 on enhanced tau accumulation persisted even after adjusting for the global cortical Aβ burden.Conclusions: Progressive tau accumulation may be more prominent in ε4 carriers, particularly in the medial and lateral temporal cortices. ApoE ε4 allele has differential effects on the Aβ burden depending on the existing amyloidosis and may enhance vulnerability to progressive tau accumulation in the AD spectrum independent of Aβ.
Age Distribution and Associated Factors of Cornea Biomechanical Parameter Stress-Strain Index in Chinese Healthy Population
Authors: Liu Guihua , Rong Hua , Pei Ruxia , Du Bei , Jin Nan , Wang Di , Jin Chengcheng , Wei Ruihua
Published: October 2020

Background: To investigate the new cornea Biomechanical parameter stress-strain index (SSI) in Chinese healthy people and the factors associated with SSI. Methods: A total of 175 eyes from 175 participants were included in this study. Axial length was measured with the Lenstar LS-900. Pentacam measured curvature of the cornea and anterior chamber volume (ACV). Cornea biomechanical properties assessments were performed by corneal visualization Scheimpflug technology (Corvis ST). Student’s t-test, one-way ANOVA, partial least square linear regression (PLSLR) and linear mixed effects (LME) model were used in the statistical analysis. Results: The mean (±SD) SSI was 1.14 ± 0.22 (range, 0.66–1.78) in all subjects and affected by age significantly after age of 35 (P < 0.05). In LME models, SSI was significantly associated with age (β=0.526, P<0.001), axial length (AL) (β=-0.541, P<0.001), intraocular pressure (IOP) (β=0.326, P<0.001) and steepest radius of anterior corneal curvature (RsF) (β=0.229, P<0.001) but not with ACV, biomechanical corrected intraocular pressure (bIOP), flattest radius of anterior corneal curvature (RfF) or central corneal thickness (CCT) (P>0.05 for each). Conclusions: SSI increased with age after the age of 35. In addition to age, SSI was positively correlated with RsF and IOP, while negatively correlated with AL.
Frequency of Fabry disease in a Juvenile Idiopathic Arthritis Cohort
Authors: Paim-Marques Luciana , Cavalcante Amanda Virginia , Verçosa Islane , Carneiro Paula , Souto-Maior Marcia , Marques Erlane , Appenzeller Simone
Published: October 2020

Background: Fabry disease (FD) is a rare, X-linked, multisystemic lysosomal storage disorder (LSD) that results from a deficiency in the hydrolase alpha-galactosidase A (⍺-GalA). During childhood, classic FD symptomatology is rare. The majority of children may show non-specific symptoms, including in the musculoskeletal system. The prevalence of FD among juvenile idiopathic arthritis (JIA) patients is unknown. Objective: The aim of this study was to identify the frequency of FD in a JIA cohort, characterizing early clinical symptoms, enzyme titers and GLA genotyping. Methods: Children with JIA followed in a tertiary Children Hospital cohort were selected. Clinical, laboratorial, and familiar information were recorded. Molecular genetic testing to detect GLA gene mutations was performed in girls and enzymatic analysis in boys. Results: In 89 patients (56.2% female, age at disease onset: 8.93 ± 4.35 years), one male (1.12%) patient presented pathogenic mutation in GLA gene, c.1244T>C p.L415P, one female patient had a variant of uncertain significance c.38C>T (p.Ala13Val). The enzymatic activity of alpha galactosidase was slightly decreased in 3 additional (3.4%) patients. We observed the presence of intronic variants in 44.44% patients in our cohort: c.1000-22C> T; c.370-81_-77del; c.640-16A> G; c.10C>T; c.548-125C> G and c.-12G> A. These variants and their combination were associated with clinical symptoms in our cohort.Conclusions: The incidence of FD in our cohort was 1.12%. Intronic variants were associated with symptoms previously described in literature. Screening for FD in JIA may be a reasonable strategy for those with atypical pattern of pain.
A Qualitative Study of Systemic Barriers Encountered by HIV-Positive Immigrants in Spain
Authors: Gogishvili Megi , Flórez Karen , Costa Sergio A. , Huang Terry T.-K.
Published: October 2020

Background: Immigrants are disproportionally impacted by HIV infection in Europe and in Spain. Immigrants are also identified as a vulnerable population during economic crises. Various socioeconomic barriers hinder HIV-positive immigrants from accessing healthcare services in the host country. As a result of the 2008 financial crisis, Spain has implemented multiple austerity measures, one of which was the enactments of Royal Decree Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 which abolished universal healthcare coverage. In this context, this study examined systemic barriers encountered by the participants while accessing health care after the enactments of 2012 RDL and RD. The study also researched distress felt by the participants and their experiences as HIV-positive immigrants living in Spain. Methods: Participants were recruited through a nongovernmental organization (NGO) during routine visits at the their center. A total of 12 participants were interviewed to reach data saturation. Participants were HIV-positive immigrants living in Spain for 1 or more years, allowing for substantial experience with navigating the healthcare system. Thematic analysis was performed to identify common themes in participants’ experiences living as HIV-positive individuals in Spain and confronting systemic barriers to healthcare access. Results: Four primary themes were identified. Participants identified experiencing emotional or physical (eg, side effects of medication) distress in adapting to life as HIV-positive individuals. Participants also expressed experiencing discrimination while living as HIV-positive immigrants in Spain. The primary systemic barrier to accessing health care encountered by participants was the inability to fulfill the requirement of having proof of registration in an Autonomous Community for the required time period, thus not being able to apply for a public health insurance card and utilize free care services. Participants identified a positive impact of third party (NGO, social worker, friend/family member) guidance on their experience of applying for a public health insurance card.Conclusions: HIV-positive immigrants are underserved in Spain. They encounter systemic barriers while accessing healthcare services, and experience fear and/or discrimination. The study underscores the role of NGOs in helping HIV-positive immigrants navigate the healthcare system. More research is needed on comprehensive approaches to address healthcare needs of HIV-positive immigrants in Spain.
Interventions to prevent anastomotic leak after esophageal surgery: A systematic review and meta-analysis
Authors: Grigor Emma J.M. , Kaaki Suha , Fergusson Dean A. , Maziak Donna E. , Seely Andrew J.E.
Published: October 2020

Background: Anastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review and critical appraisal of interventions designed to reduce AL risk. Methods: We searched MEDLINE and Embase from 1946 to January 2019 for randomized controlled trials (RCTs) evaluating interventions to minimize esophagogastric AL. Pooled risk ratios (RR) for AL was performed using random effects. Results: Two reviewers screened 441 abstracts and identified 17 RCTs eligible for inclusion; 11 studies were meta-analyzed. Omentoplasty reduced the risk of AL significantly by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared to no omentoplasty (3 studies, n = 611 patients). Early removal of NG tube reduced AL risk significantly by 62% [RR: 0.38; 95% CI: 0.02, 0.65] compared to prolonged NG tube (2 studies, n = 293 patients); Stapled (vs. hand-sewn) anastomosis did not significantly reduce AL risk [RR: 0.92; 95% CI: 0.45, 1.87] compared to hand-sewn (6 studies, n = 1,454 patients). The quality of evidence was high for omentoplasty (vs. no omentoplasty), moderate for early removal of NG tube (vs. conventional removal), and very low for stapled anastomosis (vs. hand-sewn). Conclusions: This is the first meta-analysis to summarize the graded quality of evidence for all RCT interventions designed to reduce AL following esophagectomy. Our findings demonstrated that omentoplasty reduced the risk of AL with a high quality of evidence. Although early nasogastric tube removal reduced AL risk, there is a need for further research to strengthen the quality of evidence. Evidence profiles presented in our review may help inform the development of clinical practice recommendations. Systematic review registration: CRD42019127181
Warming up Cooling Cooperators
Authors: Ferguson Eamonn , Lawrence Claire , Gemelli Carley , Rozsa Amy , Niekrasz Konrad , Masser Barbara , Davison Tanya
Published: October 2020

The warm-glow of giving is one mechanism proposed to account for high levels of human cooperation. However, little is known about how warm-glow can be harnessed to sustain long-term cooperation to benefit wider society (vaccinations, blood donation). We argue that the power of warm-glow to sustain long-term cooperation cools offs over time but can be warmed-up with a simple intervention message. We test, and confirm this prediction, in a field-based experiment (n = 5,821) comparing warm-glow versus positive affect messages to predict long-term cooperation (blood donation) and confirm our findings in a subsequent implementation study comparing donation attendance in a 3 year pre-implementation period, prior to the warm-glow message being sent to all 1st time donors in Australia (Ns = 90,317, 93,430 & 89,606) to a 2 year post-implementation period (Ns = 81,766 & 88,551). Exogenously manipulated warm-glow can encourage long-term cooperation that benefits society. Wider societal implications are discussed.
A Multi-Tier Approach to Estimate Energy Efficiency in Urban Passenger Mobility
Authors: Gonçalves Daniel Neves Schmitz , Bandeira Renata Albergaria de Mello , Assis Tássia Faria de , D'Agosto Marcio Almeida , Goes George Vasconcelos , Almeida Isabela Rocha Pombo Lessi de , Costa Mariane Gonzales da , Freitas Rodrigo Rodrigues de
Published: October 2020

Background: Recent studies evidence a lack of accurate methods to estimate energy efficiency in urban areas. This is due to the complex nature of obtaining wide range of activity and energy data from a single municipality, especially from developing countries, where data is usually scarce. Under these circumstances, this paper develops a method for estimating the energy efficiency in urban passenger mobility, considering three different levels of detail. The innovative factor is the use of a multi-tier approach to compare and adjust outputs. The method was applied in Sorocaba, Brazil, estimating a baseline of energy efficiency in this city. Results: Results show that energy efficiency varied from 0.67 passenger per kilometer/Mega Joule in 2013 to 0.70 passenger per kilometer /Mega Joule in 2017, which are consistent with the Brazilian passenger transport energy efficiency. Conclusions: The method proved to be an important mechanism for benchmarking purposes and for the decision-making process on transport investments. Moreover, it can be applied in cities from countries with different cultural and economic contexts.
Dog Breeds and Body Conformations with Predisposition to Osteosarcoma in the UK: A Case-Control Study
Authors: Edmunds Grace Louise , Smalley Matthew J , Beck Sam , Errington Rachel J , Gould Sara , Winter Helen , Brodbelt David C , O'Neill Dan G
Published: October 2020

BackgroundOsteosarcoma is an aggressive and painful bone neoplasm in dogs. Previous studies have reported epidemiological associations suggesting that large body mass, long bone length and the genetics of certain breeds including the Rottweiler are associated with elevated osteosarcoma risk. However, these studies were often limited by selection bias and confounding, and have rarely offered insights into breed-associated protection as well as breed-associated predisposition for osteosarcoma. The current study includes 1756 osteosarcoma cases presenting to VPG Histology (Bristol, UK) that are compared against a control population of 905,211 dogs without osteosarcoma taken from primary care electronic patient records in the VetCompass™ dataset. Methods and Study DesignRetrospective, case-control study. Multivariable logistic regression analysis explored associations between demographic risk factors (including breed, chondrodystrophy, age, sex/neuter status, skull-shape, and body mass) and osteosarcoma. ResultsWe identified several breeds with increased and reduced odds of osteosarcoma. At highest risk were the Rottweiler and Great Dane, with >10 times the odds of osteosarcoma compared with crossbreeds, and the Rhodesian Ridgeback; which has not featured in previous lists of at-risk breeds for osteosarcoma, and had an odds ratio of 11.31 (95% confidence interval 7.37 - 17.35). Breeds at lowest risk of osteosarcoma (protected breeds) included the Bichon Frise, the French Bulldog and the Cavalier King Charles Spaniel, all with odd ratios of less than 0.30 compared with crossbreeds. Body mass was strongly associated with osteosarcoma risk; dogs over 40kg exhibited osteosarcoma odds of 45.44 (95% confidence interval 33.74 - 61.20) compared with dogs less than 10kg. Chondrodystrophic breeds had an osteosarcoma odds ratio of 0.13 (95% confidence interval 0.11 - 0.16) compared with non-chondrodystrophic breeds. ConclusionsOverall, this study provides evidence of strong breed-associated osteosarcoma risk and protection, suggesting a genetic basis for osteosarcoma pathogenesis. The study findings highlight that breeds bred for long legs or large body mass are generally overrepresented amongst at-risk breeds, whilst those bred for short leg length or small body mass are generally protected. These findings could inform genetic studies to identify osteosarcoma risk alleles in canines and humans; as well as increasing awareness amongst vets and owners, resulting in improved breeding practices and clinical management of osteosarcoma in dogs.
Proper positioning of mice for Cobb angle radiographic measurements
Authors: Chen Zhe Yi , Luk Keith Dip Kei , Song You Qiang , Gao Bo , Cheung Jason Pui Yin
Published: October 2020

BackgroundThere is no recommended standard for positioning of a mouse for radiographic assessment of the spine. This is necessary to have reproducible radiographic data and avoid false positive results. The objective of this study was to investigate the impact of various postures on Cobb angle measurements and to set up a positioning standard for imaging mouse spines. MethodsThis study was conducted in three parts. Firstly, we identified the problem of lack of posture standardization for radiographs. We collected 77 C57BL/6J mice for spine radiographs and found a scoliosis prevalence of 28.6% with large variations in curve magnitude. Secondly, 24 C57BL/6J mice underwent 4 consecutive weekly radiographs and observed high variations (relative standard deviation: 125.3%) between radiographs. Thirdly, we collected another 82 C57BL/6J mice and designed 14 different postures that could take place during imaging. These postures were related to curling of the limbs, and head, pelvic and tail tilting. ResultsThe results showed that head and pelvic tilting significantly affects the curve magnitude with effect size (Glass’s delta) over 1.50. Avoiding these incorrect positions during radiographs is warranted. The standard recommended posture for mouse imaging entails positioning the snout, interorbital space, neck and whole spine in one line, and with the limbs placed symmetrical to the trunk, whilst avoiding stretching the body of the mouse. ConclusionsOur work exemplified the importance of standard protocol during imaging when using animal model in the scoliosis study. We recommend utilizing this standard in studying various disorders of the spine.
Joint Modeling in Detecting Predictors of Cd4 Cell Count and Status of Tuberculosis Among HIV Infected Patients Under HAART at Felege Hiwot Teaching and Specialized Hospital, North-west Ethiopia
Authors: Agegn Setegn Byabil , Tegegn Awoke seyoum
Published: October 2020

Background: Globally, the number of TB patients who had been diagnosed with HIV status reached 2.1 million, which is equivalent to 34 % of notified cases of TB. This research was conducted with the objective to identify potential predictors for the status of TB and CD4 cell count for adult HIV patients at Felege Hiwot Teaching and Specialized Hospital North-west Ethiopia.Methods: A retrospective repeated measures were taken from a sample of 226 HIV patients. Separate and joint models were conducted for data analysis of CD4 cell count and TB status of HIV infected patients. Results: The descriptive statistics indicates that among the HIV patients under HAART, 26.6% had additional TB cases. Hence, the expected number of CD4 cell count of HIV patients who were co-infected with TB was decreased by 2.34 as compared to HIV patients who were free from TB. In joint analysis, age, opportunistic infectious disease, adherence to medication, body mass index and social supports were significantly associated with CD4 cell count and TB status. In addition, one-way interaction terms (time * educational level) was also associated with both outcomes. As patients’ age increased by one year, the expected number of CD4 cell count was decreased by 0.025 cells per/mm3 keeping the other variables constant. The expected number of CD4 cell count for patients whose status were ambulatory was decreased by 3.95 as compared to working status. Both separate and joint modeling approach revealed consistent results for significant predictors. However, joint models were more adequate and efficient. Conclusions: Among the predictors of CD4 cell count and TB status, WHO stages, age of patients, functional status of patients, hemoglobin level and residence area were significant predictors for the variable of interests. More attention should be given for HIV/TB co- infected ambulatory and bedridden patients.
Trends in Suicide Mortality in Montenegro From 2000 to 2018
Authors: Stevović Lidija Injac , Repišti Selman , Radojičić Tamara , Injac Olivera
Published: October 2020

Background: This is an ecological study that analyzes suicides committed in Montenegro during the 2000-2018 period, taking into account gender, age and methods of suicide. Methods: Suicide rates and trends up until 2009 were obtained from the official registers of Bureau of Statistics of Montenegro (MONSTAT) while the later data were obtained from the Department of Interior’s. MONSTAT also provided data on unemployment and average salary. As per statistical methods, descriptive and correlations were calculated. Results: The average crude suicide rate was 21.06, for males 29.93 and for females 12.42. Crude suicide rates were not associated with unemployment rate or average salary. However, the unemployment rate was significantly correlated with lethal methods of suicide, namely suicide by firearm and by hanging. Average net salary was negatively correlated with suicide by firearm. Conclusions: The ratio of males and females who committed suicide was 2.41. In the last three years, this ratio continues to rise in favor of males (reaching 4.29 in 2018). This could be explained by specific cultural features where males are expected to be the main financial contributors to the households. The labor market of Montenegro does not offer adequate opportunities to set and maintain a stable economic situation which puts additional pressure and stress on males.
Family Socioeconomic Position and Lung Cancer Risk: A Meta-analysis and a Mendelian Randomization Study
Authors: Wang Runchen , Li Caichen , Huo Zhenyu , Ge Fan , Zhong Ran , Jiang Yu , Wen Yaokai , Su Zixuan , Liang Hengrui , Cheng Bo , Li Jianfu , Xiong Shan , He Jianxing , Liang Wenhua
Published: October 2020

BackgroundFamily socioeconomic position (SEP) in childhood is an important factor to predict some chronic diseases. However, the association between family SEP in childhood and the risk of lung cancer is not clear. MethodsA systematic search was performed to explore their relationship. We selected education level, socioeconomic positions of parents and childhood housing conditions to represent an individual family SEP. Hazard ratios (HRs) of lung cancer specific-mortality were synthesized using a random effects model. Two-sample Mendelian randomization (MR) was carried out with summary data from published genome-wide association studies of SEP to assess the possible causal relationship of SEP and risk of lung cancer. ResultsThrough meta-analysis of 13 studies, we observed that poorer SEP was associated with increased lung cancer risk (HR: 1.25, 95% CI: 1.10, 1.43). In addition, the dose-response analysis revealed a negative correlation between SEP in childhood and lung cancer in adulthood. Same conclusion was reached in MR [(education level) OR 0.50, 95% CI: 0.39, 0.63; P: <0.001]. ConclusionsThis study indicates that poor family SEP in childhood is a causal risk factor for lung cancer. We believe this population may receive greater benefit from lung cancer screening programs.Systematic review registrationProspero ID: 159082
A Study on the Standard Setting, Validity and Reliability of the Standardized Patient Performance Rating Scale – Student Version
Authors: Gonullu Ipek , Dogan Celal Deha , Erden Sengul
Published: October 2020

BackgroundA standardized patient is a healthy person, trained to role-play a patient who gives feedback on the performance of the student. During the clinical skills training of students, the performance of a standardized patient is essential for the effectiveness of clinical education. MethodsIn this study, we have developed and determined the psychometric properties and standard-setting of the 9-item "Standardized Patient Performance Rating Scale – Student Version," which is designed for assessing the individual performance of standardized patients. For the scale development process, 702 medical students and seven educators participated in the study. Exploratory and confirmatory factor analyses were performed. Cronbach's alpha internal consistency coefficient and split-half reliability coefficient were calculated. For the standard-setting study, the extended Angoff method was used. ResultsAs a result of the exploratory factor analysis, the scale had a single-factor structure as confirmed by confirmatory factor analysis. Cronbach's alpha internal consistency coefficient was calculated as 0.91. The score of a standardized patient at the borderline was 24.11 out of 45.Conclusions"Standardized Patient Performance Rating Scale – Student Version" is a valid and reliable scale for assessing standardized patients' performances, and can be used for the standardized patient selection and evaluation process in the health sciences.
tRNA-Derived Fragments in Seminal Plasma Exosomes Are Non-invasive Biomarkers for Diagnosis of Non-obstructive Azoospermia With Spermatogenic Failure
Authors: Zhu Zuobin , Han Xiaoxiao , Li Ying , Zhu Yao , Li Zhenbei , Zhang Qiang , Wang Liang , Chen Hongjin , Hao Lin , Hu Fangfang , Cao Yijuan , Han Conghui
Published: October 2020

BackgroundThere is lack of accurate and non-invasive preoperative evaluation for improving microdissection testicular sperm success rate. tRNA-derived small RNA (tsRNAs) perform a variety of physiological functions and are related to many physiological and pathological processes. This study sought to identify the potential of exosomal tsRNA as a novel non-invasive diagnostic biomarker for non-obstructive azoospermia (NOA) with spermatogenic failure.MethodsSeminal plasma exosome tsRNA levels were used in a two-stage (screened by tsRNA sequencing on Illumina NextSeq instrument and validated by qRT-PCR) case-control designed study. The expression levels of the selected tsRNAs were further examined in the testicular tissues of NOA patients and obstructive azoospermia (OA) patients, and their underlying role in the pathogenesis of non-obstructive azoospermia was performed by bioinformatic analysis.ResultsIn this study, two tsRNAs (tRF-Val-AAC-010: AUC = 0.96, specificity = 80%, sensitivity = 95%; tRF-Pro-AGG-003: AUC = 0.96, specificity = 87%, sensitivity=95%) were found to have a good predictive accuracy which also showed differential expression in testicular tissue between NOA patients and OA patients. We also found that the combinations of tRF-Val-AAC-010 and tRF-pro -AGG-003 have a better discriminating ability between NOA patients and OA patients than single biomarkers. Finally, the bioinformatic analysis showed that the two selected tsRNAs were involved in spermatogenesis.ConclusionThis study first evaluated tsRNAs as potential biomarkers for NOA diagnosis and identified the exosomal tRF-Val-AAC-010 and tRF-pro-AGG-003 in seminal plasma valuable as biomarkers for NOA diagnosis.