bluuebunny/crossref_metadata_2025 huggingface dataset:
Transferability, development of simple sequence repeat (SSR) markers and application to the analysis of genetic diversity and population structure of the African fan palm (Borassus aethiopum Mart.) in Benin
Authors: Kpatènon Mariano Joly , Salako Kolawolé Valère , Santoni Sylvain , Zekraoui Leila , Latreille Muriel , Tollon-Cordet Christine , Mariac Cédric , Jaligot Estelle , Beulé Thierry , Adéoti Kifouli
Published: December 2020

Background

In Sub-Saharan Africa,Borassus aethiopumMart. (African fan palm) is an important non-timber forest product-providing palm that faces multiple anthropogenic threats to its genetic diversity. However, this species is so far under-studied, which prevents its sustainable development as a resource. The present work is a first attempt at characterizing the genetic diversity and population structure ofB. aethiopumacross nine collection sites spanning the three climatic regions of Benin, West Africa, through the use of microsatellite markers.

Results

During a first phase we relied on the reported transferability of primers developed in other palm species. We find that, in disagreement with previously published results, only 22.5% of the markers tested enable amplification ofB. aethiopumDNA and polymorphism detection is very low.

In a second phase, we generated aB. aethiopum-specific genomic dataset through high-throughput sequencing and used it for the de novo detection of microsatellite loci. Among the primer pairs targeting these, 11 detected polymorphisms and were further used for analyzing genetic diversity. Across the nine sites, expected heterozygosity (He) ranges from 0.263 to 0.451 with an overall average of 0.354, showing a low genetic diversity. Analysis of molecular variance (AMOVA) shows that within-site variation accounts for 53% of the genetic variation. Accordingly, the low number of migrants and positive values of the fixation index (F) in sites from both the Central (Sudano-Guinean) and the Southern (Guinean) climatic regions suggest limited gene flow between sites. The global correlation between genetic and geographic distances is weak; however, our clustering analyses indicate thatB. aethiopumpalms from Savè (Center) are genetically more similar to those from the North than to samples from other Central sites.

Conclusions

In the light of our results, we discuss the use of inter-species transfer vs. de novo development of microsatellite markers in genetic diversity analyses targeting under-studied species, and suggest future applications for our molecular resources. We propose that, while prominent short-range pollen and seed dispersal in Benin explain most of our results, gene flux between the Central and Northern regions, as a result of animal and/or human migrations, might underlie the Savè discrepancy.
Joint modelling of longitudinal lipids and time to coronary heart disease in the Jackson Heart Study
Authors: Kassahun-Yimer Wondwosen , Valle Karen A. , Oshunbade Adebamike A. , Hall Michael E. , Min Yuan-I. , Cain-Shields Loretta , Anugu Pramod , Correa Adolfo
Published: December 2020

Background

Multiple longitudinal responses together with time-to-event outcome are common in biomedical studies. There are several instances where the longitudinal responses are correlated with each other and at the same time each longitudinal response is associated with the survival outcome. The main purpose of this study is to present and explore a joint modeling approach for multiple correlated longitudinal responses and a survival outcome. The method will be illustrated using the Jackson Heart Study (JHS), which is one of the largest cardiovascular studies among African Americans.

Methods

Four longitudinal responses, i.e., total cholesterol (TC), high density lipoprotein (HDL) cholesterol, triglyceride (TG) and inflammation measured by high-sensitivity C-reactive protein (hsCRP); and time-to-coronary heart disease (CHD) were considered from the JHS. The repeated lipid and hsCRP measurements from a given subject overtime are likely correlated with each other and could influence the subject’s risk for CHD. A joint modeling framework is considered. To deal with the high dimensionality due to the multiple longitudinal profiles, we use a pairwise bivariate model fitting approach that was developed in the context of multivariate Gaussian random effects models. The method is further explored through simulations.

Results

The proposed model performed well in terms of bias and relative efficiency. The JHS data analysis showed that lipid and hsCRP trajectories could exhibit interdependence in their joint evolution and have impact on CHD risk.

Conclusions

We applied a unified and flexible joint modeling approach to analyze multiple correlated longitudinal responses and survival outcome. The method accounts for the correlation among the longitudinal responses as well as the association between each longitudinal response and the survival outcome at once. This helps to explore how the combination of multiple longitudinal trajectories could be related to the survival process.
Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA
Authors: Rasu Rafia S. , Zalmai Rana , Karpes Matusevich Aliza R. , Hunt Suzanne L. , Phadnis Milind A. , Rianon Nahid
Published: December 2020

Background

About 50% of all hospitalized fragility fracture cases in older Americans are hip fractures. Approximately 3/4 of fracture-related costs in the USA are attributable to hip fractures, and these are mostly covered by Medicare. Hip fracture patients with dementia, including Alzheimer’s disease, have worse health outcomes including longer hospital length of stay (LOS) and charges. LOS and hospital charges for dementia patients are usually higher than for those without dementia. Research describing LOS and acute care charges for hip fractures has mostly focused on these outcomes in trauma patients without a known pre-admission diagnosis of osteoporosis (OP). Lack of documented diagnosis put patients at risk of not having an appropriate treatment plan for OP. Whether having a diagnosis of OP would have an effect on hospital outcomes in dementia patients has not been explored. We aim to investigate whether having a diagnosis of OP, dementia, or both has an effect on LOS and hospital charges. In addition, we also report prevalence of common comorbidities in the study population and their effects on hospital outcomes.

Methods

We conducted a cross-sectional analysis of claims data (2012–2013) for 2175 Medicare beneficiaries (≥65 years) in the USA.

Results

Compared to those without OP or dementia, patients with demenia only had a shorter LOS (by 5%; P = .04). Median LOS was 6 days (interquartile range [IQR]: 5–7), and the median hospital charges were $45,100 (IQR: 31,500 − 65,600). In general, White patients had a shorter LOS (by 7%), and those with CHF and ischemic heart disease (IHD) had longer LOS (by 7 and 4%, respectively). Hospital charges were 6% lower for women, and 16% lower for White patients.

Conclusion

This is the first study evaluating LOS in dementia in the context of hip fracture which also disagrees with previous reporting about longer LOS in dementia patients. Patients with CHF and IHD remains at high risk for longer LOS regardless of their diagnosis of dementia or OP.
Describing nearly two decades of Chagas disease in Germany and the lessons learned: a retrospective study on screening, detection, diagnosis, and treatment of Trypanosoma cruzi infection from 2000 – 2018
Authors: Guggenbühl Noller Jessica Michelle , Froeschl Guenter , Eisermann Philip , Jochum Johannes , Theuring Stefanie , Reiter-Owona Ingrid , Bissinger Alfred Lennart , Hoelscher Michael , Bakuli Abhishek , von Sonnenburg Franz-Josef Falkner , Rothe Camilla , Bretzel Gisela , Albajar-Viñas Pedro , Grout Lise , Pritsch Michael
Published: December 2020

Background

The highly complex and largely neglected Chagas disease (CD) has become a global health problem due to population movements between Latin America and non-endemic countries, as well as non-vectorial transmission routes. Data on CD testing and treatment from routine patient care in Germany of almost two decades was collected and analysed.

Methods

German laboratories offering diagnostics for chronic Trypanosoma cruzi (T. cruzi) infection in routine patient care were identified. All retrievable data on tests performed during the years of 2000–2018 were analysed. Additional clinical information regarding patients diagnosed with CD was collected through questionnaires.

Results

Five German laboratories with diagnostics for T. cruzi infection in routine patient care were identified. Centres in Hamburg and Munich offered two independent serological tests to confirm the CD diagnosis, as recommended by WHO during the entire time period 2000–2018. Overall, a total of n = 10,728 independent tests involving n = 5991 individuals were identified with a progressive increase in testing rates over time, only n = 130 (16.0%) of the tested individuals with known nationality came from CD endemic countries. Of all test units conducted at the included institutes, a total of n = 347/10,728 (3.2%) tests on CD were positive, of which n = 200/347 (57.6%) were ELISA, n = 133/347 (38.3%) IFT, n = 10/347 (2.9%) PCR, and n = 4/347 (1.2%) RDT. Of the n = 5991 individuals only n = 81 (1.4%) with chronic infection were identified, n = 52 females and n = 28 males. Additional clinical information could only be collected from n = 47.

Conclusion

The results of this study give insight into the deployment of screening, detection, diagnosis, and treatment of T. cruzi over the last two decades in Germany and existing deficits therein; the creation of guidelines for Germany could be a step forward to improve the existing gaps.
Survey on neutralizing antibodies against Zika virus eighteen months post-outbreak in two southern Thailand communities
Authors: Densathaporn Theerut , Sangthong Rassamee , Sakolnapa Monvaris , Surasombatpattana Smonrapat , Kemapunmanus Marisa , Masrinoul Promsin , Yoksan Sutee , McNeil Edward B. , Chongsuvivatwong Virasakdi
Published: December 2020

Background

In 2016 and 2017, Zika virus (ZIKV) infection outbreaks occurred in two communities in southern Thailand. This re-immerging infection can widely spread by mosquito bites and cause serious complications in a central nervous system among children born to infected mothers. Thus, they should be protected. This study aims to (1) To determine the prevalence of neutralizing ZIKV antibodies in the post-outbreak areas among the general population and pregnancy women residing at various distances from the houses of the nearest index patients; (2) To examine the cross-neutralizing capacity of antibodies against ZIKV on other flaviviruses commonly found in the study areas; (3) To identify factors associated with the presence of neutralizing ZIKV antibodies.

Methods

The two post-outbreak communities were visited at 18 months after the outbreaks. We enrolled (1) 18 confirmed ZIKV infected (index) cases, (2) sample of 554 neighbors in the outbreak areas who lived at various distances from the index patients’ houses, (3) 190 residents of non-outbreak areas, and (4) all pregnant women regardless of gestational age residing in the study areas (n = 805). All serum specimens underwent the plaque reduction neutralization test (PRNT). Ten randomly selected ZIKV seropositive and ten randomly selected seronegative specimens were tested for dengue virus serotypes 1–4 (DENV1–4) and Japanese encephalitis virus (JEV) antibodies using PRNT90. Serum titer above 1:10 was considered positive. Multiple logistic regression was used to assess factors associated with seropositivity.

Results

Out of all 18 index cases, 9 remained seropositive. The seroprevalence (95% CI) in the two outbreak areas were 43.7% (35.9–51.6%) and 29.7% (23.3–36.0%) in general population, and 24.3% (20.1–28.8%) and 12.8% (9.7–16.5%) in pregnant women. Multivariate analysis showed that seropositivity was independent of the distance gradient from the index’s houses. However, being elderly was associated with seropositivity. DENV1–4 and JEV neutralizing antibodies were present in most ZIKV-positive and negative subsamples.

Conclusion

Protective herd immunity for ZIKV infection is inadequate, especially among pregnant women in the two post-outbreak areas in southern Thailand.
Bordetella bronchiseptica: a rare cause of meningitis
Authors: Radcliffe Christopher , Lier Audun , Doilicho Natnael , Parikh Sunil , Kaddouh Firas
Published: December 2020

Background

Bordetella bronchiseptica is a gram-negative, obligate aerobic coccobacillus known to cause disease in domesticated animals and pets. In humans, B. bronchiseptica commonly leads to respiratory infections like pneumonia or bronchitis, and animal contact usually precedes the onset of symptoms.

Case presentation

We report a case of post-traumatic B. bronchiseptica meningitis without recent surgery in the setting of immunosuppression with a monoclonal antibody. Our case concerns a 77-year-old male with ulcerative colitis on infliximab who sustained a mechanical fall and developed a traumatic cerebrospinal fluid leak complicated by meningitis. He received meropenem then ceftazidime during his hospital course, and temporary neurosurgical drain placement was required. His clinical condition improved, and he was discharged at his baseline neurological status.

Conclusions

B. bronchiseptica is an unusual cause of meningitis that may warrant consideration in immunocompromised hosts with known or suspected animal exposures. To better characterize this rare cause of meningitis, we performed a systematic literature review and summarized all previously reported cases.
Attitudes and beliefs in Swedish midwives and obstetricians towards obesity and gestational weight management
Authors: Christenson Anne , Torgerson Jarl , Hemmingsson Erik
Published: December 2020

Background

Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers’ beliefs about obesity, and their attitudes towards gestational weight management.

Method

A web survey was emailed to Swedish maternity care clinics. Existing questionnaires, “Beliefs About Obese People” (BAOP), “Perceived weight bias in health care” and “Attitudes toward obese patients” was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic.

Results

274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: “I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed”. Having had training in motivational interviewing seemed positively associated with midwives’ inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals.

Conclusion

Swedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation.
REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal
Authors: Gurung Rejina , Gurung Abhishek , Basnet Omkar , Eilevstjønn Joar , Myklebust Helge , Girnary Sakina , Shrestha Shree Krishna , Singh Dela , Bastola Laxman , Paudel Prajwal , Baral Sandhya , KC Ashish
Published: December 2020

Background

Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal.

Methods

A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews.

Discussion

This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes.

Trial registration

10.1186/ISRCTN18148368, date of registration-31 July 2018
Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial
Authors: Farnaghi Fariba , Rahmani Razieh , Hassanian-Moghaddam Hossein , Zamani Nasim , McDonald Rebecca , Gholami Narges , Gachkar Latif
Published: December 2020

Objectives

To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children.

Methods

In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg;n = 15) or oral lorazepam (0.05 mg/Kg;n = 15) to prevent relapse of toxicity.

Results

The median age [IQR] (range) was 15[10, 36] (6-144) months. The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The most common symptoms/signs were agitation (29; 96.7%), mydriatic pupils (26; 86.7%), and tachycardia (20; 66.6%). Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. There was no report of benzodiazepine complications in either group.

Conclusions

Clonazepam and lorazepam treatment was equally effective at similar doses. However, considering the higher potency of clonazepam, it seems that lorazepam is the safer benzodiazepine for oral maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications.

Trial registration

IRCT20180610040036N2, April 18th, 2020. Retrospectively registered.
Inequality in child undernutrition among urban population in India: a decomposition analysis
Authors: Singh S. K. , Srivastava Shobhit , Chauhan Shekhar
Published: December 2020

Background

With increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. This study analyses child undernutrition among urban poor and non-poor and decomposes the contribution of various factors influencing socio-economic inequality. This paper uses data from two recent rounds of National Family Health Survey (NFHS-3&4) conducted during 2005–06 and 2015–16.

Methods

The concentration index (CI) and the concentration curve (CC) measure socio-economic inequality in child growth in terms of stunting, wasting, and underweight. Wagstaff decomposition further analyses key contributors in CI by segregating significant covariates into five groups-mother’s factor, health-seeking factors, environmental factors, child factors, and socio-economic factors.

Results

The prevalence of child undernutrition was more pronounced among children from poor socio-economic strata. The concentration index decreased for stunting (− 0.186 to − 0.156), underweight (− 0.213 to − 0.162) and wasting (− 0.116 to − 0.045) from 2005 to 06 to 2015–16 respectively. The steepness in growth was more among urban poor than among urban non-poor in every age interval. Maternal education contributed about 19%, 29%, and 33% to the inequality in stunting, underweight and wasting, respectively during 2005–06. During 2005–06 as well as 2015–16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting as well as underweight. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors.

Conclusion

All the nutrition-specific and nutrition-sensitive interventions in urban areas should be prioritized, focusing on urban poor, who are often clustered in low-income slums. Rich-poor inequality in child growth calls out for integration and convergence of nutrition interventions with policy interventions aimed at poverty reduction. There is also a need to expand the scope of the Integrated Child Development Services (ICDS) program to provide mass education regarding nutrition and health by making provisions of home visits of workers primarily focusing on pregnant and lactating mothers.
Arthroscopic evaluation and treatment of a squeaking hip. A case report
Authors: Bellity Jonathan , Elkaïm Marc , Hannouche Didier , Nizard Rémy
Published: December 2020

Background

Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips.

Case presentation

A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free.

Conclusions

The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement.
Stretching and relaxing the plantar fascia may change plantar fascia thickness but not pressure pain thresholds: a cross-sectional study of patients with plantar fasciopathy
Authors: Ostermann Stefanie , Olesen Jens Lykkegaard , Holden Sinéad , Riel Henrik
Published: December 2020

Background

Despite the established relevance of ultrasonography and assessment of pressure pain thresholds in patients with plantar fasciopathy, patient and probe positioning has been mostly ignored and are not necessarily reported in research. The primary aim of this study was to compare plantar fascia thickness in stretched and relaxed positions in patients with plantar fasciopathy. The secondary aim was to compare plantar heel pressure pain thresholds in these positions.

Methods

In this cross-sectional study, we measured the plantar fascia thickness with ultrasonography, and localised pressure pain thresholds using pressure algometry of 20 patients with plantar fasciopathy. These were assessed bilaterally, with the plantar fascia in both a stretched and relaxed position. In the stretched position, toes were maximally dorsiflexed, while in the relaxed position participants’ feet were hanging freely over the end of the table.

Results

The plantar fascia of the most symptomatic foot was significantly thicker when stretched compared with the relaxed position (sagittal: mean difference 0.2 mm, 95%CI: 0.1–0.4, P = 0.013; frontal: mean difference − 0.27, 95%CI: − 0.49 to − 0.06, P = 0.014). The plantar fascia was significantly thinner in the frontal plane compared with the sagittal plane in both positions (stretched: mean difference − 0.2 mm, 95%CI: − 0.42 to − 0.03, P = 0.025; relaxed: mean difference − 0.3 mm, 95%CI:-0.49 to − 0.08, P = 0.008). There was no difference between pressure pain thresholds in stretched or relaxed positions in either foot (P > 0.4).

Conclusions

The plantar fascia was significantly thicker in a stretched compared with a relaxed position and in the sagittal compared with the frontal plane, but differences were smaller than the standard deviation. Pressure pain thresholds were not different between the positions. These results highlight the importance of how ultrasonography is performed and reported in research to allow for replication.

Trial registration

The study was pre-registered September 25th, 2017 on ClinicalTrials.gov (NCT03291665).
The COVID-19 pandemic: impact on surgical departments of non-university hospitals
Authors: Stöß Christian , Steffani Marcella , Kohlhaw Kay , Rudroff Claudia , Staib Ludger , Hartmann Daniel , Friess Helmut , Müller Michael W.
Published: December 2020

Background

During the first wave of the COVID-19 pandemic, German health care centres were restructured for the treatment of COVID-19 patients. This was accompanied by the suspension of the surgical programme. The aim of the survey was to determine the effects of COVID-19 on surgical care in non-university hospitals in Germany.

Methods

This cross-sectional study was based on an anonymous online survey, which was accessible from April 24th to May 10th, 2020 for surgeons of the Konvent der leitenden Krankenhauschirurgen (Convention of leading Hospital Surgeons) in Germany. The analysis comprised of 22.8% (n = 148/649) completed surveys.

Results

Communication and cooperation with authorities, hospital administration and other departments were largely considered sufficient. In the early phase of the COVID-19 pandemic, 28.4% (n = 42/148) of the respondents complained about a short supply of protective equipment available for the hospital staff. 7.4% (n = 11/148) of the participants stated that emergency operations had to be postponed or rescheduled. A decreased quantity of emergency surgical procedures and a decreased number of surgical emergency patients treated in the emergency room was reported in 43.9% (n = 65/148) and 63.5% (n = 94/148), respectively. Consultation and treatment of oncological patients in the outpatient clinic was decreased in 54.1% (n = 80/148) of the surveyed hospitals. To increase the capacity for COVID-19 patients, a reduction of bed and operating room occupancy of 50.8 ± 19.3% and 54.2 ± 19.1% were reported, respectively. Therefore, 90.5% (n = 134/148) of all participants expected a loss of revenue of 28.2 ± 12.9% in 2020.

Conclusion

The first wave of the COVID-19 pandemic had a significant impact on surgical care in Germany. The reduction in the bed and the operating room capacity may have lead to considerable delays in urgent and semi-elective surgical interventions. In addition to the risk of worsening patient care, we anticipate severe financial damage to the clinics in 2020 and beyond. National and supranational planning is urgently needed to ensure the surgical care of patients during the ongoing COVID-19 pandemic.
Impact of SARS-CoV-2 pandemic on bariatric care in Poland: results of national survey
Authors: Major Piotr , Stefura Tomasz , Wysocki Michał , Małczak Piotr , Rzepa Anna , Proczko-Stepaniak Monika , Szeliga Jacek , Pędziwiatr Michał
Published: December 2020

Background

The SARS-CoV-2 pandemic has reached Poland on March 4th, 2020 and undoubtedly affected all areas of life and medical care, including bariatric care. The study was planned to identify the impact of the SARS-CoV-2 pandemic on bariatric care in Poland.

Methods

The online survey was designed and distributed to bariatric surgeons. The questionnaire was divided into three parts: demographic characteristics of participants and their bariatric centers, examining the impact of the pandemic on the bariatric care and last part with questions about planned care after the pandemic.

Results

49 surgeons participated in the survey. 27 (55%) participants worked in hospitals transformed into COVID-dedicated units. Only 9 (18%) respondents declared uninterrupted bariatric surgery during a pandemic. 91% of surgeons declared continuation of bariatric care with telemedicine techniques. All participants declared a high willingness to resume bariatric surgery after the SARS-CoV-2 pandemic and responded that bariatric procedures should resume immediately when World Health Organisation (WHO) announces the end of a pandemic regardless of oncological treatment. 90% of respondents believe that the pandemic will not affect the safety of bariatric procedures in the future.

Conclusions

Access to bariatric care during the pandemic is limited and redirected to telemedicine. Surgeons are ready to resume bariatric operations immediately after the pandemic, but its end is difficult to determine. In surgeons’ opinion pandemic will not affect the safety of bariatric surgery in the future. The extended waiting list and financial aspects will be the main issues after the pandemic.
Ureteroenteric strictures: a single center experience comparing Bricker versus Wallace ureteroileal anastomosis in patients after urinary diversion for bladder cancer
Authors: Christoph Frank , Herrmann Franziska , Werthemann Peter , Janik Thomas , Schostak Martin , Klopf Christian , Weikert Steffen
Published: December 2020

Background

To evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis.

Methods

A total of 137 patients underwent ileal conduit for bladder cancer. Ureters were anastomosed by two experienced surgeons, one performing a Bricker and the other, a Wallace anastomosis. Stricture was identified during clinical follow-up.

Results

Seventy-five patients underwent a Bricker anastomotic, and 65 received a Wallace anastomosis. The average age was 70 in both groups, males were predominant (66% Bricker, 70% Wallace). Follow up period was 36.5 months in Bricker group and 17 months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1 kg/m2 Bricker and 26.4 kg/m2 Wallace). We observed that the stricture rate after performing the Bricker anastomosis technique was 25.3% (19/75) as compared to 7.7% (5/65) after Wallace anastomosis technique, which was statistically significant (p = 0.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7 kg/m2, p = 0.05). On average it took 8.5 months in the Bricker group and three months in the Wallace group (p = 0.6) to develop stricture.

Conclusions

The stricture rate was significantly higher when Bricker technique was applied. Although the BMI was not different in both groups, patients with a higher BMI were more likely to develop stricture. We believe that the approach of the separate and refluxing technique of Bricker anastomosis especially in obese patients poses a higher risk for anastomotic stricture formation.
Feedback in the clinical setting
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig
Published: December 2020

Provision of feedback forms an integral part of the learning process. Receipt of feedback enriches the learning experience, and helps to narrow the gap between actual and desired performance. Effective feedback helps to reinforce good practice, motivating the learner towards the desired outcome. However, a common complaint from learners is that the receipt of feedback is infrequent and inadequate. This paper briefly explores the role of feedback within the learning process, the barriers to the feedback process, and practical guidelines for facilitating feedback.
Leadership in healthcare education
Authors: van Diggele Christie , Burgess Annette , Roberts Chris , Mellis Craig
Published: December 2020

Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.
Evaluation of conditional treatment effects of adjuvant treatments on patients with synovial sarcoma using Bayesian subgroup analysis
Authors: Seo Sung Wook , Kim Jisoo , Son Jihye , Lim Sungbin
Published: December 2020

Background

The impact of adjuvant chemotherapy or radiation therapy on the survival of patients with synovial sarcoma (SS), which is a rare soft-tissue sarcoma, remains controversial. Bayesian statistical approaches and propensity score matching can be employed to infer treatment effects using observational data. Thus, this study aimed to identify the individual treatment effects of adjuvant therapies on the overall survival of SS patients and recognize subgroups of patients who can benefit from specific treatments using Bayesian subgroup analyses.

Methods

We analyzed data from patients with SS obtained from the surveillance, epidemiology, and end results (SEER) public database. These data were collected between 1984 and 2014. The treatment effects of chemotherapy and radiation therapy on overall survival were evaluated using propensity score matching. Subgroups that could benefit from radiation therapy or chemotherapy were identified using Bayesian subgroup analyses.

Results

Based on a stratified Kaplan–Meier curve, chemotherapy exhibited a positive average causal effect on survival in patients with SS, whereas radiation therapy did not. The optimal subgroup for chemotherapy includes the following covariates: older than 20 years, male, large tumor (longest diameter > 5 cm), advanced stage (SEER 3), extremity location, and spindle cell type. The optimal subgroup for radiation therapy includes the following covariates: older than 20 years, male, large tumor (longest diameter > 5 cm), early stage (SEER 1), extremity location, and biphasic type.

Conclusion

In this study, we identified high-risk patients whose variables include age (age > 20 years), gender, tumor size, tumor location, and poor prognosis without adjuvant treatment. Radiation therapy should be considered in the early stages for high-risk patients with biphasic types. Conversely, chemotherapy should be considered for late-stage high-risk SS patients with spindle cell types.
Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis
Authors: Gu Shuyan , Shi Lizheng , Shao Hui , Wang Xiaoyong , Hu Xiaoqian , Gu Yuxuan , Dong Hengjin
Published: December 2020

Background

Clinical guidelines recommend a stepped-escalation treatment strategy for type 2 diabetes (T2DM). Across multiple treatment strategies varying in efficacy and costs, no clinical or economic studies directly compared them. This study aims to estimate and compare the cost-effectiveness of 10 commonly used pharmacologic combination strategies for T2DM.

Methods

Based on Chinese guideline and practice, 10 three-stepwise add-on strategies were identified, which start with metformin, then switch to metformin plus one oral drug (i.e., sulfonylurea, thiazolidinedione, α-glucosidase inhibitor, glinide, or DPP-4 inhibitor) as second line, and finally switch to metformin plus one injection (i.e., insulin or GLP-1 receptor agonist) as third line. A cohort of 10,000 Chinese patients with newly diagnosed T2DM was established. From a healthcare system perspective, the Cardiff model was used to estimate the cost-effectiveness of the strategies, with clinical data sourced from a systematic review and indirect treatment comparison of 324 trials, costs from claims data of 1164 T2DM patients, and utilities from an EQ-5D study. Outcome measures include costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs).

Results

Over 40-year simulation, the costs accumulated for a patient ranged from $7661 with strategy 1 to $14,273 with strategy 10, while the QALY gains ranged from 13.965 with strategy 1 to 14.117 with strategy 8. Strategy 7 was dominant over seven strategies (strategies 2~6, 9~10) with higher QALYs but lower costs. Additionally, at a willingness-to-pay threshold of $30,787/QALY (i.e., 3 times GDP/capita for China), strategy 7 was cost-effective compared with strategy 1 (ICER of strategy 7 vs. 1, $3371/QALY) and strategy 8 (ICER of strategy 8 vs. 7, $132,790/QALY). Ranking the strategies by ICERs and NMBs, strategy 7 provided the best value for money when compared to all other strategies, followed by strategies 5, 9, 8, 1, 3, 6, 10, 2, and 4. Scenario analyses showed that patients insist on pharmacologic treatments increased their QALYs (0.456~0.653) at an acceptable range of cost increase (ICERs, $1450/QALY~$12,360/QALY) or even at cost saving compared with those not receive treatments.

Conclusions

This study provides evidence-based references for diabetes management. Our findings can be used to design the essential drug formulary, infer clinical practice, and help the decision-maker design reimbursement policy.
Endothelial shear stress enhancements: a potential solution for critically ill Covid-19 patients
Authors: Nour Sayed
Published: December 2020

Most critically ill Covid-19 patients succumb to multiple organ failure and/or sudden cardiac arrest (SCA) as a result of comorbid endothelial dysfunction disorders which had probably aggravated by conventional mechanical assist devices. Even worse, mechanical ventilators prevent the respiratory pump from performing its crucial function as a potential generator of endothelial shear stress (ESS) which controls microcirculation and hemodynamics since birth. The purpose of this work is to bring our experience with ESS enhancement and pulmonary vascular resistance (PVR) management as a potential therapeutic solution in acute respiratory distress syndrome (ARDS). We propose a non-invasive device composed of thoracic and infradiaphragmatic compartments that will be pulsated in an alternating frequency (20/40 bpm) with low-pressure pneumatic generator (0.1–0.5 bar). Oxygen supply, nasogastric with, or without endotracheal tubes are considered.
Task-shifting directly observed treatment and multidrug-resistant tuberculosis injection administration to lay health workers: stakeholder perceptions in rural Eswatini
Authors: Peresu Ernest , Heunis J. Christo , Kigozi N. Gladys , De Graeve Diana
Published: December 2020

Background

Eswatini is facing a critical shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. This study assessed multiple stakeholders’ perceptions of task-shifting directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections to lay health workers (LHWs).

Methods

A mixed methods study comprising a cross-sectional survey using a semi-structured questionnaire with community treatment supporters (CTSs) and a focus group discussion with key stakeholders including representatives from the Eswatini Ministry of Health (MOH), donor organisations, professional regulatory institutions, nursing academia, civil society and healthcare providers was conducted in May 2017. Descriptive statistics, thematic content analysis and data triangulation aided in the interpretation of results.

Results

A large majority of CTSs (n = 78; 95.1%) were female and 33 (40.2%) were older than 50 years. Most (n = 7; 70.0%) key stakeholders had over 10 years of work experience in policy-making, advocacy in the fields of HRH or day-to-day practice in MDR-TB management. Task-shifting of MDR-TB injection administration was implemented without national policy guidance and regulation. Stakeholders viewed the strategy to be driven by the prevailing shortage of professional frontline HRH and limited access to MDR-TB treatment. Task-shifting was perceived to improve medication adherence, and reduce stigma and transport-related MDR-TB treatment access barriers. Frontline healthcare workers and implementing donor partners fully supported task-shifting. Policy-makers and other stakeholders accepted task-shifting conditionally due to fears of poor standards of care related to perceived incompetence of CTSs. Appropriate compensation, adequate training and supervision, and non-financial incentives were suggested to retain CTSs. A holistic task-shifting policy and collaboration between the MOH, academia and nursing council in regulating the practice were recommended.

Conclusions

Stakeholders generally accepted the delegation of DOT supervision and administration of intramuscular MDR-TB injections to LHWs as a strategy to increase access to treatment, albeit with some apprehension. Findings from this study stress that task-shifting is not a panacea for HRH shortages, but a short-term solution that must form part of an overall simultaneous strategy to train, attract and retain adequate numbers of professional healthcare workers in Eswatini. To address some of the apprehension and ambivalence about expanding access to MDR-TB services through task-shifting, attention should be paid to important aspects such as competence-based training, certification and accreditation, adequate supportive on-the-job supervision, recognition, compensation, and expediting policy and regulatory support for LHWs.
Gut microbiota composition and metabolomic profiles of wild and captive Chinese monals (Lophophorus lhuysii)
Authors: Jiang Dandan , He Xin , Valitutto Marc , Chen Li , Xu Qin , Yao Ying , Hou Rong , Wang Hairui
Published: December 2020

Background

The Chinese monal (Lophophorus lhuysii) is an endangered bird species, with a wild population restricted to the mountains in southwest China, and only one known captive population in the world. We investigated the fecal microbiota and metabolome of wild and captive Chinese monals to explore differences and similarities in nutritional status and digestive characteristics. An integrated approach combining 16S ribosomal RNA (16S rRNA) gene sequencing and ultra-high performance liquid chromatography (UHPLC) based metabolomics were used to examine the fecal microbiota composition and the metabolomic profile of Chinese monals.

Results

The results showed that the alpha diversity of gut microbes in the wild group were significantly higher than that in the captive group and the core bacterial taxa in the two groups showed remarkable differences at phylum, class, order, and family levels. Metabolomic profiling also revealed differences, mainly related to galactose, starch and sucrose metabolism, fatty acid, bile acid biosynthesis and bile secretion. Furthermore, strong correlations between metabolite types and bacterial genus were detected.

Conclusions

There were remarkable differences in the gut microbiota composition and metabolomic profile between wild and captive Chinese monals. This study has established a baseline for a normal gut microbiota and metabolomic profile for wild Chinese monals, thus allowing us to evaluate if differences seen in captive organisms have an impact on their overall health and reproduction.
Spatial filtering for enhanced high-density surface electromyographic examination of neuromuscular changes and its application to spinal cord injury
Authors: Zhang Xu , Li Xinhui , Tang Xiao , Chen Xun , Chen Xiang , Zhou Ping
Published: December 2020

Background

Spatial filtering of multi-channel signals is considered to be an effective pre-processing approach for improving signal-to-noise ratio. The use of spatial filtering for preprocessing high-density (HD) surface electromyogram (sEMG) helps to extract critical spatial information, but its application to non-invasive examination of neuromuscular changes have not been well investigated.

Methods

Aimed at evaluating how spatial filtering can facilitate examination of muscle paralysis, three different spatial filtering methods are presented using principle component analysis (PCA) algorithm, non-negative matrix factorization (NMF) algorithm, and both combination, respectively. Their performance was evaluated in terms of diagnostic power, through HD-sEMG clustering index (CI) analysis of neuromuscular changes in paralyzed muscles following spinal cord injury (SCI).

Results

The experimental results showed that: (1) The CI analysis of conventional single-channel sEMG can reveal complex neuromuscular changes in paralyzed muscles following SCI, and its diagnostic power has been confirmed to be characterized by the variance of Z scores; (2) the diagnostic power was highly dependent on the location of sEMG recording channel. Directly averaging the CI diagnostic indicators over channels just reached a medium level of the diagnostic power; (3) the use of either PCA-based or NMF-based filtering method yielded a greater diagnostic power, and their combination could even enhance the diagnostic power significantly.

Conclusions

This study not only presents an essential preprocessing approach for improving diagnostic power of HD-sEMG, but also helps to develop a standard sEMG preprocessing pipeline, thus promoting its widespread application.