bluuebunny/crossref_metadata_2025 huggingface dataset:
Complicated versus complexity: when an old woman and her daughter meet the health care system
Authors: Sund Levander Märta , Tingström Pia
Published: October 2020

Background

Detecting infection in frail elderly is a challenge due to lack of specific signs and symptoms. We highlight the complex situation when an elderly woman with urinary tract infection (UTI) and her daughter meet the highly qualified health care system. The aim was to describe and analyze the process when an elderly individual with an acute infection encounters the healthcare system.

Methods

A descriptive, retrospective Single Case Study design with a qualitative approach was used. Data from interviews with the old women and her daughter, medical record data and different regulatory documents were gathered and analysed with a qualitative content analysis. In a second step, the results were interpreted with concepts from the complexity theory. Complexity theory has been used as a conceptual framework for analysis or a framework for interpretation. In this study we are using the theory for interpretation by comparing the results with the complexity theory, which is explored in the discussion.

Results

The latent content analysis of the daughter’s story is interpreted as though she perceives the situation as causing a life crisis and a threat to her mother’s entire existence. The old women herself does not take part in what is happening, though after returning to home she is trying to understand her behaviour and what has happened. The health care tries different diagnoses and treatment according to standardized care plans without success. When urinary tract infection is finally diagnosed and treated successfully, the old women recovers quickly.

Conclusion

The healthcare system should embrace the complexity in the encounter with an elderly individual. However, we found that the immediate reaction from the healthcare system is to handle the patients’ problem as complicated by complexity reduction. Shortcomings are that elderly patients with multiple disorders are difficult to evaluate and triage “correctly” for later placement in the appropriate continuum of care, although the findings of this case study also imply that with time the system instead took on an approach of absorption of complexity.
Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa
Authors: Muhwava Lorrein Shamiso , Murphy Katherine , Zarowsky Christina , Levitt Naomi
Published: October 2020

Background

The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being.

Methods

Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women’s lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach.

Results

Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends.

Conclusions

The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women’s overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.
Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: a national survey
Authors: Kazzaz Yasser M. , Da’ar Omar B.
Published: October 2020

Background

As increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists’ comfort and importance levels of organ donation competencies.

Methods

We conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians’ characteristics.

Results

With a response rate of 76%, we found that 40–60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists’ rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed.

Conclusions

Pediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.
Time trends in the regional distribution of physicians, nurses and midwives in Europe
Authors: Winkelmann Juliane , Muench Ulrike , Maier Claudia B.
Published: October 2020

Background

Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.

Methods

We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005–2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).

Results

There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.

Conclusions

The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.
Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study
Authors: Chen Anqi , Fielding Scott , Hu X. Joan , McLane Patrick , McRae Andrew , Ospina Maria , Rosychuk Rhonda J.
Published: October 2020

Background

This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada.

Methods

Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages.

Results

There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91).

Conclusions

Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.
Estimated costs for the delivery of safer conception strategies for HIV-discordant couples in Zimbabwe: a cost analysis
Authors: Hughes Carolyn Smith , Brown Joelle , Murombedzi Caroline , Chirenda Thandiwe , Chareka Gift , Mhlanga Felix , Mateveke Bismark , Gitome Serah , Makurumure Tinei , Matubu Allen , Mgodi Nyaradzo , Chirenje Zvavahera , Kahn James G.
Published: October 2020

Background

In recent years, safer conception strategies have been developed to help HIV-serodiscordant couples conceive a child without transmitting HIV to the seronegative partner. The SAFER clinical trial assessed implementation of these strategies in Zimbabwe.

Methods

As a part of the SAFER study, we estimated the costs (in 2017 $US) associated with individual and combination strategies, in the trial setting and real-world practice, from a healthcare system perspective. Safer conception strategies included: 1) ART with frequent viral load testing until achieving undetectable viral load (ART-VL); 2) daily oral pre-exposure prophylaxis (PrEP); 3) semen-washing with intrauterine insemination; and 4) manual self-insemination at home. For costs in the trial, we used a micro-costing approach, including a time and motion study to quantify personnel effort, and estimated the cost per couple for individual and combination strategies for a mean of 6 months of safer services. For real-world practice, we modeled costs for three implementation scenarios, representing differences from the trial in input prices (paid by the Ministry of Health and Child Care [MOHCC]), intervention intensity, and increments to current HIV prevention and treatment practices and guidelines. We used one-way sensitivity analyses to assess the impact of uncertainty in input variables.

Results

Individual strategy costs were $769–$1615 per couple in the trial; $185–$563 if using MOHCC prices. Under the target intervention intensity and using MOHCC prices, individual strategy costs were $73–$360 per couple over and above the cost of current HIV clinical practices. The cost of delivering the most commonly selected combination, ART-VL plus PrEP, ranged from $166–$517 per couple under the three real-world scenarios. Highest costs were for personnel, lab tests, and strategy-specific consumables, in variable proportions by clinical strategy and analysis scenario. Total costs were most affected by uncertainty in the price of PrEP, number of semen-washing attempts, and scale-up of semen-washing capacity.

Conclusions

Safer conception methods have costs that may be affordable in many low-resource settings. These cost data will help implementers and policymakers add safer conception services. Cost-effectiveness analysis is needed to assess value for money for safer conception services overall and for safer strategy combinations.

Trial registration

Registry Name: Clinicaltrials.gov. Trial registration number: NCT03049176. Registration date: February 9, 2017.
Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial
Authors: Wijkman Magnus O. , Claggett Brian , Diaz Rafael , Gerstein Hertzel C. , Køber Lars , Lewis Eldrin , Maggioni Aldo P. , Wolsk Emil , Aguilar David , Bentley-Lewis Rhonda , McMurray John J. , Probstfield Jeffrey , Riddle Matthew , Tardif Jean-Claude , Solomon Scott D. , Pfeffer Marc A.
Published: October 2020

Background

The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure.

Methods

We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization.

Results

Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99–1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04–1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86–1.04) P = 0.26; P for interaction 0.005).

Conclusions

The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration.

Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010
miR-21 regulates immunosuppression mediated by myeloid-derived suppressor cells by impairing RUNX1-YAP interaction in lung cancer
Authors: Meng Guangping , Wei Jinying , Wang Yanjun , Qu Danhua , Zhang Jie
Published: October 2020

Background

Myeloid-derived suppressor cells (MDSCs) are known suppressors of antitumor immunity and contribute to immunosuppressive microenvironment during tumor development including lung cancer. Accumulating evidence shows microRNAs (miRNAs) affect tumor-expanded MDSC accumulation and function in tumor microenvironment and favor solid tumor growth. Herein, we aim to characterize the role of miR-21 in regulating the accumulation and activity of MDSCs in lung cancer.

Methods

The proportions of MDSCs, T helper cells (Th), and cytotoxic T lymphocytes (CTL) were evaluated by flow cytometric analyses of peripheral blood and tumor tissues collected from Lewis lung-cancer-bearing mice. T cell proliferation assay was performed in CD4+ or CD8+ T cells cocultured with MDSCs. MDSC apoptosis was examined by flow cytometric analysis. The levels of IL-10, TGF-β, and GM-CSF in mouse serum were determined by ELISA. miR-21 targeting RUNX1 and RUNX1 interaction with YAP were evaluated by RIP, dual-luciferase reporter gene, and ChIP assays.

Results

MiR-21 inhibition by its antagomir reduced the proportion of MDSCs, increased the proportion of Th and CTL in peripheral blood and tumor tissues of Lewis lung-cancer-bearing mice, protected Th and CTL from the suppression of MDSCs, increased apoptosis of MDSCs, but reduced IL-10, TGF-β and GM-CSF levels in mouse serum. RUNX1 could transcriptionally inhibit the YAP expression, whereas miR-21 targeting RUNX1 led to elevated YAP expression levels. Mechanistic investigation showed that miR-21 maintained MDSC accumulation in tumor microenvironment and promoted immunosuppressive ability of MDSCs in Lewis lung-cancer-bearing mice by down-regulating RUNX1and up-regulating YAP.

Conclusions

Taken together, the study provides evidence that targeting miR-21 in MDSCs may be developed as an immunotherapeutic approach to combat lung cancer development.
Prognostic value of systemic immune-inflammation index in patients with urologic cancers: a meta-analysis
Authors: Huang Yilong , Gao Yunfeng , Wu Yushen , Lin Huapeng
Published: October 2020

Background

Several studies have reported that the systemic immune-inflammation index (SII) is associated with the prognosis of patients with urologic cancers (UCs). The aim of this study was to systematically evaluate the prognostic value of SII in UC patients.

Methods

We searched public databases for relevant published studies on the prognostic value of SII in UC patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and pooled to assess the relationships between SII and overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), overall response rate (ORR) and disease control rate (DCR).

Results

A total of 14 studies with 3074 patients were included. From the pooled results, we found that high SII was associated with worse overall survival (OS) in patients with UC (HR 2.58, 95% CI 1.59–4.21). Patients with high SII values also had poorer PFS (HR 1.92, 95% CI 1.29–2.88) and CSS (HR 2.58, 95% CI 1.36–4.91) as well as lower ORRs (HR 0.40, 95% CI 0.22–0.71) than patients with low SII values. In addition, the subgroup analysis of OS and PFS showed that the prognosis of patients with high SII was worse than that of patients with low SII.

Conclusions

SII might be a promising noninvasive predictor in patients with UC. However, more samples and multicenter studies are needed to confirm the effectiveness of SII in predicting the prognosis of patients with UC.
E2F1/2/7/8 as independent indicators of survival in patients with cervical squamous cell carcinoma
Authors: Yang Chang , Zhang Zhao-Cong , Liu Tian -Bo , Xu Ye , Xia Bai-Rong , Lou Ge
Published: October 2020

Background

Cervical cancer is the second leading cause of death in women 20–39 years old. Because coverage for cervical cancer screening is low, and the vaccination rate of human papillomavirus (HPV) is poor in some countries, potential markers to detect the disease at early stages are needed. E2F transcription factors (E2Fs) are a family of transcription factors that function in cell proliferation, differentiation, apoptosis, and tumorigenesis. As abnormal activation and regulation of E2Fs are related to tumor development and poor prognosis, we performed bioinformatic analyses and in vitro assays to evaluate the role of E2Fs in cervical cancer.

Methods

Transcriptional expression of E2Fs was initially evaluated in silico using ONCOMINE and Gene Expression Profiling Interactive Analysis (GEPIA), followed by evaluation of E2F1/2/7/8 protein levels using immunohistochemistry in 88 patient tissues. E2F2 and E2F7 mRNA levels were measured by RT-qPCR. LinkedOmics and Metascape were used to predict functions of E2Fs, and in vitro experiments were performed to assess the tumorigenic role of E2F2 and E2F7.

Results

In silico analysis showed that E2F1/2/7/8 were significantly overexpressed in cervical cancer, findings which were confirmed at the protein level using immunohistochemistry. Further, upregulation of E2F1/2/7/8 was associated with different clinicopathological prognostic factors, including positivity for lymph vessel invasion and deep invasion of cervical stroma. Increased expression of E2F1/2/7/8 was also related to shorter overall survival (OS) and disease-free survival (DFS) in patients with cervical cancer. Using multivariate analysis, we confirmed E2F1/2/7/8 as independent prognostic factors for shorter OS of patients with cervical cancer. Finally, in vitro experiments showed that E2F2 and E2F7 are involved in cell proliferation and migration and cell cycle regulation in both HPV-positive and HPV-negative cervical cancer cells.

Conclusions

E2F1/2/7/8 may be prognostic biomarkers for survival of patients with cervical cancer. E2F2 and E2F7 are involved in cell proliferation, migration, and cell cycle in both HPV-positive and HPV-negative cervical cancer cells.
SLC2A3 promotes macrophage infiltration by glycolysis reprogramming in gastric cancer
Authors: Yao Xingxing , He Zhanke , Qin Caolitao , Deng Xiangqian , Bai Lan , Li Guoxin , Shi Jiaolong
Published: October 2020

Background

Tumors display a high rate of glucose metabolism and the SLC2A (also known as GLUT) gene family may be central regulators of cellular glucose uptake. However, roles of SLC2A family in mechanism of metabolite communication with immunity in gastric cancer remains unknown.

Methods

Bioinformatics analysis and IHC staining were used to reveal the expression of SLC2A3 in gastric cancer and the correlation with survival prognosis. Real-time PCR, western blots, OCR, ECAR, lactate production and glucose uptake assays were applied to determine the effect of SLC2A3 on glycolysis reprogramming. We then investigated the consequences of SLC2A3 upregulation or inhibition on aerobic glycolysis, also explored the underlying mechanism. Bioinformatics analysis and in vitro and in vivo research were used to reveal the role of SLC2A3 in macrophage infiltration and transition.

Results

Here, we show that SLC2A3 acts as a tumor promoter and accelerates aerobic glycolysis in GC cells. Mechanistically, the SLC2A3-STAT3-SLC2A3 feedback loop could promote phosphorylation of the STAT3 signaling pathway and downstream glycolytic targeting genes. Moreover, SLC2A3 potentially contributes to M2 subtype transition of macrophage infiltration in the GC microenvironment.

Conclusions

SLC2A3 could be used as a prognostic biomarker to determine prognosis and immune infiltration in GC and may provide an intervention strategy for GC therapy.
Aryl-hydrocarbon receptor binding and the incidence of type 2 diabetes: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Duncan Bruce B. , Castilhos Cristina D. , Bracco Paula A. , Schmidt Maria I. , Kang Sora , Im Suyeol , Lee Hong-Kyu , Vigo Álvaro , Pak Youngmi K.
Published: October 2020

Background

Persistent organic pollutants (POPs) may cause diabetes, in part through aryl hydrocarbon receptor (AhR) binding. Ensuing mitochondrial dysfunction is postulated to mediate this effect. We aim to investigate the association of POPs with incident diabetes indirectly by bio-assaying AhR ligand bioactivity and intracellular ATP level induced by participant serum samples.

Methods

In incident case-cohort analyses of one ELSA-Brasil center, 1605 eligible subjects without diabetes at baseline had incident diabetes ascertained by self-report, medication use, OGTT or HbA1c at follow-up 4 years later. We assayed AhR ligand bioactivity (AhRL) and intracellular ATP content, the latter reflecting the presence of mitochondria-inhibiting substances (MIS), following incubation of recombinant mouse Hepa1c1c7 cells with participant sera for 71 incident diabetes cases and 472 randomly selected controls.

Results

In multiply-adjusted proportional hazards regression analyses, those with above-median AhRL and below-median MIS-ATP had 69 and 226% greater risk of developing diabetes (HR = 1.69; 95%CI 1.01–2.83 and 3.26; 1.84–5.78), respectively. A strong interaction was seen between the two exposures (HRhigh AhRL/low MIS-ATP vs. low AhRL/high MIS-ATP = 8.15; 2.86–23.2).

Conclusion

The markedly increased incidence of diabetes seen in those with both higher AhR ligand bioactivity and increased mitochondrial inhibition supports the hypothesis that widespread POPs exposure contributes to the diabetes epidemic.
Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018
Authors: Mokhtari-Hessari Parisa , Montazeri Ali
Published: October 2020

Background

Breast cancer still is a topic. This overview of the literature aimed to update the current knowledge on quality of life in breast cancer patients.

Methods

A review of literature in MEDLINE, Cochrane Database of Systematic Reviews and Google Scholar were carried out to identify review papers on health-related quality of life in breast cancer during the 2008 to 2018. All publications were screened using the PRISMA guideline. The methodological quality of reviews was assessed using the AMSTAR. The findings were summarized and tabulated accordingly.

Results

Within over a decade, a total of 974 review papers were identified which according to the study selection criteria finally we have evaluated 82 reviews. Of these about 85% had a reasonable methodological quality. The findings were mainly summarized on several headings including instruments used to measure quality of life, treatment, supportive care, psychological distress, and symptoms. Questionnaires had a good performance to quantify quality of life in breast cancer patients. Most reviews were focused on the impact of treatment including endocrine therapy as well as integrating complementary and alternative medicine into the current practice. According to the reviews, yoga was the most recommended exercise to improve quality of life in breast cancer patients.

Conclusion

Overall, the findings from this overview indicated that quality of life in breast cancer patients enhanced during the last decade. Several simple but effective interventions such as physical activity and psychosocial interventions proved to be effective in improving quality of life in this population. However, management of symptoms such as pain, and lymphedema, issues related to worry, sexual function especially for young patients, and the future outlooks all are among topics that deserve further consideration. Also, this overview indicated that methodological issues in measuring quality of life in breast cancer patients improved greatly, but still there is a long way to go to understand what really matter to patients.
Cytokine profiling of extracellular vesicles isolated from plasma in myalgic encephalomyelitis/chronic fatigue syndrome: a pilot study
Authors: Giloteaux Ludovic , O’Neal Adam , Castro-Marrero Jesús , Levine Susan M. , Hanson Maureen R.
Published: October 2020

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating disease of unknown etiology lasting for a minimum of 6 months but usually for many years, with features including fatigue, cognitive impairment, myalgias, post-exertional malaise, and immune system dysfunction. Dysregulation of cytokine signaling could give rise to many of these symptoms. Cytokines are present in both plasma and extracellular vesicles, but little investigation of EVs in ME/CFS has been reported. Therefore, we aimed to characterize the content of extracellular vesicles (EVs) isolated from plasma (including circulating cytokine/chemokine profiling) from individuals with ME/CFS and healthy controls.

Methods

We included 35 ME/CFS patients and 35 controls matched for age, sex and BMI. EVs were enriched from plasma by using a polymer-based precipitation method and characterized by Nanoparticle Tracking Analysis (NTA), Transmission Electron Microscopy (TEM) and immunoblotting. A 45-plex immunoassay was used to determine cytokine levels in both plasma and isolated EVs from a subset of 19 patients and controls. Linear regression, principal component analysis and inter-cytokine correlations were analyzed.

Results

ME/CFS individuals had significantly higher levels of EVs that ranged from 30 to 130 nm in size as compared to controls, but the mean size for total extracellular vesicles did not differ between groups. The enrichment of typical EV markers CD63, CD81, TSG101 and HSP70 was confirmed by Western blot analysis and the morphology assessed by TEM showed a homogeneous population of vesicles in both groups. Comparison of cytokine concentrations in plasma and isolated EVs of cases and controls yielded no significant differences. Cytokine-cytokine correlations in plasma revealed a significant higher number of interactions in ME/CFS cases along with 13 inverse correlations that were mainly driven by the Interferon gamma-induced protein 10 (IP-10), whereas in the plasma of controls, no inverse relationships were found across any of the cytokines. Network analysis in EVs from controls showed 2.5 times more significant inter-cytokine interactions than in the ME/CFS group, and both groups presented a unique negative association.

Conclusions

Elevated levels of 30-130 nm EVs were found in plasma from ME/CFS patients and inter-cytokine correlations revealed unusual regulatory relationships among cytokines in the ME/CFS group that were different from the control group in both plasma and EVs. These disturbances in cytokine networks are further evidence of immune dysregulation in ME/CFS.
The effect of breastfeeding education with grandmothers’ attendance on breastfeeding self-efficacy and infant feeding pattern in Iranian primiparous women: a quasi-experimental pilot study
Authors: Gharaei Tayebeh , Amiri-Farahani Leila , Haghani Shima , Hasanpoor-Azghady Syedeh Batool
Published: October 2020

Background

One of the most important factors that affects breastfeeding self-efficacy and exclusivity is breastfeeding support provided by the family. The aim of this study was to determine the effect of breastfeeding education sessions for primiparous women, with and without the attendance of maternal grandmothers, on breastfeeding self-efficacy and infant feeding patterns.

Methods

This quasi-experimental study was conducted on 64 primiparous women who referred to the Antenatal Clinic of Amiralmomenin Hospital, Tehran, Iran from June to December, 2018. Eligible pregnant women were allocated into two groups; either with and without grandmothers in attendance. Group assignments were determined according to the week the women had prenatal care at the hospital. All eligible women seen in the clinic during 1 week were assigned to one group and women who presented in the alternating week were assigned to the other group. In the education group with grandmothers in attendance, each woman participated in two prenatal education programs with her mother and one postpartum program approximately 3 h before discharge. In the other group, participating mothers attended breastfeeding education sessions without the grandmother’s attendance. The participating mothers answered questions from the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at the time of the hospital discharge, and 4 and 8 weeks after delivery. Questions about the infants’ feeding patterns were asked by telephone contact with the participating mothers from both groups at the same time periods.

Results

The mean BFSE scores were signficantly different between the groups with grandmothers and without grandmothers at the time of the hospital discharge (60.15 ± 4.47 vs. 56.84 ± 6.22, independent t-test; p = 0.017), and at 4 weeks (61.71 ± 2.66 vs. 56.62 ± 9.12, p = 0.004) and 8 weeks after delivery (63.68 ± 2.14 vs. 60.03 ± 6.32, p = 0.003). No significant difference existed in infant feeding patterns between the groups at the same time periods.

Conclusions

This study suggests that breastfeeding education with grandmothers’ attendance is effective in improving the mothers’ breastfeeding self-efficacy. A family-centered program should be considered in beastfeeding education for increasing of exclusive breastfeeding.
The New Zealand podiatry profession – a workforce in crisis?
Authors: Carroll Matthew , Jepson Hannah , Molyneux Prue , Brenton‐Rule Angela
Published: October 2020

Background

This is the first study to explore workforce data from the Podiatrists Board of New Zealand. The study analysed data from an online survey which New Zealand podiatrists complete as part of their application for an Annual Practising Certificate.

Methods

Survey responses between 2015 and 2019 were analysed. Data was related to work setting, employment status, work hours, location, professional affiliations, and number of graduates entering practice. Survey data was downloaded by a second party who provide data security for the Podiatrists Board of New Zealand workforce data. All data supplied for analysis were deidentified and could not be re‐linked to an individual practitioner.

Results

In 2019 there were 430 podiatrists who held an Annual Practising Certificate. Eighty percent of podiatrists who work in New Zealand are in private practice, with 8% employed in the public health sector. Podiatrist's work is a mix of general podiatry, diabetes care and sports medicine. The majority are self‐employed (40%) or business owners (19%). Approximately 40% work between 31 to 40 h per week and 46 to 50 weeks per year. The majority are female (67%) with most practising in the North Island (69%) and located in the Auckland region (33%). On average 76% of new graduates were issued an Annual Practising Certificate between 2015 and 2019.

Conclusion

The New Zealand podiatry profession is small and growing at a slow rate, consequently there is evidence of a workforce shortage. To maintain a per‐capita ratio of podiatrists approximate to Australia and the United Kingdom an additional 578 podiatrists are required in the New Zealand workforce. There are not enough new graduate practitioners entering the workforce and once practising, the majority enter private practice in the face of limited public health employment opportunities.
The Janus kinase 1/2 inhibitor baricitinib reduces biomarkers of joint destruction in moderate to severe rheumatoid arthritis
Authors: Thudium Christian S. , Bay-Jensen Anne C. , Cahya Suntara , Dow Ernst R. , Karsdal Morten A. , Koch Alisa E. , Zhang Wenling , Benschop Robert J.
Published: October 2020

Background

Tissue released blood-based biomarkers can provide insight into drug mode of action and response. To understand the changes in extracellular matrix turnover, we analyzed biomarkers associated with joint tissue turnover from a phase 3, randomized, placebo-controlled study of baricitinib in patients with active rheumatoid arthritis (RA).

Methods

Serum biomarkers associated with synovial inflammation (C1M, C3M, and C4M), cartilage degradation (C2M), bone resorption (CTX-I), and bone formation (osteocalcin) were analyzed at baseline, and weeks 4 and 12, from a subgroup of patients (n = 240) randomized to placebo or 2-mg or 4-mg baricitinib (RA-BUILD, NCT01721057). Mixed-model repeated measure was used to identify biomarkers altered by baricitinib. The relationship between changes in biomarkers and clinical measures was evaluated using correlation analysis.

Results

Treatment arms were well balanced for baseline biomarkers, demographics, and disease activity. At week 4, baricitinib 4-mg significantly reduced C1M from baseline by 21% compared to placebo (p < 0.01); suppression was sustained at week 12 (27%, p < 0.001). Baricitinib 4-mg reduced C3M and C4M at week 4 by 14% and 12% compared to placebo, respectively (p < 0.001); they remained reduced by 16% and 11% at week 12 (p < 0.001). In a pooled analysis including all treatment arms, patients with the largest reduction (upper 25% quartile) in C1M, C3M, and C4M by week 12 had significantly greater clinical improvement in the Simplified Disease Activity Index at week 12 compared to patients with the smallest reduction (lowest 25% quartile).

Conclusion

Baricitinib treatment resulted in reduced circulating biomarkers associated with joint tissue destruction as well as concomitant RA clinical improvement.

Trial registration

ClinicalTrials.gov NCT01721057; date of registration: November 1, 2012
Study of fractional order pantograph type impulsive antiperiodic boundary value problem
Authors: Ali Arshad , Shah Kamal , Abdeljawad Thabet , Khan Hasib , Khan Aziz
Published: October 2020

In this paper, we study existence and stability results of an anti-periodic boundary value problem of nonlinear delay (pantograph) type implicit fractional differential equations with impulsive conditions. Using Schaefer’s fixed point theorem and Banach’s fixed point theorem, we have established results of at least one solution and uniqueness. Also, using the Hyers–Ulam concept, we have derived various kinds of Ulam stability results for the considered problem. Finally, we have applied our obtained results to a numerical problem.
A multi-fault diagnosis method of gear-box running on edge equipment
Authors: Zhao Xiaoping , Lv Kaiyang , Zhang Zhongyang , Zhang Yonghong , Wang Yifei
Published: October 2020

Edge computing equipment is a new tool that has been widely used to monitor the operation state of industrial equipment and to diagnose and analyze faults. Therefore, the fault diagnosis algorithm used in the edge computing device plays an especially significant role in fault diagnosis. The application of deep learning method in mechanical fault diagnosis has been gradually popularized, because it has many advantages, such as strong classification ability and accurate feature extraction ability. However, many of the completed papers and models are based on single label system and are used to diagnose single target fault. The validation set is not rigorous enough, and it is difficult to accurately simulate the faults that may occur in the actual production process. Nowadays, in the era of big data, the single label system ignores the joint relationship of different fault types, and it is difficult to make a correct judgment for the location, type and degree of mechanical failure. Hence, in the process of experiment, we used the bearing data of Case Western Reserve University(CWRU) to ensure the wide range and large quantity of data sets. A fault diagnosis method of gear and bearing in the gear-box based on multi-task deep learning model is put forward. In this method, gear and bearing faults can be diagnosed simultaneously. Through a separate task layer, this method can adaptively extract the characteristics of distinct targets from the same signal, and add a Batch Normalization layer(BN) to accelerate the convergence speed of the network. Through experiments, we conclude that it is an effective method which can judge the fault situation of gear and bearing accurately in a variety of working conditions.
Incentives for Danish healthcare management based on a pilot outcome-based, patient-centric management model in psoriasis and psoriatic arthritis: the non-interventional IMPROVE study
Authors: Thomsen Simon Francis , Skov Lone , Kristensen Lars Erik , Hedegaard Morten Størling , Kjellberg Jakob , Jørgensen Tanja Schjødt , Brenøe Søren , Dodge Rikke
Published: October 2020

Background

Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients’ quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA.

Methods

The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1–3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark.

Results

Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important ‘clusters’ of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely.

Conclusion

The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems.

Trial registration

Not applicable; data collected from patient registries in Denmark.
Safety risk assessment of heritage buildings in metro construction based on SPA theory: a case study in Zhengzhou, China
Authors: Wang Qian , Yang Changming , Tian Lin , Lu Jiguang , Wu Fengwen , An Jianyong
Published: October 2020

While the urban rail transit systems have been developed rapidly, the nearby heritage buildings and historic sites are facing possible threats of unexpected damages. In particular, a rail project has a potential impact on numerous heritage buildings and sites in an old city. Thus, to better protect these heritage buildings and sites, it is crucial for decision-makers to be able to rapidly and accurately evaluate these threats. Based on Set Pair Analysis (SPA) theory, this study developed a risk assessment model to assess the safety of heritage buildings adjacent to metro construction. In this model, the risk levels of adjacent heritage buildings are ranked. Moreover, this study establishes an assessment index system comprising 16 individual indexes among four categories related to heritage building, metro, soil, and management. The index system determines the interval values for each evaluation factor. To improve the reliability of the index weight, a linear weighting method was adopted. In this study, both subjective weights calculated via the Analytic Hierarchy Process (AHP) and objective weights calculated by the Clustering Weight Method (CWM) are analyzed comprehensively. Moreover, a case study was conducted by applying the proposed assessment model into assessing the structural safety risk of a heritage building adjacent to the Zhengzhou Metro Line Three. It was found the results of the proposed model were consistent with the Matter-Element (ME) method. The proposed model can be used to provide decision-making support for controlling risk on similar projects.
Hospitalized COVID-19 patients treated with convalescent plasma in a mid-size city in the Midwest
Authors: Hartman William R. , Hess Aaron S. , Connor Joseph P.
Published: October 2020

Background

SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.

Methods

Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.

Results

31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.

Conclusion

Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.