bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum Contraceptive Use and Its Determinants in Ethiopia: A Systematic Review and Meta-analysis
Authors: Mehare Tsegaye , Mekuriaw Birhanie , Belayneh Zelalem , Sharew Yewbmirt
Published: January 2020

Background. Postpartum contraceptive use is defined as the avoidance of short spaced pregnancies and unintended pregnancy through the first 12 months after delivery. In Ethiopia, different studies have been conducted to assess the prevalence of postpartum contraceptive use and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of postpartum contraceptive use and determinants in Ethiopia using the accessible studies. Methods. The articles were identified through electronic search of reputable databases (MEDLINE through PubMed, EMBASE, HINARI, Science Direct, and Cochrane Library) and the hand search of reference listed in previous prevalence studies to retrieve more. 18 articles are included based on a comprehensive list of inclusion and exclusion criteria. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was used to analyze the data. The Cochrane Q and I2 test were used to assess the heterogeneity between the studies. A random effects model was calculated to estimate the pooled prevalence of postpartum contraceptive use. Moreover, the determinants for family planning use were reviewed. Results. The pooled prevalence of family planning use among mothers during the postpartum period in Ethiopia was 48.11% (95% CI: 36.96, 59.27). Besides, subgroup analysis revealed that the highest family planning use prevalence among postpartum mothers was observed in Addis Ababa, 65.41 (95% CI: 48.71, 82.11). Resumed sexual activity: 7.91 (95% CI: 4.62, 13.55), antenatal care: 4.98 (95% CI: 2.34, 10.21), secondary school and above level of maternal education: 3.53 (95% CI: 1.67, 7.45), postnatal care: 3.16 (95% CI: 1.7, 5.88), menses resumption: 3.12 (95% CI: 1.52, 6.39), and ≥6 months of postpartum period: 2.78 (95% CI: 1.97, 3.93) have shown a positive association with the use of family planning among mothers in the postpartum epoch. Conclusions. In this study, family planning use among mothers of the postpartum period in Ethiopia was significantly low compared to the existing global commendation on postpartum contraceptive use. Resumed sexual activity, antenatal care, secondary and above level of maternal education, postnatal care, menses resumption, and postpartum period≥6 months were found to be significantly associated with postpartum contraceptive use.
On the Chameleonic Behaviour of Cholesterol through a Fractal/Multifractal Model
Authors: Tesloianu Nicolae Dan , Ghizdovat Vlad , Agop Maricel , Rusu Cristina , Cardoneanu Anca
Published: January 2020

An increasing number of studies are beginning to show that both low-density lipoprotein and high-density lipoprotein cholesterol can constitute risk factors for myocardial infarction. Such a behaviour has been called by experts in the field the “chameleonic effect” of cholesterol. In the present paper, a fractal/multifractal model for low-density lipoprotein and high-density lipoprotein cholesterol dynamics is proposed. In such a context, a fractal/multifractal tunneling effect for systems with spontaneous symmetry breaking is analyzed so that if the spontaneous symmetry breaking is assimilated to an inflammation (in the form of a specific scalar potential), then a coupling between two fractal/multifractal states can be observed. These two states, which have been associated to biological structures such as low-density lipoprotein and high-density lipoprotein, transfer their states through a fractal/multifractal tunneling effect. Moreover, in our opinion, the widely used notions of “good” and “bad” cholesterol must be redefined as two different states (low-density lipoprotein and high-density lipoprotein) of the same biological structure named “cholesterol.” In our work, for the first time in the specialized literature, low-density lipoprotein and high-density lipoprotein have been regarded as two different states of the same biological structure (named “cholesterol”), such as in nuclear physics, the neutron and proton are two different states of the same particle named nucleon.
From Regular Catharsis with Castor Oil to Recognizing the Importance of the Intestinal Microbiota
Authors: Settanni Carlo Romano , Ianiro Gianluca , Franceschi Francesco , Gasbarrini Giovanni , Gasbarrini Antonio
Published: January 2020

The need to shed light on the unknown aspects of pathophysiology of common disorders, such as gastrointestinal ones, has led researchers through last decades to study and define the role of microorganisms within the human intestine and their interactions with the host. The progress of technology has permitted the overcoming of culture-based methods to study microbes and paved the way to molecular techniques, which allow the analysis of microbial genome, microbial functions, and metabolism. These progresses opened a window on the world of microbiology and permitted to deepen into the key role played by gut microbiota and dysbiosis in health status and diseases, both gastrointestinal and extraintestinal. So, scientists focused their attention in developing new strategies to restore eubiosis and to manipulate gut microbes by modifying dietary habits, administrating antibiotics, probiotics, and prebiotics and using fecal microbiota transplantation as treatment of gastrointestinal, infectious, cardiovascular, metabolic, immune-mediated, neuro-psychiatric, and oncological disorders. The next challenges will be to elaborate standard protocols with definite outcomes predictors in disease-specific settings.
Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Authors: Shah Shreyansh , Liang Li , Kosinski Andrzej , Hernandez Adrian F. , Schwamm Lee H. , Smith Eric E. , Fonarow Gregg C. , Bhatt Deepak L. , Feng Wuwei , Peterson Eric D. , Xian Ying
Published: January 2020

Background

Guidelines recommend against the use of intravenous tPA (tissue-type plasminogen activator; IV tPA) in acute ischemic stroke patients with prior ischemic stroke within 3 months. However, there are limited data on the safety of IV tPA in this population.

Methods and Results

A retrospective observational study of patients ≥66 years of age linked to Medicare claims and treated with IV tPA at Get With The Guidelines–Stroke hospitals (February 2009 to December 2015). We identified 293 patients treated with IV tPA who had a prior ischemic stroke within 3 months and 30 655 with no history of stroke. Patients with prior stroke had a higher stroke severity (median National Institutes of Health Stroke Scale, 11 [6–19] versus 11 [6–18]; absolute standardized difference, 11.2%) and a higher prevalence of cardiovascular comorbidities. Patients with prior stroke had a higher unadjusted risk for symptomatic intracranial hemorrhage (7.7% versus 4.8%) and in-hospital mortality (12.6% versus 8.9%), but these differences were not statistically significant after adjustment. When stratified by prespecified time epochs, the elevated risk for symptomatic intracranial hemorrhage was seen only within the first 14 days (16.3% versus 4.8%; adjusted odds ratio [aOR], 3.7 [95% CI, 1.62–8.43]) but not in other epochs (2.1% versus 4.8%; aOR, 0.38 [95% CI, 0.05–2.79] for 15–30 days and 7.4% versus 4.8%; aOR, 1.36 [95% CI, 0.77–2.40] for 31–90 days). In addition, patients with prior stroke were significantly more likely to have a combined outcome of in-hospital mortality or discharge to hospice (25.9% versus 17.0%; aOR, 1.70 [95% CI, 1.21–2.38]), less likely to be discharged to home (28.3% versus 32.3%; aOR, 0.72 [95% CI, 0.54–0.98]), or to have good functional outcomes at discharge (modified Rankin Scale, 0–1; 11.3% versus 20.0%; aOR, 0.46 [95% CI, 0.24–0.89]).

Conclusions

Stroke providers need to continue to be vigilant about the safety of IV tPA in patients with prior stroke, particularly those with an event in the previous 14 days.
Effects of Dopaminergic Drugs on Cognitive Control Processes Vary by Genotype
Authors: Furman Daniella J. , White Robert L. , Naskolnakorn Jenna , Ye Jean , Kayser Andrew , D'Esposito Mark
Published: January 2020

Dopamine (DA) has been implicated in modulating multiple cognitive control processes, including the robust maintenance of task sets and memoranda in the face of distractors (cognitive stability) and, conversely, the ability to switch task sets or update the contents of working memory when it is advantageous to do so (cognitive flexibility). In humans, the limited specificity of available pharmacological probes has posed a challenge for understanding the mechanisms by which DA, acting on multiple receptor families across the PFC and striatum, differentially influences these cognitive processes. Using a within-subject, placebo-controlled design, we contrasted the impact of two mechanistically distinct DA drugs, tolcapone (an inhibitor of catechol-O-methyltransferase [COMT], a catecholamine inactivator) and bromocriptine (a DA agonist with preferential affinity for the D2 receptor), on the maintenance and switching of task rules. Given previous work demonstrating that drug effects on behavior are dependent on baseline DA tone, participants were stratified according to genetic polymorphisms associated with cortical (COMT Val158Met) and striatal (Taq1A) DA system function. Our results were partially consistent with an inverted-U-shaped relationship between tolcapone and robust rule maintenance (interaction with COMT genotype) and between bromocriptine and cued rule switching (interaction with Taq1A genotype). However, when task instructions were ambiguous, a third relationship emerged to explain drug effects on spontaneous task switching (interaction of COMT genotype and bromocriptine). Together, this pattern of results suggests that the effects of DA drugs vary not only as a function of the DA system component upon which they act but also on subtle differences in task demands and context.
Reforming Social Customs through Law: Dynamics and Discrepancies in the Nationalist Reform of the Adoptive Daughter-in-Law
Authors: Du Yue
Published: January 2020

Tongyang, rearing daughters-in-law from childhood, was widely practiced as a form of bride price marriage and transactional family building in late imperial and Republican China. Denounced as feudal and backward in twentieth-century public discourse, this time-honored and once legally-protected form of marriage went through significant law reforms in the Republican era. This article examines how the Nationalist Guomindang (GMD) party-state (1928-1949) re-conceptualized tongyang by introducing foreign-inspired notions of parenthood as duty-bound guardianship, and marriage as a union of free choice between spouses. The reformed law annulled the legal relationship between “parents-in-law” and their adoptive daughters-in-law, which enabled adoptive daughters-in-law and their natal parents to dissolve previously established tongyang arrangements through litigation. But outside the courtroom, the Nationalist state adopted a non-interventionist approach toward the practice of tongyang, and took no actions to identify people who violated the law. This particular way of reforming social customs through reforming the law limited the effect of the GMD anti-tongyang legislation on a deeply-rooted social practice. The Nationalist reform of the adoptive daughter-in-law provides historians with a useful lens to discuss the dilemma Nationalist lawmakers faced as they treaded between the lines of offending popular customs and enforcing a rigid new social order through law, the balance of which was intimately connected with the regime’s legitimacy.
Effect of Annealing on the Structural and Optical Properties of Amorphous Ge8Se60Te30Sb2 Thin Films
Authors: Singh Pravin Kumar , Shukla Nitesh , Rao Vandita , Dwivedi D. K.
Published: January 2020

Thin film of Ge8Se60Te30Sb2 was synthesized by conventional melt quench technique. The structural properties of the pre annealed and post annealed films were studied by XRD characterization. Once the Ge8Se60Te30Sb2
film is annealed in the temperature range of 373–413 K for 2 h, it is observed that there is a continuous change in structure and formation of some polycrystalline structures in the amorphous phases. The optical transmission of these films was studied in the range 300–1000 nm as
a function of photon wavelength. The band gap value suggests that sample is a semiconductor. The optical band gap Eg was observed to decrease in the range 373–413 K with increasing annealing temperature. The absorption coefficient (α) and extinction coefficient
(k) were also evaluated. Annealing induced effect on the optical parameters was described on the basis of defect states and density of localized states arises from amorphous to crystalline phase transformation.
Globalization and wartime trade
Authors: Sadeh Tal , Feldman Nizan
Published: January 2020

This article argues that on balance globalization does not increase, and may even reduce, the opportunity cost of Militarized Interstate Disputes (MIDs), as measured by foregone merchandise trade. Specifically, globalization makes it easier for states to substitute trade partners, makes it difficult to employ trade sanctions, makes credit more available to states at conflict, and encourages trade-substituting horizontal Foreign Direct Investment (FDI) and sanctions-resilient vertical FDI. Hypotheses are supported using High Dimensional Fixed Effects regression, applied to a Gravity model, with two-way clustering of standard errors, and an analysis of the effect of globalization on the marginal effect of MIDs on international trade. This suggests that while wars are becoming infrequent in recent decades, due to other factors, trade’s contribution to peace is diminishing.
Discourses and Discursive Identities of Teachers Working as University-Based Teacher Educators in Singapore
Authors: Tan Mei Ying
Published: January 2020

This study made explicit the discourses of 10 teachers working as university-based teacher educators in Singapore to understand their enacted identities. It framed identity as discursive, constructed through language and talk. Interview data were analyzed using descriptive discourse analysis tools, with critical discourse analysis influencing the process. The discourses are as follows: (a) The value of seconded teachers is located firmly within schools, with practice and practitioner elevated above theory and academics; (b) teaching is the core role of seconded teachers, and discourses about learning, development, and research are weak; and (c) an individualistic framing situates the locus of change on teacher-practitioners. Hybrid spaces that bring theory and practice together are discursive spaces. Both the strengths and limitations of existing discursive identities need to be acknowledged, and multifaceted and complex practitioner identities explored. This article contributes to the integration of practitioners into the wider community of teacher educators in the university.
Robust control of two-link manipulator with disturbance torque and time-varying mass loads
Authors: Li Zhan , Huang Deqing
Published: January 2020

Robot manipulators play important roles in helping people do repetitive dull jobs marvelously, with taking advantage of redundancy and flexibility. Two-link manipulators are one kind of basic manipulators and are applied in industrial and medical fields. In many application scenarios, external disturbances and time-varying mass loads may appear to have negative vibration effects on motion control for manipulators, and control algorithms that can eliminate such effects are urgently required. This paper proposes a novel control approach for accurate control of two-link manipulator with disturbance joint torques and time-variant mass loads. The proposed control algorithm can make the joint angle error to sustain in a limited bound under disturbances. Meanwhile, the proposed control method is able to make the two joints of the manipulator globally converge to zero if disturbances disappear. Simulation results show the efficiency of the proposed control approach for control of the two-link manipulator with disturbance torques and time-varying mass loads, and performance comparisons with other conventional control methods demonstrate its superiority.
The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia—a pilot randomized controlled trial
Authors: Øra Hege Prag , Kirmess Melanie , Brady Marian C , Partee Iselin , Hognestad Randi Bjor , Johannessen Beate Bertheau , Thommessen Bente , Becker Frank
Published: January 2020

Objective:

Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects.

Design:

Pilot single-blinded randomized controlled trial.

Setting:

Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers.

Subjects:

People with naming impairment due to aphasia following stroke.

Intervention:

Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language.

Main measures:

Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat.

Results:

No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported.

Conclusion:

Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.
Distant metastases and synchronous malignancies on FDG-PET/CT in patients with head and neck cancer: a retrospective study
Authors: Flygare Lennart , Al-Ubaedi Amal , Öhman Wilhelm , Mo Susanna Jakobson
Published: January 2020

Background

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been proven to be a good method to detect distant spread of head and neck cancer (HNC). However, most prior studies are based on Asian populations and may not be directly transferable to western populations.

Purpose

To investigate the frequency and distribution of distant metastases and synchronous malignancies detected by PET/CT in HNC in a northern Swedish population.

Material and Methods

All primary whole-body FDG-PET/CT examinations performed on the suspicion of HNC (n = 524 patients) between 1 January 2013 and 31 December 2016 at Umeå University Hospital in Sweden were retrospectively reviewed . After the exclusion of 189 examinations without evidence of primary HNC, 335 examinations were analyzed.

Results

Distant metastases were detected in 10 (3%) patients, all with advanced primary tumors corresponding to TNM stage 3–4, most frequently in salivary gland adenocarcinoma, where 50% of patients had distant spread. Four patients had metastases below the diaphragm, representing 20% of the salivary gland malignancies. In the remaining six patients, metastases were supraphrenic, of which all but one were identified by CT alone. Synchronous malignancies were discovered in 14 (4.2%) patients, of which five were below the diaphragm.

Conclusion

The overall frequency of distant spread and synchronous malignancy in primary HNC was generally low. However, the risk for distant metastases below the diaphragm was relatively higher in salivary gland adenocarcinoma, supporting whole-body FDG-PET/CT in the primary diagnostic work-up in these patients.
Self-Rated Health Among Older Chinese Americans: The Roles of Acculturation and Family Cohesion
Authors: Wang Kaipeng , Zhang Anao , Sun Fei , Hu Rita X.
Published: January 2020

Background: Previous research has established the influence of acculturation and family cohesion on Chinese Americans’ mental health and health behavior; however, the influence of acculturation and family cohesion on self-rated health among this population has not been examined. The purpose of this study is to examine the association between family cohesion, acculturation, and self-rated health among older Chinese Americans. Method: Data came from structured interviews with 385 Chinese Americans aged 55 and older living in a large metropolitan area in Southwest. We used logistic regression to examine the association between acculturation, family cohesion, and self-rated health. Results: Acculturation was positively associated with self-rated health only among those with medium (odds ratio [OR] = 2.27, p < .05) and high (OR = 1.93, p < .05) family cohesion, but not among those with low family cohesion. Discussion: Findings highlight the significance of involving family members and strengthening family support in the acculturation and supportive services provided to older Chinese Americans.
Performance analysis of a new hydropneumatic inerter-based suspension system with semi-active control effect
Authors: Yang Lin , Wang Ruochen , Meng Xiangpeng , Sun Zeyu , Liu Wei , Wang Yong
Published: January 2020

This paper develops a hydropneumatic inerter-based suspension system theoretical model to analyze its performance, based on the mechanical network theory of inerter and semi-active control. Comparison of the stiffness and damping characteristics among a passive hydropneumatic suspension system, semi-active hydropneumatic suspension system based on skyhook control, and hydropneumatic inerter-based suspension system is conducted. Moreover, the relationship between the internal coefficient of the inerter and the damping coefficient of the hydropneumatic suspension is investigated. The simulation results of the flow–volume curves of the hydropneumatic inerter-based suspension system are close to those of the semi-active hydropneumatic suspension system based on skyhook control. Furthermore, the performance of a quarter vehicle model with the hydropneumatic inerter-based suspension system is analyzed and compared to that with the semi-active hydropneumatic suspension system based on skyhook control. The simulation results show that the performance of the hydropneumatic inerter-based suspension system is as good as that of the semi-active hydropneumatic suspension system based on skyhook control, which means that the hydropneumatic inerter-based suspension system can achieve similar performance for semi-active control suspension. Finally, a prototype is developed, and a comparative bench test is carried out to verify the accuracy of the simulations. In addition, the hydropneumatic inerter-based suspension system can achieve semi-active control performance without additional hardware or energy loss.
Hypodermoclysis as a Strategy for Patients With End-of-Life Cancer in Home Care Settings
Authors: Coelho Tatiana A. , Wainstein Alberto J. A. , Drummond-Lage Ana P.
Published: January 2020

Background:

The increase in the elderly population associated with a higher incidence of cancer strongly endorses palliative care (PC). Hypodermoclysis (HDC) is a feasible technique for drugs and fluids delivery at the home care setting.

Objectives:

To assess the use and benefits of HDC in patients with end-of-life cancer assisted by a single home-based palliative care program (HPCP) in Belo Horizonte, Brazil.

Methods:

This was a retrospective study that analyzed medical charts from patients with end-of-life cancer who were assisted by an HPCP in a 1-year period of time.

Results:

A total of 333 patients, 81.7% with advanced cancer, were included. The most frequent symptoms were fatigue (44.4%) and pain (43.2%). Hypodermoclysis was used in 77.5% of the patients for the administration of fluids or medicines. Continuous palliative sedation was applied to 70.5% of patients. The place of death was home for 90.2% of the patients.

Conclusion:

Receiving home care assistance with palliative intention may decrease the need for dying patients with cancer to visit emergency units, as their symptoms were well controlled. Hypodermoclysis was a safe and effective alternative for hydration and drug delivery when provided and supervised by an experienced team. The place of death is a reliable indicator of the quality of death, and, in this study, the HPCP allowed patients to die at home with their families. It is essential for PC professionals to understand the impact of HDC use at home care setting for patients with end-of-life cancer allowing the increase of quality of death indicators.
Cancer health promotion in Ghana: A survey of community pharmacists’ perception and barriers
Authors: Mensah Kofi B , Oosthuizen Frasia , Bangalee Varsha
Published: January 2020

Available data indicate that cancer has emerged as an important cause of morbidity and mortality in Ghana. Globally, one of the interventions aimed at disease prevention is through health promotion. To our knowledge, there are no published reports examining the practices of community pharmacists towards cancer health promotion in Ghana. This study was set to examine the perception and perceived barriers of community pharmacists in the provision of cancer health promotion services in Ghana.

Methods

A cross-sectional study was conducted using electronic questionnaire to assess the perception and perceived barriers of Ghanaian community pharmacists towards provision of cancer health promotion.

Key findings

The majority of community pharmacists (77.30%) believe that cancer health promotion is an important part of their daily practice. The survey participants were more likely to have a positive perception of the role of the pharmacist if they were older, male, Christian, or had completed the PharmD program ( p < 0.05 for all parameters). Lack of cancer educational materials (69%) was the major perceived barrier in providing cancer health promotion services.

Conclusion

Ghanaian community pharmacists recognise to play an important role in the provision of cancer health promotion service.
Evaluation of prognostic factors for return of urinary and defecatory function in cats with sacrocaudal luxation
Authors: Couper Elizabeth , De Decker Steven
Published: January 2020

Objectives

The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation.

Methods

Medical records and radiographs were reviewed for cats with sacrocaudal luxation. Information obtained from the clinical records included signalment, clinical presentation, concurrent traumatic injuries, treatment details, outcome and survival time. Severity of neurological signs was graded from 1 to 5, based on previous grading systems for cats with sacrocaudal luxation. Degree of vertebral displacement was calculated on survey radiographs. Outcomes were collected from serial neurological examinations and telephone interviews. Cats had to be given a minimum of 30 days to regain urinary function to be included in the study.

Results

Seventy cats were included. Fifty-five of 61 cats (90%) regained voluntary urinary function. A higher neurological grade was associated with a decreased likelihood ( P = 0.01) and longer duration ( P = 0.0003) of regaining urinary function. No significant associations were found between urinary outcome and age, sex, anal tone, perineal sensation, tail base sensation, degree of craniocaudal or dorsoventral sacrocaudal displacement, concurrent orthopaedic injury, tail amputation, defecatory function at diagnosis and survival. Cats that regained defecatory function had longer survival times than those that did not recover defecatory function ( P = 0.03). Defecatory outcome was not significantly associated with any other variables.

Conclusions and relevance

In agreement with previous studies, neurological grade is the most important prognostic indicator for cats with sacrocaudal luxation. Determination of the severity of neurological signs can also aid in advising owners the time frame in which urinary function is expected to return. Faecal incontinence may be a more important prognostic factor than previously suspected.
The development of Garfinkel’s ‘Trust’ argument from 1947 to 1967: Demonstrating how inequality disrupts sense and self-making
Authors: Turowetz Jason , Rawls Anne Warfield
Published: January 2020

Garfinkel began developing his famous Trust argument, that a minimum of equality and reciprocity he called ‘Trust Conditions’ is a prerequisite for sense-making in interaction, while working with Parsons from 1946 to 1952. The argument grounds a social justice approach to social order and meaning with affinities to Durkheim’s ‘implicit conditions of contract’ and Du Bois’ ‘double consciousness’. Tracing the development of the Trust argument, we examine 14 unpublished PhD proposals from 1948 in which Garfinkel formulated his approach through studies of Jewish identity that, with his earlier research on Race and subsequent studies of the ‘pre-medical candidate’ and transgender identity, demonstrate how inequality disrupts normal ordinary practices of sense and self-making. As a social theory, Garfinkel’s position builds on approaches to social action, interaction and language by Parsons, Schutz and Wittgenstein. As a systematic research programme, however, Garfinkel’s ethnomethodology charted new territory. Inspired by his own experiences as a Jewish man, he was the first to focus on how interactional troubles reveal the ‘hidden’ taken-for-granted details of how social objects and identities are cooperatively achieved in interaction and document how inequality interferes with that achievement.
Introducing critical Tiriti policy analysis through a retrospective review of the New Zealand Primary Health Care Strategy
Authors: Came Heather , O’Sullivan D , McCreanor T
Published: January 2020

Background

Te Tiriti o Waitangi was negotiated between the British Crown and Indigenous Māori leaders of Aotearoa New Zealand in 1840. Māori understood the agreement as an affirmation of political authority and a guarantee of British protection of their lands and resources. The Crown understood it as a cession of sovereignty. The tension remains, though legal and political developments in the last 35 years, have established that the agreement places a mandatory obligation on the Crown to protect and promote Māori health. It also requires that Māori may exercise rangatiratanga, or responsibility and authority, in relation to health policy development and implementation.

Methods

Te Tiriti is, then, an instrument against which health policy is justly and efficaciously evaluated. This paper introduces critical Tiriti analysis as such an evaluative method. Critical Tiriti analysis involves reviewing policy documents against the Preamble and the Articles of te Tiriti o Waitangi. The review process has five defined phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Māori final word.

Results

We present a working example of critical Tiriti analysis using the New Zealand Government’s Primary Health Care Strategy published in 2001. This policy analysis found poor alignment with te Tiriti overall and the indicators of its implementation that we propose.

Conclusion

This paper provides direction to policy makers wanting to improve Māori health outcomes and ensure Māori engagement, leadership and substantive authority in the policy process. It offers an approach to analysing policy that is simple to use and, inherently, a tool for advancing social justice.
Pseudomonas aeruginosa-mannose-sensitive hemagglutinin inhibits chemical-induced skin cancer through suppressing hedgehog signaling
Authors: Xiu Dianhui , Cheng Min , Zhang Wenlei , Ma Xibo , Liu Lin
Published: January 2020

Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PAM) is an inactivate P. aeruginosa with mannose-sensitive hemagglutinin. Recently, the anticancer properties of PAM against many cancers have been reported across a range of studies. However, the exact mechanism through which PAM prevents skin cancer remains unclear. The aim of this study is to show to what extent PAM could inhibit the dimethylbenzanthracene (DMBA)/12-O-tetradecanoylphorbol-13-acetate (TPA)-induced skin cancer. JB6 cells were treated by TPA so as to establish an in vitro model. The effects of PAM on proliferation of the cells were analyzed using cell counting kit-8 assays. Effects on epithelial–mesenchymal transition (EMT) were assayed by real-time PCR and Western blotting. A DMBA/TPA-induced skin cancer mouse model was also established. The results showed that TPA promoted EMT changes through the activation of the hedgehog (Hh) pathway, which was reversed by PAM. Moreover, PAM inhibited the cancer growth and Hh pathway in vivo. These data indicate that PAM may serve as a potential anticancer agent for the treatment of skin cancer.

Impact statement

Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PAM) restrained the chemical-induced skin cancer cells in vitro and in vivo partly through suppressing the Hh signaling pathway, indicating that PAM may be a promising anticancer agent for treating skin cancer.
Simulating human–machine coupled model for gait trajectory optimization of the lower limb exoskeleton system based on genetic algorithm
Authors: Ren Bin , Liu Jianwei , Chen Jiayu
Published: January 2020

The lower limb exoskeleton robot is capable of providing assisted walking and enhancing exercise ability of humans. The coupling human–machine model has attracted a lot of research efforts to solve the complex dynamics and nonlinearity within the system. This study focuses on an approach of gait trajectory optimization of lower limb exoskeleton coupled with human through genetic algorithm. The human–machine coupling system is studied in this article through multibody virtual simulation environment. Planning of the motion trajectory is carried out by the genetic algorithm, which is iteratively generated under optimization of a set of specially designed fitness functions. Human motion captured data are used to guide the evolution of gait trajectory generation method based on genetic algorithm. Experiments are carried out using the MATLAB/Simulink Multibody physical simulation engine and genetic algorithm-toolbox to generate a more natural gait trajectory, the results show that the proposed gait trajectory generation method can provide an anthropomorphic gait for lower limb exoskeleton device.
The Need for Precision Medicine to be Applied to Diabetes
Authors: Klonoff David C. , Florez Jose C. , German Michael , Fleming Alexander
Published: January 2020

Precision medicine refers to the tailoring of medical treatment for an individual based on large amounts of biologic and extrinsic data. The fast advancing fields of molecular biology, gene sequencing, machine learning, and other technologies enable precision medicine to utilize this detailed information to enhance clinical management decision-making for an individual in the real time of the disease course. Traditional clinical decision making is based on reacting to a relatively limited number of phenotypes that are determined by history, physical examination, and conventional lab tests. Precision medicine depends on highly detailed profiling of the patient’s genetic, morphologic, and metabolic makeup. The precision medicine approach can be applied to individuals with diabetes to select treatments most likely to offer benefit and least likely to cause side effects, offering prospects of improved clinical outcomes and economic costs savings over current empiric practices. As genetic, metabolomic, immunologic, and other sophisticated testing becomes less expensive and more widespread in the medical record, it is expected that precision medicine will become increasingly applied to diabetes care.
Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma
Authors: Jutesten Henrik , Lydrup Marie-Louise , Landberg Axel , Risberg Daniel , Ekberg Olle , Zackrisson Sophia , Buchwald Pamela
Published: January 2020

Background

Permanent stoma (PS) is common following treatment of anastomotic leakage (AL) after anterior resection (AR) and ways of predicting successful treatment outcome are missing.

Purpose

To explore radiological variables in rectal contrast studies in their relation to end-result of PS following treatment for AL after AR.

Material and Methods

The Swedish Cancer Registry (SCRCR) was explored for AL cases after AR for rectal cancer in patients operated in the region of Skåne from 1 January 2001 to 31 December 2011. Among identified AL cases, patients subjected to radiological imaging consistent with AL were evaluated according to a predetermined set of radiological variables. Information of PS as the end-result after AL treatment were retrieved from medical records.

Results

Thirty-two patients had radiological imaging available for analysis confirming AL after AR; PS rate after a median follow-up of 87 months (range = 21–165) after AR was 62%. Radiological findings compatible with abscess ( P = 0.023) and a leak size ≤6 mm ( P = 0.049) were significantly associated with PS.

Conclusion

In this limited explorative study, our findings suggest that abscess status and leak size could correspond to outcome of PS in treatment for AL after AR. Additional studies are warranted to further explore this subject.
Chinese Paradiplomacy: A Theoretical Review
Authors: Liu Tianyang , Song Yao
Published: January 2020

This article presents a review of the theoretical and empirical studies of paradiplomacy produced to date, focusing on the literature on subnational diplomacy in China, specifically. It argues that the analytical frameworks of previous paradiplomacy studies lead their focus to be restricted to a very limited aspect of the phenomenon only. Moreover, previous studies focusing on the engagement of Chinese provinces in world politics mainly relied on the central-provincial frameworks and susceptible to a geographic bias. This article contributes to the existing literature in two ways: first, by improving the existing framework to better reflect the most essential dimensions of the international actorness of subnational actors and second, by expanding the geographical scope of the study of paradiplomacy to include more non-Western, centralized political system. It presents one of the first academic attempts to systematically review the existing literature regarding paradiplomatic theory and the paradiplomatic activities in China.
Whole genome sequencing of Borrelia miyamotoi isolate Izh-4: reference for a complex bacterial genome
Authors: Kuleshov Konstantin V. , Margos Gabriele , Fingerle Volker , Koetsveld Joris , Goptar Irina A. , Markelov Mikhail L. , Kolyasnikova Nadezhda M. , Sarksyan Denis S. , Kirdyashkina Nina P. , Shipulin German A. , Hovius Joppe W. , Platonov Alexander E.
Published: January 2020

Background

The genus Borrelia comprises spirochaetal bacteria maintained in natural transmission cycles by tick vectors and vertebrate reservoir hosts. The main groups are represented by a species complex including the causative agents of Lyme borreliosis and relapsing fever group Borrelia. Borrelia miyamotoi belongs to the relapsing fever group of spirochetes and forms distinct populations in North America, Asia, and Europe. As all Borrelia species B. miyamotoi possess an unusual and complex genome consisting of a linear chromosome and a number of linear and circular plasmids. The species is considered an emerging human pathogen and an increasing number of human cases are being described in the Northern hemisphere. The aim of this study was to produce a high quality reference genome that will facilitate future studies into genetic differences between different populations and the genome plasticity of B. miyamotoi.

Results

We used multiple available sequencing methods, including Pacific Bioscience single-molecule real-time technology (SMRT) and Oxford Nanopore technology (ONT) supplemented with highly accurate Illumina sequences, to explore the suitability for whole genome assembly of the Russian B. miyamotoi isolate, Izh-4. Plasmids were typed according to their potential plasmid partitioning genes (PF32, 49, 50, 57/62). Comparing and combining results of both long-read (SMRT and ONT) and short-read methods (Illumina), we determined that the genome of the isolate Izh-4 consisted of one linear chromosome, 12 linear and two circular plasmids. Whilst the majority of plasmids had corresponding contigs in the Asian B. miyamotoi isolate FR64b, there were only four that matched plasmids of the North American isolate CT13–2396, indicating differences between B. miyamotoi populations. Several plasmids, e.g. lp41, lp29, lp23, and lp24, were found to carry variable major proteins. Amongst those were variable large proteins (Vlp) subtype Vlp-α, Vlp-γ, Vlp-δ and also Vlp-β. Phylogenetic analysis of common plasmids types showed the uniqueness in Russian/Asian isolates of B. miyamotoi compared to other isolates.

Conclusions

We here describe the genome of a Russian B. miyamotoi clinical isolate, providing a solid basis for future comparative genomics of B. miyamotoi isolates. This will be a great impetus for further basic, molecular and epidemiological research on this emerging tick-borne pathogen.
Prediction of pre-eclampsia in nulliparous women using routinely collected maternal characteristics: a model development and validation study
Authors: Al-Rubaie Ziad T. A. , Hudson H. Malcolm , Jenkins Gregory , Mahmoud Imad , Ray Joel G. , Askie Lisa M. , Lord Sarah J.
Published: January 2020

Background

Guidelines recommend identifying in early pregnancy women at elevated risk of pre-eclampsia. The aim of this study was to develop and validate a pre-eclampsia risk prediction model for nulliparous women attending routine antenatal care “the Western Sydney (WS) model”; and to compare its performance with the National Institute of Health and Care Excellence (NICE) risk factor-list approach for classifying women as high-risk.

Methods

This retrospective cohort study included all nulliparous women who gave birth in three public hospitals in the Western-Sydney-Local-Health-District, Australia 2011–2014. Using births from 2011 to 2012, multivariable logistic regression incorporated established maternal risk factors to develop and internally validate the WS model. The WS model was then externally validated using births from 2013 to 2014, assessing its discrimination and calibration. We fitted the final WS model for all births from 2011 to 2014, and compared its accuracy in predicting pre-eclampsia with the NICE approach.

Results

Among 12,395 births to nulliparous women in 2011–2014, there were 293 (2.4%) pre-eclampsia events. The WS model included: maternal age, body mass index, ethnicity, multiple pregnancy, family history of pre-eclampsia, autoimmune disease, chronic hypertension and chronic renal disease. In the validation sample (6201 births), the model c-statistic was 0.70 (95% confidence interval 0.65–0.75). The observed:expected ratio for pre-eclampsia was 0.91, with a Hosmer-Lemeshow goodness-of-fit test p-value of 0.20. In the entire study sample of 12,395 births, 374 (3.0%) women had a WS model-estimated pre-eclampsia risk ≥8%, the pre-specified risk-threshold for considering aspirin prophylaxis. Of these, 54 (14.4%) developed pre-eclampsia (sensitivity 18% (14–23), specificity 97% (97–98)). Using the NICE approach, 1173 (9.5%) women were classified as high-risk, of which 107 (9.1%) developed pre-eclampsia (sensitivity 37% (31–42), specificity 91% (91–92)). The final model showed similar accuracy to the NICE approach when using lower risk-threshold of ≥4% to classify women as high-risk for pre-eclampsia.

Conclusion

The WS risk model that combines readily-available maternal characteristics achieved modest performance for prediction of pre-eclampsia in nulliparous women. The model did not outperform the NICE approach, but has the advantage of providing individualised absolute risk estimates, to assist with counselling, inform decisions for further testing, and consideration of aspirin prophylaxis.
Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries
Authors: Sum Grace , Koh Gerald Choon-Huat , Mercer Stewart W. , Wei Lim Yee , Majeed Azeem , Oldenburg Brian , Lee John Tayu
Published: January 2020

Background

The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs.

Methods

Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007–10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overalln = 41, 557).

Results

A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina.

Conclusion

Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.