bluuebunny/crossref_metadata_2025 huggingface dataset:
Single limb cable driven wearable robotic device for upper extremity movement support after traumatic brain injury
Authors: Kadivar Zahra , Beck Christopher E , Rovekamp Roger N , O’Malley Marcia K
Published: June 2021

Introduction

Recently, soft exosuits have been proposed for upper limb movement assistance, most supporting single joint movements. We describe the design of a portable wearable robotic device (WRD), “Armstrong,” able to support three degrees-of-freedom of arm movements, and report on its feasibility for movement support of individuals with hemiparesis after traumatic brain injury (TBI).

Methods

We introduce Armstrong and report on a pilot evaluation with two male individuals post-TBI (T1 and T2) and two healthy individuals. Testing involved elbow flexion/extension with and without robotic-assisted shoulder stabilization; shoulder abduction with and without robotic-assisted elbow stabilization; and assisted shoulder abduction and flexion. Outcome measures included range of motion and root mean square trajectory and velocity errors.

Results

TBI subjects performed active, passive, hybrid and active assistive movements with Armstrong. Subjects showed improvements in movement trajectory and velocity. T1 benefited from hybrid, active, and assistive modes due to upper extremity weakness and muscle tone. T2 benefited from hybrid and assistive modes due to impaired coordination. Healthy subjects performed isolated movements of shoulder and elbow with minimal trajectory and velocity errors.

Conclusions

This study demonstrates the safety and feasibility of Armstrong for upper extremity movement assistance for individuals with TBI, with therapist supervision.
Feasibility of a real-time pattern-based kinematic feedback system for gait retraining in pediatric cerebral palsy
Authors: Liu Xuan , Oliveira Nuno , Ehrenberg Naphtaly , Cheng JenFu , Bentley Katherine , Blochlinger Sheila , Shoval Hannah , Barrance Peter
Published: June 2021

Introduction

Visual biofeedback of lower extremity kinematics has the potential to enhance retraining of pathological gait patterns. We describe a system that uses wearable inertial measurement units to provide kinematic feedback on error measures generated during periods of gait in which the knee is predominantly extended (‘extension period’) and flexed (‘flexion period’).

Methods

We describe the principles of operation of the system, a validation study on the inertial measurement unit derived knee flexion angle on which the system is based, and a feasibility study to assess the ability of a child with cerebral palsy to modify a gait deviation (decreased swing phase knee flexion) in response to the feedback.

Results

The validation study demonstrated strong convergent validity with an independent measurement of knee flexion angle. The gait pattern observed during training with the system exhibited increased flexion in the flexion period with maintenance of appropriate extension in the extension period.

Conclusions

Inertial measurement units can provide robust feedback during gait training. A child with cerebral palsy was able to interpret the novel two phase visual feedback and respond with rapid gait adaptation in a single training session. With further development, the system has the potential to support clinical retraining of deviated gait patterns.
Governance of global value chains after the Covid-19 pandemic: A new wave of regionalization?
Authors: Pla-Barber José , Villar Cristina , Narula Rajneesh
Published: June 2021

The disruption of the trade and investment activities of multinational enterprises as a consequence of the Covid-19 pandemic has reinvigorated the debate on the configuration of global value chains (GVCs) as well as the risks and challenges associated with offshoring. This article depicts how the pandemic might affect GVC configuration by driving a trend toward a more regional footprint in industries in which resilience and reliability are critical. Such a shift would create new opportunities for reshoring, and affect both the types of upgrading trajectories and the governance systems in value chains. The article also draws from the intersection of the global-strategy and value-chain fields to propose potential topics and avenues for further research related to these trends.

JEL Classification: M16, M21, M14
The Past as a Benchmark in Defining Turkey’s Status Politics
Authors: Mehmetcik Hakan , Belder Ferit
Published: June 2021

This article deals with Turkey’s status politics since the 2000s, by employing an aspirational constructivist approach that links social psychology with social constructivism in international relations. It focuses on the temporal side of status, stemming from historical identity construction in Turkish foreign policy (TFP) rhetoric and practices under the rule of the Justice and Development Party (JDP) since 2002. Turkey’s status politics is motivated by its past legacies rather than by a peer-to-peer comparison. Therefore, different variances and practices of identity politics in TFP offer valuable insights into its status-seeking practices. The article offers five images of the past that define various role sets and status claims for Turkey.
‘Bonbibi’ Could Wait Till Our Boss Decides: Looking at the Changing Face of the Indian Sundarbans
Authors: Mukhopadhyay Prama
Published: June 2021

Internal migration constitutes a major source of steady flow of population in India, and reports published by the World Economic Forum (WEF),1 2017 state that interstate migration in the country has doubled during 2001–2011, compared to the previous decade.2 In developing countries, such migration is often considered to be an effective way for income diversification for the economically marginalised sections of the society, even though its effect on ‘human development’ is oft debated.

This article would engage with this debate and bring out how migration from the Indian part of the Sundarbans to other parts of the country is not only changing the demography of the region but is also having a strong impact on the local perception and attachment towards the deltaic landscape. By bringing in ethnographic details from a village in the Indian Sundarbans, which was predominately inhabited by the fishing community earlier, this article would bring out how traditional occupations like fishing are slowly losing their popularity in the face of the lure of out-migration, as the very identity of the ‘indigenous’ Sundarban fisher folks—who were once rightfully considered to be the true conservator of the forests—is changing. From there, this article would engage with the broader debate of rethinking whether migration can be considered as a positive indicator of development in such ecologically fragile areas like the Sundarban deltas, which used to indeed have a distinct economic, social and cultural life of its own.
Emerging Therapeutics Based on the Amino Acid Neurotransmitter System: An Update on the Pharmaceutical Pipeline for Mood Disorders
Authors: Hecking Julia , Davoudian Pasha A. , Wilkinson Samuel T.
Published: June 2021

Mood disorders represent a pressing public health issue and significant source of disability throughout the world. The classical monoamine hypothesis, while useful in developing improved understanding and clinical treatments, has not fully captured the complex nature underlying mood disorders. Despite these shortcomings, the monoamine hypothesis continues to dominate the conceptual framework when approaching mood disorders. However, recent advances in basic and clinical research have led to a greater appreciation for the role that amino acid neurotransmitters play in the pathophysiology of mood disorders and as potential targets for novel therapies. In this article we review progress of compounds that focus on these systems. We cover both glutamate-targeting drugs such as: esketamine, AVP-786, REL-1017, AXS-05, rapastinel (GLYX-13), AV-101, NRX-101; as well as GABA-targeting drugs such as: brexanolone (SAGE-547), ganaxolone, zuranolone (SAGE-217), and PRAX-114. We focus the review on phase-II and phase-III clinical trials and evaluate the extant data and progress of these compounds.
Strategies for Including Students With Extensive Support Needs in SWPBIS
Authors: Walker Virginia L. , Loman Sheldon L.
Published: June 2021

Schools that implement School-wide Positive Behavioral Interventions and Supports (SWPBIS) offer a multitiered continuum of supports that increases in intensity to support the behavioral needs of all students within a school. Although the number of schools that have adopted SWPBIS continues to rise, students with extensive support needs (ESN) may be excluded from various aspects of SWPBIS at the Tier 1 and Tier 2 levels. Given that SWPBIS is intended to be fully inclusive, the purpose of this article is to provide educators and other staff with practical tools and guidelines for including students with ESN in Tiers 1 and 2 of SWPBIS. We also present additional considerations for self-assessment, collaborative teaming, and professional development for including students with ESN in SWPBIS.
Disruption of a GATA2-TAL1-ERG regulatory circuit promotes erythroid transition in healthy and leukemic stem cells
Authors: Thoms Julie A. I. , Truong Peter , Subramanian Shruthi , Knezevic Kathy , Harvey Gregory , Huang Yizhou , Seneviratne Janith A. , Carter Daniel R. , Joshi Swapna , Skhinas Joanna , Chacon Diego , Shah Anushi , de Jong Ineke , Beck Dominik , Göttgens Berthold , Larsson Jonas , Wong Jason W. H. , Zanini Fabio , Pimanda John E.
Published: June 2021

Changes in gene regulation and expression govern orderly transitions from hematopoietic stem cells to terminally differentiated blood cell types. These transitions are disrupted during leukemic transformation, but knowledge of the gene regulatory changes underpinning this process is elusive. We hypothesized that identifying core gene regulatory networks in healthy hematopoietic and leukemic cells could provide insights into network alterations that perturb cell state transitions. A heptad of transcription factors (LYL1, TAL1, LMO2, FLI1, ERG, GATA2, and RUNX1) bind key hematopoietic genes in human CD34+ hematopoietic stem and progenitor cells (HSPCs) and have prognostic significance in acute myeloid leukemia (AML). These factors also form a densely interconnected circuit by binding combinatorially at their own, and each other’s, regulatory elements. However, their mutual regulation during normal hematopoiesis and in AML cells, and how perturbation of their expression levels influences cell fate decisions remains unclear. In this study, we integrated bulk and single-cell data and found that the fully connected heptad circuit identified in healthy HSPCs persists, with only minor alterations in AML, and that chromatin accessibility at key heptad regulatory elements was predictive of cell identity in both healthy progenitors and leukemic cells. The heptad factors GATA2, TAL1, and ERG formed an integrated subcircuit that regulates stem cell-to-erythroid transition in both healthy and leukemic cells. Components of this triad could be manipulated to facilitate erythroid transition providing a proof of concept that such regulatory circuits can be harnessed to promote specific cell-type transitions and overcome dysregulated hematopoiesis.
Unravelling the mechanisms driving multimorbidity in COPD to develop holistic approaches to patient-centred care
Authors: Burke H. , Wilkinson T.M.A.
Published: June 2021

COPD is a major cause of morbidity and mortality worldwide. Multimorbidity is common in COPD patients and a key modifiable factor, which requires timely identification and targeted holistic management strategies to improve outcomes and reduce the burden of disease.

We discuss the use of integrative approaches, such as cluster analysis and network-based theory, to understand the common and novel pathobiological mechanisms underlying COPD and comorbid disease, which are likely to be key to informing new management strategies.

Furthermore, we discuss the current understanding of mechanistic drivers to multimorbidity in COPD, including hypotheses such as multimorbidity as a result of shared common exposure to noxious stimuli (e.g.tobacco smoke), or as a consequence of loss of function following the development of pulmonary disease. In addition, we explore the links to pulmonary disease processes such as systemic overspill of pulmonary inflammation, immune cell priming within the inflamed COPD lung and targeted messengers such as extracellular vesicles as a result of local damage as a cause for multimorbidity in COPD.

Finally, we focus on current and new management strategies which may target these underlying mechanisms, with the aim of holistic, patient-centred treatment rather than single disease management.
Effects of mechanical ventilation with expiratory negative airway pressure on porcine pulmonary and systemic circulation: mechano-physiology and potential application
Authors: Hagiwara-Nagasawa Mihoko , Kambayashi Ryuichi , Goto Ai , Chiba Koki , Wada Takeshi , Nunoi Yoshio , Izumi-Nakaseko Hiroko , Takei Yoshinori , Matsumoto Akio , Lurie Keith G. , Sugiyama Atsushi
Published: June 2021

We studied the impact of mechanically regulated, expiratory negative airway pressure (ENAP) ventilation on pulmonary and systemic circulation including its mechanisms and potential applications. Microminipigs weighing about 10 kg were anesthetized (n = 5). First, hemodynamic variables were evaluated without and with ENAP to approximately −16 cmH2O. ENAP significantly increased heart rate and cardiac output, but decreased right atrial, pulmonary arterial and pulmonary capillary wedge pressures. Second, the evaluation was repeated following pharmacological adrenergic blockade, modestly blunting ENAP effects. Third, fluvoxamine (10 mg/kg) was intravenously administered to intentionally induce cardiovascular collapse in the presence of adrenergic blockade. ENAP was started when systolic pressure was < 40 mmHg in the animals assigned to ENAP treatment-group. Fluvoxamine induced cardiovascular collapse within 4 out of 5 animals. ENAP increased systolic pressure to > 50 mmHg (n = 2): both animals fully recovered without neurological deficit, whereas without ENAP both animals died of cardiac arrest (n = 2). ENAP may become an innovative treatment for drug-induced cardiovascular collapse.
PIKE-R2P: Protein–protein interaction network-based knowledge embedding with graph neural network for single-cell RNA to protein prediction
Authors: Dai Xinnan , Xu Fan , Wang Shike , Mundra Piyushkumar A. , Zheng Jie
Published: June 2021

Background

Recent advances in simultaneous measurement of RNA and protein abundances at single-cell level provide a unique opportunity to predict protein abundance from scRNA-seq data using machine learning models. However, existing machine learning methods have not considered relationship among the proteins sufficiently.

Results

We formulate this task in a multi-label prediction framework where multiple proteins are linked to each other at the single-cell level. Then, we propose a novel method for single-cell RNA to protein prediction named PIKE-R2P, which incorporates protein–protein interactions (PPI) and prior knowledge embedding into a graph neural network. Compared with existing methods, PIKE-R2P could significantly improve prediction performance in terms of smaller errors and higher correlations with the gold standard measurements.

Conclusion

The superior performance of PIKE-R2P indicates that adding the prior knowledge of PPI to graph neural networks can be a powerful strategy for cross-modality prediction of protein abundances at the single-cell level.
Identifying genomic islands with deep neural networks
Authors: Assaf Rida , Xia Fangfang , Stevens Rick
Published: June 2021

Background

Horizontal gene transfer is the main source of adaptability for bacteria, through which genes are obtained from different sources including bacteria, archaea, viruses, and eukaryotes. This process promotes the rapid spread of genetic information across lineages, typically in the form of clusters of genes referred to as genomic islands (GIs). Different types of GIs exist, and are often classified by the content of their cargo genes or their means of integration and mobility. While various computational methods have been devised to detect different types of GIs, no single method is capable of detecting all types.

Results

We propose a method, which we call Shutter Island, that uses a deep learning model (Inception V3, widely used in computer vision) to detect genomic islands. The intrinsic value of deep learning methods lies in their ability to generalize. Via a technique called transfer learning, the model is pre-trained on a large generic dataset and then re-trained on images that we generate to represent genomic fragments. We demonstrate that this image-based approach generalizes better than the existing tools.

Conclusions

We used a deep neural network and an image-based approach to detect the most out of the correct GI predictions made by other tools, in addition to making novel GI predictions. The fact that the deep neural network was re-trained on only a limited number of GI datasets and then successfully generalized indicates that this approach could be applied to other problems in the field where data is still lacking or hard to curate.
Metagenomic diagnosis of severe psittacosis using multiple sequencing platforms
Authors: Wang Kaiying , Liu Xiong , Liu Huiying , Li Peihan , Lin Yanfeng , Yin Dongdong , Yang Lang , Li Jinhui , Li Shenlong , Jia Leili , Bai Changqing , Jiang Yongqiang , Li Peng , Song Hongbin
Published: June 2021

Background

Chlamydia psittaci is an avian pathogen that can cause lethal human infections. Diagnosis of C. psittaci pneumonia is often delayed due to nonspecific clinical presentations and limited laboratory diagnostic techniques.

Results

The MinION platform established the diagnosis in the shortest time, while BGISEQ-500 generated additional in-depth sequence data that included the rapid characterization of antibiotic susceptibility. Cytopathy appeared only in cell cultures of BALF. BALF yielded a higher bacterial load than sputum or blood, and may be the most suitable clinical specimen for the genomic diagnosis of severe pneumonia.

Conclusions

This study indicated that the benefits of metagenomic sequencing include rapid etiologic diagnosis of unknown infections and the provision of additional relevant information regarding antibiotic susceptibility. The continued optimization and standardization of sampling and metagenomic analysis promise to enhance the clinical utility of genomic diagnosis.
Complete genome sequence of Arthrobacter sp. PAMC25564 and its comparative genome analysis for elucidating the role of CAZymes in cold adaptation
Authors: Han So-Ra , Kim Byeollee , Jang Jong Hwa , Park Hyun , Oh Tae-Jin
Published: June 2021

Background

The Arthrobacter group is a known set of bacteria from cold regions, the species of which are highly likely to play diverse roles at low temperatures. However, their survival mechanisms in cold regions such as Antarctica are not yet fully understood. In this study, we compared the genomes of 16 strains within the Arthrobacter group, including strain PAMC25564, to identify genomic features that help it to survive in the cold environment.

Results

Using 16 S rRNA sequence analysis, we found and identified a species of Arthrobacter isolated from cryoconite. We designated it as strain PAMC25564 and elucidated its complete genome sequence. The genome of PAMC25564 is composed of a circular chromosome of 4,170,970 bp with a GC content of 66.74 % and is predicted to include 3,829 genes of which 3,613 are protein coding, 147 are pseudogenes, 15 are rRNA coding, and 51 are tRNA coding. In addition, we provide insight into the redundancy of the genes using comparative genomics and suggest that PAMC25564 has glycogen and trehalose metabolism pathways (biosynthesis and degradation) associated with carbohydrate active enzyme (CAZymes). We also explain how the PAMC26654 produces energy in an extreme environment, wherein it utilizes polysaccharide or carbohydrate degradation as a source of energy. The genetic pattern analysis of CAZymes in cold-adapted bacteria can help to determine how they adapt and survive in such environments.

Conclusions

We have characterized the complete Arthrobacter sp. PAMC25564 genome and used comparative analysis to provide insight into the redundancy of its CAZymes for potential cold adaptation. This provides a foundation to understanding how the Arthrobacter strain produces energy in an extreme environment, which is by way of CAZymes, consistent with reports on the use of these specialized enzymes in cold environments. Knowledge of glycogen metabolism and cold adaptation mechanisms in Arthrobacter species may promote in-depth research and subsequent application in low-temperature biotechnology.
Short-term physical exercise impacts on the human holobiont obtained by a randomised intervention study
Authors: Moitinho-Silva Lucas , Wegener Michelle , May Sandra , Schrinner Florian , Akhtar Awais , Boysen Teide J. , Schaeffer Eva , Hansen Clint , Schmidt Timo , Rühlemann Malte C. , Hübenthal Matthias , Rausch Philipp , Kondakci Mustafa T. , Maetzler Walter , Weidinger Stephan , Laudes Matthias , Süß Philip , Schulte Dominik , Junker Ralf , Sommer Felix , Weisser Burkhard , Bang Corinna , Franke Andre
Published: June 2021

Background

Human well-being has been linked to the composition and functional capacity of the intestinal microbiota. As regular exercise is known to improve human health, it is not surprising that exercise was previously described to positively modulate the gut microbiota, too. However, most previous studies mainly focused on either elite athletes or animal models. Thus, we conducted a randomised intervention study that focused on the effects of different types of training (endurance and strength) in previously physically inactive, healthy adults in comparison to controls that did not perform regular exercise. Overall study duration was ten weeks including six weeks of intervention period. In addition to 16S rRNA gene amplicon sequencing of longitudinally sampled faecal material of participants (six time points), detailed body composition measurements and analysis of blood samples (at baseline and after the intervention) were performed to obtain overall physiological changes within the intervention period. Activity tracker devices (wrist-band wearables) provided activity status and sleeping patterns of participants as well as exercise intensity and heart measurements.

Results

Different biometric responses between endurance and strength activities were identified, such as a significant increase of lymphocytes and decrease of mean corpuscular haemoglobin concentration (MCHC) only within the strength intervention group. In the endurance group, we observed a significant reduction in hip circumference and an increase in physical working capacity (PWC). Though a large variation of microbiota changes were observed between individuals of the same group, we did not find specific collective alterations in the endurance nor the strength groups, arguing for microbiome variations specific to individuals, and therefore, were not captured in our analysis.

Conclusions

We could show that different types of exercise have distinct but moderate effects on the overall physiology of humans and very distinct microbial changes in the gut. The observed overall changes during the intervention highlight the importance of physical activity on well-being. Future studies should investigate the effect of exercise on a longer timescale, investigate different training intensities and consider high-resolution shotgun metagenomics technology.

Trial registration

DRKS, DRKS00015873. Registered 12 December 2018; Retrospectively registered.
Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis
Authors: Zhang Xiao-Ming , Chen Denghong , Xie Xiao-Hua , Zhang Jun-E , Zeng Yingchun , Cheng Andy SK
Published: June 2021

Background

The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality.

Methods

We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model.

Results

Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00).

Conclusions

Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.
The sex difference in gait speed among older adults: how do sociodemographic, lifestyle, social and health determinants contribute?
Authors: Sialino Lena D. , Schaap Laura A. , van Oostrom Sandra H. , Picavet H. Susan J. , Twisk Johannes W.R. , Verschuren W. M. Monique , Visser Marjolein , Wijnhoven Hanneke A.H.
Published: June 2021

Background

This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among older women compared to men.

Methods

Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55–81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3–4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) socio-demographic, lifestyle, social and health determinants of gait speed.

Results

Women had a 0.054 m/s (95 % CI: 0.076 − 0.033, adjusted for height and age) lower mean gait speed compared to men. In general, men and women had similar determinants of gait speed. However, higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). More often having a lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In contrast, men more often being a smoker, having a lower physical activity and a smaller personal network size compared to women contributed to a lower gait speed among men (i.e. higher exposure).

Conclusions

Both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among older women. The identified (modifiable) contributing factors should be taken into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice, which is currently often lacking.
Transitions between levels of dependency among older people receiving social care – a retrospective longitudinal cohort study in a Swedish municipality
Authors: Zingmark Magnus , Norström Fredrik
Published: June 2021

Background

Knowledge is scarce on how needs for home help and special housing evolve among older people who begin to receive support from municipal social care. The purpose of this study was to describe baseline distributions and transitions over time between levels of dependency among older persons after being granted social care in a Swedish municipality.

Methods

Based on a longitudinal cohort study in a Swedish municipality, data was collected retrospectively from municipal records. All persons 65 years or older who received their first decision on social care during 2010 (n = 415) were categorized as being in mild, moderate, severe, or total dependency, and were observed until the end of 2013. Baseline distributions and transitions over time were described descriptively and analysed with survival analysis, with the Kaplan-Meier estimator, over the entire follow-up period. To test potential differences in relation to gender, we used the Cox-Proportional hazards model.

Results

Baseline distributions between mild, moderate, severe, and total dependency were 53, 16, 24, and 7.7%. During the first year, between 40 and 63% remained at their initial level of dependency. Among those with mild and moderate levels of dependency at baseline, a large proportion declined towards increasing levels of dependency over time; around 40% had increased their dependency level 1 year from baseline and at the end of the follow-up, 75% had increased their dependency level or died.

Conclusions

Older people in Sweden being allocated home help are at high risk for decline towards higher levels of dependency, especially those at mild or moderate dependency levels at baseline. Taken together, it is important that municipalities make use of existing knowledge so that they implement cost-effective preventative interventions for older people at an early stage before a decline toward increasing levels of dependency.
Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission
Authors: Pettit Natasha N. , Nguyen Cynthia T. , Lew Alison K. , Bhagat Palak H. , Nelson Allison , Olson Gregory , Ridgway Jessica P. , Pho Mai T. , Pagkas-Bather Jade
Published: June 2021

Background

Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19.

Methods

This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics > 48 h following admission or if another source of infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics.

Results

A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n = 76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n = 170), p < 0.001. The median DOT in the post-intervention group was 1.3 days shorter (p < 0.001) than the pre-intervention group, and antibiotics directed at atypical bacteria DOT was reduced by 2.8 days (p < 0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p = 0.001). There were no differences between groups in terms of clinical outcomes.

Conclusion

Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.
Determinants of the continuum of maternal health care in Cambodia: an analysis of the Cambodia demographic health survey 2014
Authors: Chham Savina , Radovich Emma , Buffel Veerle , Ir Por , Wouters Edwin
Published: June 2021

Introduction

Cambodia has achieved significant progress in maternal health, yet remains in the group of countries with the highest maternal mortality ratio in South-East Asia. Extra efforts are needed to improve maternal health through assessing the coverage of maternal health services as a continuum of care (CoC) and identifying the gaps. Our study aims to explore the coverage level of the Optimal CoC by (1) measuring the continuity of optimal antenatal care (ANC), skilled birth attendance (SBA) and optimal post-natal care (PNC), (2) identifying the determinants of dropping out from one service to another and (3) of not achieving the complete CoC.

Method

The study employed data from the Cambodia Demographic Health Survey 2014. We restricted our analysis to married women who had a live birth in the five years preceding the survey (n = 5678). Bi-variate and multivariate logistic regression were performed using STATA version 14.

Results

Almost 50% of women had achieved the complete optimal CoC, while the remaining have used only one or two of the services. The result shows that the level of women’s education was positively associated with the use of optimal ANC, the continuation to using optimal PNC and achieving the complete CoC. More power of women in household decision making was also positively associated with receiving the complete CoC. The birth order was negatively associated with achieving the complete CoC, while exposure to the mass media and having health insurance increased the odds of achieving the complete CoC. Household wealth consequently emerged as an influential predictor of dropping out and not achieving the complete CoC. Receiving all different elements of ANC care improved the continuity of care from optimal ANC to SBA and from SBA to optimal ANC.

Conclusion

The findings urge policy makers to approach maternal health care as a continuum of care with different determinants at each step. Household wealth was found to be the most influential factor, yet the study discovered also other barriers to optimal maternal health care which need to be addressed: future intervention should thus not only aim to increase wealth or health insurance coverage but also stimulate the education of women and empower women to claim power in household decision-making.
Mapping chronic disease prevalence based on medication use and socio-demographic variables: an application of LASSO on administrative data sources in healthcare in the Netherlands
Authors: Füssenich Koen , Boshuizen Hendriek C. , Nielen Markus M. J. , Buskens Erik , Feenstra Talitha L.
Published: June 2021

Background

Policymakers generally lack sufficiently detailed health information to develop localized health policy plans. Chronic disease prevalence mapping is difficult as accurate direct sources are often lacking. Improvement is possible by adding extra information such as medication use and demographic information to identify disease. The aim of the current study was to obtain small geographic area prevalence estimates for four common chronic diseases by modelling based on medication use and socio-economic variables and next to investigate regional patterns of disease.

Methods

Administrative hospital records and general practitioner registry data were linked to medication use and socio-economic characteristics. The training set (n = 707,021) contained GP diagnosis and/or hospital admission diagnosis as the standard for disease prevalence. For the entire Dutch population (n = 16,777,888), all information except GP diagnosis and hospital admission was available. LASSO regression models for binary outcomes were used to select variables strongly associated with disease. Dutch municipality (non-)standardized prevalence estimates for stroke, CHD, COPD and diabetes were then based on averages of predicted probabilities for each individual inhabitant.

Results

Adding medication use data as a predictor substantially improved model performance. Estimates at the municipality level performed best for diabetes with a weighted percentage error (WPE) of 6.8%, and worst for COPD (WPE 14.5%)Disease prevalence showed clear regional patterns, also after standardization for age.

Conclusion

Adding medication use as an indicator of disease prevalence next to socio-economic variables substantially improved estimates at the municipality level. The resulting individual disease probabilities could be aggregated into any desired regional level and provide a useful tool to identify regional patterns and inform local policy.
Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland
Authors: Shebehe J. , Ottertun E. , Carlén K. , Gustafson D.
Published: June 2021

Background

Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample.

Methods

The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0–6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI).

Results

Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences.

Conclusion

Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach.
Temporal trends in the prevalence of metabolic syndrome among middle-aged and elderly adults from 2011 to 2015 in China: the China health and retirement longitudinal study (CHARLS)
Authors: Liu Bo , Chen Guanqun , Zhao Ruijie , Huang Dan , Tao Lixin
Published: June 2021

Background

Metabolic syndrome (MetS) is a major risk factor for cardiovascular diseases. The objective of the study was to evaluate the updated prevalence of MetS and provide a comprehensive illustration of the possible temporal changes in MetS prevalence in China from 2011 to 2015.

Methods

The data for this study are from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). CHARLS is a nationally representative survey targeting populations aged 45 and above from 28 provinces in mainland China. A total of 11,847 and 13,013 participants were eligible for data analysis at the two time points.

Results

The estimated prevalence of MetS in 2015 was 20.41% (95% CI: 19.02–21.8%) by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) criteria, 34.77% (95% CI: 33.12–36.42%) by the International Diabetes Federation (IDF) criteria, 39.68% (95% CI: 37.88–41.47%) by the revised ATP III criteria, and 25.55% (95% CI: 24.19–26.91%) by the Chinese Diabetes Society (CDS) criteria. The prevalence was higher among women and elderly adults and in urban and northern populations. Furthermore, the trends in the prevalence decreased significantly between 2011 and 2015 by the ATP III, revised ATP III and CDS criteria. However, trends increased significantly from 2011 to 2015 by the IDF criteria.

Conclusions

A higher prevalence of MetS is found in those who reported being middle aged and elderly, women, residing in northern China or living in urban areas. Additionally, temporal changes in the prevalence of MetS varied according to different criteria. Increased attention to the causes associated with populations who have higher levels of MetS is warranted.
Morbidity and mortality reduction associated with polysomnography testing in idiopathic pulmonary fibrosis: a population-based cohort study
Authors: Vozoris Nicholas T. , Wilton Andrew S. , Austin Peter C. , Kendzerska Tetyana , Ryan Clodagh M. , Gershon Andrea S.
Published: June 2021

Background

It is not well-known if diagnosing and treating sleep breathing disorders among individuals with idiopathic pulmonary fibrosis (IPF) improves health outcomes. We evaluated the association between receipt of laboratory-based polysomnography (which is the first step in the diagnosis and treatment of sleep breathing disorders in Ontario, Canada) and respiratory-related hospitalization and all-cause mortality among individuals with IPF.

Methods

We used a retrospective, population-based, cohort study design, analyzing health administrative data from Ontario, Canada, from 2007 to 2019. Individuals with IPF were identified using an algorithm based on health administrative codes previously developed by IPF experts. Propensity score matching was used to account for potential differences in 41 relevant covariates between individuals that underwent polysomnography (exposed) and individuals that did not undergo polysomnography (controls), in order minimize potential confounding. Respiratory-related hospitalization and all-cause mortality were evaluated up to 12 months after the index date.

Results

Out of 5044 individuals with IPF identified, 201 (4.0%) received polysomnography, and 189 (94.0%) were matched to an equal number of controls. Compared to controls, exposed individuals had significantly reduced rates of respiratory-related hospitalization (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.24–0.75), p = 0.003) and all-cause mortality (HR 0.49, 95% CI 0.30–0.80), p = 0.004). Significantly reduced rate of respiratory-related hospitalization (but not all-cause mortality) was also observed among those with >  = 1 respiratory-related hospitalization (HR 0.38, 95% CI 0.15–0.99) and systemic corticosteroid receipt (HR 0.37, 95% CI 0.19–0.94) in the year prior to the index date, which reflect sicker subgroups of persons.

Conclusions

Undergoing polysomnography was associated with significantly improved clinically-important health outcomes among individuals with IPF, highlighting the potential importance of incorporating this testing in IPF disease management.
Using a mixture of local bone dust and morselized bone as graft materials in single- and double-level ACDF
Authors: Ma Fei , Xu Shicai , Liao Yehui , Tang Qiang , Tang Chao , Wang Qing , Zhong Dejun
Published: June 2021

Background

Using a cage filled with local bone in anterior cervical discectomy and fusion (ACDF) can eliminate morbidities associated with autograft harvest from the iliac crest while achieving high fusion rates. However, there is still no consensus regarding the methods for using local bone grafts. This retrospective study was performed to compare the clinical and radiological outcomes of using a mixture of bone dust and morselized bone versus morselized bone alone in ACDF.

Methods

A retrospective study of 228 patients affected by cervical degenerative disease who had undergone single- or double-level ACDF between January 2014 and June 2018 was performed. Nanohydroxyapatite/polyamide-66 (n-HA/PA66) combined with morselized bone was used in 111 patients (group A: single-level ACDF in 51 patients and double-level ACDF in 60 patients), whereas the n-HA/PA66 cage combined with a mixture of bone dust and morselized bone was used in 117 patients (group B: single-level ACDF in 58 patients and double-level ACDF in 59 patients). The fusion rate, extent of cage subsidence, fusion segmental height (FSH), C2-7 lordosis, segmental sagittal alignment (SSA), 10-point visual analog scale (VAS) score, and Neck Disability Index (NDI) were compared between the two groups.

Results

The VAS score and NDI were significantly reduced after the operation in group A and group B. At the final follow-up, the fusion rate was 90.2 % (46/51) and 94.8 % (55/58) in patients treated with single-level ACDF in group A and group B, respectively (p > 0.05). In patients treated with double-level ACDF, bone fusion was achieved in 52 patients (86.7 %) in group A and 55 patients (93.2 %) in group B (p > 0.05). The fusion rate of single- and double-level ACDF was higher in patients in group B than those in group A at the 3-month, 6-month and 12-month follow-ups (p < 0.05). The extent of cage subsidence after single- and double-level ACDF was lower in patients in group B (1.5 ± 0.5 mm and 2.3 ± 0.8 mm, respectively) than in those in group A (1.8 ± 0.7 mm and 2.9 ± 1.4 mm, respectively) (p < 0.05). There was no significant difference between the two groups in the C2-7 lordosis, FSH, SSA, VAS score, or NDI before or after the operation (p > 0.05).

Conclusions

Using a mixture of local bone dust and morselized bone as cage-filling materials yielded comparably good clinical outcomes as using morselized bone alone in single- and double-level ACDF. However, the mixture graft of bone dust and morselized bone was more beneficial in promoting early fusion and reducing cage subsidence.