bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Pesticide Exposure Affect Male Farmer’s Lower Urinary Tract Symptoms?
Authors: Kim Min Gi , Ji-Young Song , Roh Sangchul
Published: August 2020

Purpose: Research on the relationship between lower urinary tract symptoms and pesticides is limited. Thus, we investigated the relationship between full-time male farmers’ exposure to organophosphorus and pyrethroid pesticides and the degree of lower urinary tract symptoms. Methods: Four metabolites of each of organophosphate and pyrethroid in urine from 348 full-time male farmers were analysed. Subjects’ pesticide-related characteristics including international prostate symptoms score (IPSS) and pesticide poisoning symptoms within 48 hours of exposure to pesticides and general characteristics were assessed through one-to-one interviews using a structured questionnaire. Findings: Lower urinary tract symptoms of full-time male farmers with 1-2 pesticide poisoning symptoms (odds ratio [OR] 2.63, 95% confidence interval [CI]1.21-5.73) and ≥3 symptoms (OR 10.36, 95% CI 2.18-49.15) were significantly higher than those without symptoms. The odds ratios of two- and three-fractile groups of pyrethroid urinary metabolites were 2.50 (95% CI 1.23-5.06) and 2.72 (95% CI 1.37-5.43), respectively, compared to the one fractile group. Conclusion: Relationships among pesticide poisoning symptoms within 48 hours of exposure to pesticides, total amount of pyrethroid pesticide metabolites in urine, and the lower urinary tract symptoms of male farmers were observed in the present study, and this needs further investigation.
Perceived stress of clinical practice among associate degree nursing students in Taiwan
Authors: Wu Chia-Shan , Rong Jiin-Ru , Huang Mei-zen
Published: August 2020

Background: Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. This study aimed to examine factors associated with perceived stress of clinical practice and to investigate the effect of health status on perceived stress.Methods: This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan.Results: Health status scores varied from 28–139, with an average of 68.40 (SD = 25.75). Perceived stress scores ranged from 0–95 points with an average score of 36.65 (SD ± 15.95). Factors linked to perceived stress were general health status, practice subject, practice grade, gender, and sleeping hours. The CART analysis showed health status as the most important predictor to perceived stress.Conclusions: General health status can be used as a measure to predict vulnerability to stress and to identify students who are most vulnerable.
Management of Anticoagulated Patients in Dentoalveolar Surgery: A Retrospective Study Comparing Bridging Versus Unpaused Vitamin K Antagonist Medication.
Authors: Buchbender Mayte , Rößler F , Kesting Marco , Frohwitter Gesche , Adler Werner , Rau Andrea
Published: August 2020

Objectives: The aim of this study was to investigate the occurrence of postoperative bleeding following dentoalveolar surgery in patients with either continued vitamin K antagonist medication or perioperative bridging using heparin. Study design: A retrospective study was performed analyzing patients who underwent tooth extraction between 2012 and 2017. Patients were retrospectively allocated into two comparative groups: un-paused vitamin K antagonist medication versus bridging using heparin. A healthy, non-anticoagulated cohort with equivalent surgery served as a control group. Main outcome measures were: the occurrence and frequency of postoperative bleeding, the number of removed teeth, the surgical technique of tooth removal (extraction/ osteotomy/ combined extraction and osteotomy) and the prothrombin time.Results: In total, 475 patients were included in the study with 170 patients in the group of un-paused vitamin K antagonist medication VG, 135 patients in the Bridging group BG and 170 patients in the control group CG. Postoperative bleeding was significant: CG vs.VG p=0.004; CG vs. BG p<0.001, BG vs.VG p<0.001. A significant correlation of number of the extracted teeth in the BG (p=0.014) and no significance in VG (p=0.298) and CG (p=0.210) and in the BG vs. VG and CG with p<0.001 in terms of surgical intervention extraction. No difference observed in terms of prothrombin time.Conclusion: Bridging increases the risk for bleeding compared to un-paused vitamin K antagonist medication. The perioperative management of anticoagulated patients requires a well- coordinated interdisciplinary teamwork to minimize or at best avoid both: postoperative bleeding and thromboembolic incidences.
Technology enhanced training in family medicine during Covid-19 pandemic, trainers and trainees’ view
Authors: Ahmed Marwa Mostafa , Sayed Inas Talaat El , Fares Samar
Published: August 2020

Purpose of the study: how to shift from face-to-face clinical training into technology enhanced training during Covid 19 pandemic.Study design: Online trainer simulation with pre-prepared case scenarios and case discussion was our designed interventional training using Zoom application.Results: Regarding trainee’s feedback to the zoom training, 85% of them thought that it was useful. More than 75% of them recommended this online training for future trainees. More than 80% of the trainers were satisfied with the online training experience. More than 75% of them thought that this was a beneficial experience for the participating house officers. Although two-third of the trainers perceived the training to be mildly and moderately overloading, yet more than 80% of them were satisfied with this training experience and about three-fourth of them preferred it on face-to-face training. They suggested increasing the time of the session to allow for more feedback and discussion.Conclusion: Technology enhanced training is a good way of training that can improve many aspects of clinical family medicine skills as communication skills, patient-centred approach, clinical reasoning, and construction of management plan. It can be applied in other specialties especially in crisis times. In the future, it can be used as blended method of training beside face to face training in the clinics so they can complement each other.
Predicting Outcomes in Older ED Patients with Influenza in Real Time Using a Big Data-Driven and Machine Learning Approach to the Hospital Information System
Authors: Hsu Chien-Chin , Tan Tian-Hoe , Chen Chia-Jung , Hsu Shu-Lien , Liu Tzu-Lan , Lin Hung-Jung , Wang Jhi-Joung , Liu Chung-Feng , Huang Chien Cheng
Published: August 2020

Background: Predicting outcomes in older patients with influenza in the emergency department (ED) by machine learning (ML) has never been implemented. Therefore, we conducted this study to clarify the clinical utility of implementing ML.Methods: We recruited 5508 older ED patients (≥65 years old) in three hospitals between 2009 and 2018. Patients were randomized into a 70%/30% split for ML model training and testing. Using 10 clinical variables from their electronic health records, a random forest model using the synthetic minority oversampling technique preprocessing algorithm was constructed to predict five outcomes. Results: The areas under the curves of predicting outcomes using the random forest model were 0.807 for hospitalizations, 0.974 for pneumonia, 0.994 for sepsis or septic shock, 0.981 for intensive care unit admission, and 0.851 for death in the testing data. The predictive model was further applied in the hospital information system to assist physicians’ decisions in real time.Conclusions: ML is a promising way to assist physicians in predicting outcomes in older ED patients with influenza in real time. Evaluations of the effectiveness and impact are needed in the future.
The Impact of Patient’s Body Habitus on PET Image Quality in Digital and Analogic PET/CT
Authors: Weyts Kathleen , Quak Elske , Licaj Idlir , Lasnon Charline , Ciappuccini Renaud , Foucras Gauthier , Savigny Jean-François , Bardet Stéphane , Jaudet Cyril
Published: August 2020

Background: New digital versus analogic PET has higher temporal resolution and more stable count rate, potentially limiting the degradation of PET image quality in larger patients. We wanted to describe the influence of patient’s body habitus on [18F]FDG PET image quality primary in digital PET/CT and analogic PET/CT.Results:We studied retrospectively the relation between patient’s weight, BMI, fatty massand PET image quality, described by the coefficient of variance in the liver (CVliv) and visually.177 unique patient exams on digital PET/CT (weight 35-127 kg; BMI 15-44 kg/m2) were performed with 2 protocols (protocol 1: N=52: 3MBq (0,08mCi)/kg [18F]FDG; 2minutes/bed position; 2iterations10subsets; 2mm diameter voxels and protocol 2: N=125: 4MBq (0,11mCi) /kg [18F]FDG; 1min/bed position; 4iterations4subsets; 2mm voxels).74 unique patient exams were analyzed on analogic PET/CT (weight 38-130 kg; BMI 14-52 kg/m2; with one protocol: 4MBq (0,11mCi)/kg [18F]FDG; 2min40sec/bedposition for BMI<25 and 3min40sec for BMI ≥25; 3iterations21subsets; 4mm voxels).Uni-and multivariable linear regression analysis showed positive association of CVliv with weight, BMI, fatty mass (p£0.009) and male sex (p£0,03) for both camera’s, with good fit in CVliv versus weight model on digital PET/CT (R2 up to 0.62). 4MBq (0,11mCi) protocol on digital PET/CT versus analogic PET/CT obtained lower CVliv on digital PET/CT in patients <70kg, without a difference if 70-<90kg and in Pearson correlation coefficients (p=0,26) despite substantially longer acquisition time for analogic PET/CT. For digital PET/CT CVliv increased similarly with weight for both protocols, up to 26% [95% Confidence Interval 2-56%] for ³90 kg versus <70kg, but overall CVliv values were lower in 4MBq (0,11mCi) protocol 2.Also visually PET image quality decreased with habitus on each camera (p£0.001) and was lower in females on digital PET/CT only (p=0,04).Conclusions:[18F]FDG PET image quality decreases with weight and enlarging body habitus on digital and analogic PET/CT imposing further optimization and harmonization also in digital PET/CT. This is important for clinical routine, but also (multicentric) research and development of artificial intelligence software.
Fungal alpha-diversity drives the stochasticity of bacterial and fungal community assembly in soil aggregates in the apple orchard
Authors: Zheng Wei , Zhao Zhiyuan , Lv Fenglian , Yin Yanan , Wang Zhaohui , Zhao Zhengyang , Li Ziyan , Zhai Bingnian
Published: August 2020

Background In soil ecosystems, bacteria and fungi always co-exist in the same niche and interact with each other, especially in different sized soil aggregates. The bacterial and fungal community assembly process and bacteria-fungi interactions in soil aggregates, which is important for bacterial and fungal community diversity and composition, is still unclear.Methods We examined bacterial and fungal community assembly in soil macroaggregate (> 0.25 mm), microaggregate (0.053–0.25 mm) and smaller microaggregate (silt + clay, < 0.053 mm) in an apple orchard. The microbial community assembly processes were analyzed by normalized stochasticity ratio index (NST).Results Bacterial community diversity, composition and assembly were more affected by agricultural practice and aggregate than fungal community. Bacterial community assembly was more stochastic in silt + clay than in macroaggregate, and was more stochastic (NST > 50%) than fungal community in soil aggregates. Meanwhile, bacterial NST was negatively correlated with fungal diversity, and fungal NST was positively correlated with fungal diversity. Co-occurrence network suggested that the bacteria and fungi were less strongly interacting in the network of silt + clay, compared to macroaggregate. The results indicated that fungi impact on the bacterial community assembly in soil aggregate, and the stochasticity of bacterial community assembly was increased with the decrease of interaction between bacteria and fungi in soil aggregates.Conclusions This study enhances our understanding of the mechanism of bacterial and fungal community assembly and co-exists pattern of bacteria and fungi in soil aggregates.
Exploring the Optimal Range of Central Venous Pressure in Sepsis and Septic Shock Patients: A Retrospective Study in 208 Hospitals
Authors: Song Xiaodong , Tang Zhaoxia , Li Shuhe , Xu Jinghong , Huang Fa , Hu Xiaoguang , Tong Li , Cao Lu , Zhu Yanping , Yao Jiyou , Lin Xiaobin , Guan Xiangdong , Lui Ka Yin , Cai Changjie
Published: August 2020

Background: The appropriate range of central venous pressure (CVP) in sepsis patients remains controversial. The aim of this study was to investigate the optimal CVP range in sepsis and septic shock patients admitted to intensive care unit.Methods: We performed a retrospective study with adult sepsis patients with CVP records based on the eICU Collaborative Research Database. Cases were divided into three groups according to mean CVP level during ICU stay: low (< 8 mmHg), normal (8–12 mmHg), and high (> 12 mmHg). Baseline characteristics and clinical outcomes of three groups were compared. Multivariable logistic regression was used to assess the relationship between different CVP levels (by equal interval of 4 mmHg) and in-hospital death risk. Results: 5302 sepsis patients were included in this study. Lactate level, serum creatinine, proportion of mechanical ventilation and dialysis were significantly higher in high CVP group compared to normal CVP group (2.6 [1.6,3.4] vs 2.2 [1.4,2.9] mmol/L; 1.5 [1,2.4] vs 1.2 [0.8,2] mg/dL; 52.2% vs 48.2%; 14.6% vs 9.7%; p < 0.05, respectively). In addition, high CVP group tended to have higher ICU mortality (24.8% vs 15.9%, p < 0.05) and hospital mortality (32.2% vs 22.4%, p < 0.05). The logistic regression analyses revealed that, in sepsis patients, CVP range of 12-16 mmHg, 16-20 mmHg and > 20 mmHg was related to increased in-hospital death risk compared to 8-12 mmHg level (OR: 1.349, 2.287, 3.210, respectively; 95% CI: 1.161–1.568, 1.897–2.757, 2.403–4.290, respectively); there were no significant differences between 0-4 mmHg, 4-8 mmHg and 8-12 mmHg levels regarding in-hospital death risk. Whereas in septic shock patients, CVP level of 0-4 mmHg, 12-16 mmHg, 16-20 mmHg and > 20 mmHg all contributed to increased in-hospital death risk (OR: 1.914, 1.652, 3.305, 3.554, respectively; 95% CI: 1.165–3.146, 1.299–2.101, 2.444–4.47, 2.233–5.654, respectively).Conclusions: High CVP level (> 12 mmHg) was related to worse clinical outcomes in both sepsis and septic shock patients; while very low CVP level (< 4 mmHg) in septic shock patients was also harmful. More strict fluid administration was essential in septic shock population.
The Effects of Melatonin and Propolis on Markers of Inflammation, Oxidative Stress, Clinical Outcomes, and Survival Rate in Patients with Primary Sepsis Hospitalized in Intensive Care Unit: A Randomized Clinical Trial
Authors: Pahlavani Naseh , Sedaghat Alireza , Ferns Gordon A , Mir Mahdie , Malekahmadi Mahsa , Moghaddam Ahmad Bagheri , Tabesh Hamed , Sadeghi Omid , Kiapey Seyedeh Shabnam Mazloumi , Navashenaq Jamshid Gholizadeh , Firouzi Safieh , Jarahi Lida , Najafi Mohsen Fathi , Rezvani Reza , Norouzy Abdolreza , Heshmati Maryam , Safarian Mohammad , Ghayour-Mobarhan Majid
Published: August 2020

Background: Systemic Inflammatory Response Syndrome (SIRS) that occurs under stressful conditions affecting all organs of the body. Previous studies have shown that propolis and melatonin have the potential to improve inflammation and oxidative stress, so the aim of this study was to investigate the effects of these supplements on SIRS treatment.Method: This was a randomized, controlled clinical trial in SIRS patients comprising 55 subjects that were randomly assigned to 3 intervention or control groups. In the 3 intervention groups, patients were treated with propolis alone (at dose of 1000 mg/day), propolis (1000 mg/day) plus melatonin (20 mg/day), and melatonin alone (20 mg/day) respectively, while there was no intervention in the control group. The inflammatory and oxidative stress markers and clinical outcomes were measured before and after of the intervention, also 28-day survival rate was assessed. Results: Propolis plus melatonin reduced serum interleukin 6 (p = 0.001) and CRP levels (p <0.001), and was associated with an increased gavage intake (p = 0.016). At the end of the study, there was no difference between the groups in the oxidative stress and hematological indices. In the propolis+melatonin group, the clinical outcomes were significantly improved (p <0.05). Also the SOFA score between the groups did not differ at any time, its changes was significant during the time (p>0.001). The average survival after 28 days of follow-up in the propolis, propolis+melatonin, melatonin and control groups were 24.08, 25.69, 22.05 and 19.42 days respectively, although this was not statistically significant (p=0.07).Conclusion and relevance: Supplementation with propolis+melatonin may help to improve clinical outcomes by reducing inflammation and was probably associated with an increase in the calorie intake, leading to an increase in the survival rate in SIRS patients, although more studies are necessary to prove these effects. Trial registration: IRCT20181025041460N1.
Relationship Between Classification of Fabellae and the Severity of Keen Osteoarthritis: A Relevant Study in Chinese Population
Authors: Zhang Lei , Wen Youliang , He Chunying , Zeng Yan , Luo Jiangqin , He Chunyan , Wang Junqiu , Feng Qi
Published: August 2020

Background: The fabella is a sesamoid bone having anatomical variations and it is more common in patients with primary keen osteoarthritis (KOA). The purpose of this study was to classify the fabellae and discuss the relationship between the classification of fabellae and the severity of KOA in Chinese. Material and methods: 136 patients were measured and classified using CT three-dimensional reconstruction. According to the CT imaging characteristics, the fabellae were divided into 5 types: type Ⅰ, a fabella on the lateral femoral condyle; type Ⅱ, a fabella on the medial femoral condyle; type Ⅲ, a fabella on the lateral femoral condyle and a fabella on the medial femoral condyle; type Ⅳ, two fabellae on the medial femoral condyle and type Ⅴ, two fabellae on the lateral femoral condyle. The severity of KOA was assessed on the Recht grade by MRI. The data were analyzed with SPSS 24.0. Results: The classification of fabellae were correlated with KOA grades (c 2 =35.026, P<0.05). In terms of KOA grades, grade Ⅰ and grade Ⅱ were occupied most of fabellar type Ⅱ (32, 72.8%); type Ⅱ and other types were significant statistical difference (P<0.05). Grade Ⅰ and grade Ⅱ were also the most of fabellar type Ⅳ (4, 100%). Fabellar type Ⅴ’s biggest component were grade Ⅲ and grade Ⅳ (6, 75%). Type Ⅳ and type Ⅴ were significant statistical difference (P<0.05). Conclusion: The classification of fabellae were correlated with KOA grades. The type Ⅱ may mean the lower KOA grades while type Ⅴ may mean the higher KOA grades. Trial registration: the Ethics Inspection Committee at Southwest Medical University, V1.0/20180801. Registered 20 August 2018.
WITHDRAWN: A Universal Approach to Target Various HBB Gene Mutations in Hematopoietic Stem/Progenitor Cells for Beta-Thalassemia Gene Therapy by CRISPR/Cas9 and the rAAV6 Vector
Authors: He Li-Na , Yang Yi , Cheng Yi , Wu Han , Lin Shou-Heng , Song Bing , Liu Neng-Qing , Chen Di-Yu , Lu Dian , Yang Ying-Hong , Zeng Juan , Fan Yong , Sun Xiaofang
Published: August 2020

Background: Engineered nuclease-mediated gene targeting through homology-directed repair (HDR) in autologous hematopoietic stem and progenitor cells (HSPCs) has the potential to cure β-thalassemia (β-thal). Although previous studies have precisely corrected site-specific HBB mutations by HDR in vitro and in vivo, targeting the various HBB mutations in β-thal is still challenging. Here, we devised a universal strategy to achieve repaired most types of HBB mutations through the CRISPR/Cas9 and the rAAV6 donor.Methods: Using cord blood-derived HSPCs from health donors, we tested the strategy to achieved highly efficient targeted integration by optimizing design and delivery parameters of a ribonucleoprotein (RNP) complex comprising Cas9 protein and modified single guide RNA, together with a rAAV6 donor. We assessed the edited HSPCs function in vitro by methylcellulose colonies assay, CFU assay, differentiation experiment and Wright-Giemsa staining. Edited HSPCs transplanted into NSI mice to assess the long-term reconstitution in vivo. Whole-genome sequencing was used to analysis the off-target mutagenesis of edited HSPCs.Results: Edited HSPCs exhibited normal multilineage formation and erythroid differentiation abilities without off-target mutagenesis and retained the ability to engraft. Moreover, we used the strategy to efficiently correct the β-CD41/42 mutation of patient-derived HSPCs, erythrocytes differentiation from which expressed more HBB mRNA than uncorrected cells.Conclusion: This strategy demonstrated a universal approach to correct most types of HBB gene mutations in β-thal.
Spatial Transmission Network Construction of Influenza-Like Illness Using Dynamic Bayesian Network and Vector-Autoregressive Moving Average Model
Authors: Qiu Jianqing , Wang Huimin , Zhang Tao , Yang Changhong
Published: August 2020

Background: Influenza is an acute respiratory infection caused by an influenza virus, and the primary intervention strategy is seasonal vaccine. Due to various influenza strains and their rapid mutation each year, how to recognize the key population and timing of the vaccination becomes essential. Considering the importance of finding possible spreading directions and effects of influenza between cities for department of influenza prevention, the construction of influenza transmission network becomes meaningful.Methods: 21 cities in Sichuan province were divided into different learning communities according to whether they were adjacent to each other or not. In each community, the first-order conditional dependencies approximation algorithm was performed to learn the possible structure of the time-lagged correlations between different time series vectors of the ILI estimated weekly number, and the vector autoregressive moving average models were performed for learning the lag orders and parameters of the time-lagged correlations between different time series vectors in each community.Results: It detected a number of significant time-lagged correlations between cities in Sichuan province using two models, and the lag was from 1 week to 3 weeks. The parameters indicating the suspected propagation relationship were between -0.90 and 0.75, and the proportion of the negative values in parameters increased with time. Furthermore, the spreading routes learning from two models were almost in accordance with the traffic network of Sichuan province.Conclusions: This study proposed an innovative framework for exploring the potentially stable transmission routes between different regions and measuring specific size of the transmission effect. It could be used for the infectious disease key area confirmation by considering their adjacent areas’ incidence and the transmission relationship.
FLT-PET for the Assessment of Systemic Sarcoidosis Including Cardiac and Cns Involvement: a Prospective Study With Comparison to FDG-PET
Authors: Martineau Patrick , Pelletier-Galarneau Matthieu , Juneau Daniel , Leung Eugene , Nery Pablo , deKemp Rob , Beanlands Rob , Birnie David
Published: August 2020

BACKGROUND:FDG’s biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. FLT has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement.MATERIALS AND METHODS:14 subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen’s kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed. RESULTS:12 subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p<0.001) higher for FDG than FLT (5.8 (3.0) vs 2.3 (1.1), respectively), but not (p=0.90) after adjusting for blood pool activity (2.8 (1.4) vs 2.8 (1.1), respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG.CONCLUSIONS:FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.
Joint Optic Disc and Dup Segmentation Based on Densely Connected Depthwise Separable Convolution Deep Network
Authors: Liu Bingyan , Pan Daru , Song Hui
Published: August 2020

Background: Glaucoma is an eye disease that causes vision loss and even blindness. The cup to disc ratio is the main indicator used to screen and diagnose glaucoma, optic disc and optic cup segmentation can assist computer in diagnosing glaucoma.Therefore, accurate segmentation of optic disc and optic cup is beneficial to the screening and diagnosis of glaucoma and helps patients diagnose and treat early. Method: In this paper, we consider the segmentation of the optic disc and the optic cup as a multi-category semantic segmentation task, and proposed a deep learning-based model model named DDSC-Net(densely connected depthwise separable convolution network) to extract the optic disc and the optic cup. The backbone network is composed of densely connected deep separable convolution blocks to form a deeper network and the image pyramid input is introduce into the input layer to widen the network. In the post-process, we apply the morphological method to refine the output segmentation results. Result: The proposed method is evaluated on two publicly available datasets, DRISHTI-GS dataset and REFUGE dataset. And the experiment results show that our DDSC-Net outperforms state-of-the-art optic disc and cup segmentation methods in terms of disc coefficients and Jaccard score. Furthermore,our method achieves the best result on the more challenging optic cup segmentation task. Conclusion: The promising segmention performances reveal that our method has potential in assisting the screening and diagnosis of the glaucoma.
Kangaroo mother care practice and its associated factors among postnatal mothers who gave birth in public general hospitals of Eastern and Central zone, Tigray, North Ethiopia
Authors: Gebremedhin Haftay , Hidru Hagos Degefa , Gidey Berihu , Mehari Medhin , Berwo Meresa , Tilahun Muzayene , Legese Haftom
Published: August 2020

Background:Kangaroo mother care (KMC) practice ‘is the early, prolonged and continuous skin-to skin contact between the mother and her low birth weight baby that practiced in the hospital and after early discharge until at least the 40 th weeks of postnatal period with exclusive breast feeding and proper follow-up’. Low birth weight is an underling factor in 60-80% of all neonatal deaths. Therefore, this study aimed to assess kangaroo mother care practice and its associated factors among post natal mothers who gave birth in public hospitals of Eastern and Central zone, Tigray, North Ethiopia.Methods:An institutional based cross-sectional study was conducted in Eastern and central zone of Tigray Region from March –August/2019. A total of 411 study participants were selected using simple random sampling technique. Binary and Multiple logistic regression analysis were used to see the association of independent variables to the outcome variable at a P<0.05 using SPSS version 20.0 software.Results:A total of 397 study participants were included in the study with a response rate of 96.6%. Of these, the mean age of the respondents was 27.4(±5.7). More than half (54.4%) of mothers were practiced KMC to their low birth weight baby. Mothers age [AOR (95%CI):0.21(0.05,0.95)], occupational status of mothers [AOR (95%CI): 0.11(0.04,0.34)], occupational status of fathers [AOR (95%CI): 4.1(1.54,11.07)], monthly income[AOR(95%CI): 0.27(0.09,0.76)], place of delivery [AOR(95%CI):0.29(0.11,0.76) and complications of newborn baby at birth [AOR(95%):3.1(1.21,8.09)] were the factors significantly associated with kangaroo mother care practice.Conclusion:There was low proportion of mothers practiced kangaroo mother care to their low birth weight baby. Hence, health care providers should demonstrate for family members and mothers on how to practice kangaroo mother care immediately after delivery in health institution and to be continued at home.
Exploring adaptations and successful implementation of Traditional Healers as adherence partners for people living with HIV in rural Mozambique: A qualitative assessment
Authors: Audet Carolyn M , Pettapiece-Phillips Mariah , Salato Jose
Published: August 2020

BackgroundImplementing evidence-based interventions to improve adherence to antiretroviral therapy (ART) is essential to controlling the HIV epidemic in sub-Saharan Africa. Evidence-based community health worker interventions address barriers to medication retention by shifting the task from overburdened health facilities and emphasizing a more patient-centered approach in a comfortable location.MethodsWe employed traditional healers to implement an evidence-based community health worker program for people living with HIV (PLHIV) in rural Mozambique. Participants received support services for 2 months after their first positive test. Healers were trained to provide counseling, HIV education, support with disclosure, and advocacy at the health unit. We interviewed 23 PLHIV and conducted focus groups with 19 traditional healers to explore implementation fidelity and identify unplanned adaptations made during the program.ResultsHealers and PLHIV report counseling, HIV education sessions, and support with disclosure were largely delivered with fidelity. Due to the extreme poverty in the region, healers reported the need to add additional messages to support people who needed to take medication but had no food to mitigate the side effects. Patient advocacy at the health center proved difficult to implement. Negative attitudes towards PLHIV and traditional healers led to participants reporting extremely poor treatment by health care providers; the lack of respect made it difficult for healers to assist PLHIV with issues like long wait times, lost patient identification cards, or enduring medication side effects. Healers adopted directly observed therapy as an unplanned strategy to support non-adherent PLHIV.ConclusionGiven low levels of literacy and substantially different views on disease causation, healers delivered most core components of the intervention with fidelity. Healers attempted to implement the patient advocacy component but resistance from health care providers proved challenging. Future efforts will need to develop more effective strategies to overcome negative healer-clinician dynamic.Clinical Trials RegistryName of the registry: Traditional Healers as Adherence Partners for Persons Living with HIV in Rural Mozambique (PLHIV). Trial registration number: NCT03076359. Date of registration: 3/6/2017, retrospectively registered. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03076359?cond=Hiv&cntry=MZ&draw=2&rank=7
Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years. A randomised clinical trial
Authors: Lynge Susanne , Dissing Kristina Boe , Vach Werner , Christensen Henrik Wulf , Hestbaek Lise
Published: August 2020

BackgroundTo investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7-14 with recurrent headaches.MethodsDesign: A two-arm randomised superiority single-blinded clinical trial.Setting: One chiropractic clinic and one paediatric specialty practice in Denmark Participants: 199 children aged 7 to 14 years, who experienced at least one episode of headache per week for the previous 6 months and with at least one musculoskeletal dysfunction identified. Interventions: All participants and parents received standard oral and written advice to reduce headaches. In addition, children in the active treatment group received chiropractic spinal manipulation and children in the control group received sham manipulation for a period of 4 months. The number and frequency of treatments were based on the chiropractor’s individual evaluation in the active treatment group, and the children in the control group received approximately eight visits during the treatment period.Primary outcome measures: ‘Number of days with headache’, ‘pain intensity’ and ‘medication’ were reported weekly by text messages, and global perceived effect by text message after 4 months. A planned fixed sequence strategy based on an initial outcome data analysis was used to prioritize outcomes. ‘Number of days with headache’ and ‘pain intensity’ were chosen as equally important outcomes of highest priority, followed by global perceived effect and medication. The significance level for the first two outcomes was fixed to 0.025 to take multiplicity into account.ResultsChiropractic spinal manipulation resulted in significantly fewer days with headaches (reduction of 0.81 vs. 0.41, p=0.019, NNT=7) and better global perceived effect (2.63 vs. 3.24, p<0.001, NNT=5) compared with a sham manipulation procedure. There was no difference between groups for pain intensity during headache episodes. Due to methodological shortcomings, no conclusions could be drawn about medication use.Conclusions Chiropractic spinal manipulation resulted in fewer headaches and higher global perceived effect, with only minor side effects. It did not lower the intensity of the headaches.Since the treatment is easily applicable, of low cost and minor side effects, chiropractic spinal manipulation might be considered as a valuable treatment option for children with recurrent headaches.Trial registrationClinicalTrials.gov, identifier NCT02684916, registered 02/18/2016 – retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02684916
Study on spatial-temporal distribution and environmental ties of Japanese B Encephalitis’s mosquito vector as well as landing rate in The Olympic forest park
Authors: Liu Mei-De , Zhang Yong , Tong Ying , Zhang Hong-Jiang , Li Qiu-Hong , Liu Ting , Zhou Xiao-Jie , Zeng Xiao-Peng
Published: August 2020

Background: Mosquito surveillance is crucial for understanding the epidemic potential, planning early-warning, and effective control strategies. As a key public place in Beijing, the Beijing Olympic Forest Park (BOFP) makes serious epidemiological means for the Beijing, and the survey on the Japanese B Encephalitis (JBE) vector of Culex tritaeniorhynchus and mosquito landing in BOFP is crucial for the people living as well as JBE surveillance and control. It was hypothesized that the Cx. tritaeniorhynchus could be trapped in a well-urbanization area of Beijing, and the distribution of Cx. tritaeniorhynchus and mosquito landing rate are determined by the environmental factors. Methods: Thus, this investigation was performed to understand the spatial-temporal distribution of Cx. Tritaeniorhynchus and landing rate in BOFP, and the relationship between environmental features and densities of Cx. tritaeniorhynchus as well as mosquito landing rate, considering the vector competent of Cx. tritaeniorhynchus and important epidemiological means of BOFP in Beijing. From July to September, the Cx. tritaeniorhynchus was trapped with CDC-lights together with CO2 and the landing rate on the same sites as light traps were also investigated. What’s more, the ties of environmental factors to the density of Cx. tritaeniorhynchus and landing rate was performed with SPSS, after the environmental factors datasets had been extracted with the 3S procedures. Results: As result showed, the highest density of Cx. tritaeniorhynchus could be detected in September in the wetland environment, and the density was related to the grass-water in 400meters buffer (GW_400) and lower-trees in 100meter buffer distance (LT_100). For the landing rate investigation, the highest landing rates was observed in the wetland environment during September. In addition, there were two environmental features could be identified to correlate to landing rates; that is, grass-water in 400meters buffer (GW_400) and high-trees in 100meter buffer distance (HT_100). It was concluded that the Cx. tritaeniorhynchus, the vector of JBE, could be detected in BOFP (well-urbanization area), and the environmental factor could affect not only the spatial distribution of JBE vector but also the mosquito landing rates in BOFP. Conclusions: The information achieved from this study could offer advice to people escaping from mosquito biting and provide useful information to prevent mosquito-borne diseases in Beijing, which means a lot to the public health of Beijing.
Disentangling environmental effects in microbial association networks
Authors: Deutschmann Ina Maria , Lima-Mendez Gipsi , Krabberød Anders K. , Raes Jeroen , Vallina Sergio M. , Faust Karoline , Logares Ramiro
Published: August 2020

Background: Ecolocial interctions among microorganisms are fundamental for ecosystem function, yet they are mostly unknown or poorly understood. High-throughput-omics can indicate microbial interactions by associations across time and space, which can be represented as association networks. Links in these networks could result from either ecological interactions between microorganisms, or from environmental selection, where the association is environmentally-driven. Therefore, before downstream analysis and interpretation, we need to distinguish the nature of the association, particularly if it is due to environmental selection or not.Results: We present EnDED (Environmentally-Driven Edge Detection), an implementation of four approaches as well as their combination to predict which links between microorganisms in an association network are environmentally-driven. The four approaches are Sign Pattern, Overlap, Interaction Information, and Data Processing Inequality. We tested EnDED on networks from simulated data of 50 microorganisms. The networks contained on average 50 nodes and 1,087 edges, of which 60 were true interactions but 1,026 false associations (i.e. environmentally-driven or due to chance). Applying each method individually, we detected a moderate to high number of environmentally-driven edges—87% Sign Pattern and Overlap, 67% Interaction Information, and 44% Data Processing Inequality. Combining these methods in an intersection approach resulted in retaining more interactions, both true and false (32% of environmentally-driven associations). The addition of noise to the simulated datasets did not alter qualitatively these results. After validation with the simulated datasets, we applied EnDED on a marine microbial network inferred from 10 years of monthly observations of microbial-plankton abundance. The intersection combination predicted that 14.2% of the associations were environmentally-driven, while individual methods predicted 31.4% (Data Processing Inequality), 38.3% (Interaction Information), and up to 83.4% (Sign Pattern as well as Overlap).Conclusions: To reach accurate hypotheses about ecological interactions, it is important to determine, quantify, and remove environmentally-driven associations in marine microbial association networks. For that, EnDED offers up to four individual methods as well as their combination. However, especially for the intersection combination, we suggest to use EnDED with other strategies to reduce the number of false associations and consequently the number of potential interaction hypotheses.
Effect of zinc, magnesium, and copper substitutions on the initial permeability of nickel ferrite
Authors: SHAFIEE SAREH , Arab Ali , RIAHI-NOURI NASTARAN
Published: August 2020

Zinc, magnesium, and copper substituted nickel spinel ferrite were synthesized in the form of Ni1 − x (Zn06Mg0.2Cu0.2) x Fe2O4 (where x = 0.0, 0.3, 0.5 and 0.7) via auto combustion method. The effect of the presence of these dopants on the average of crystallite, average particle size, the lattice constant, morphology, initial permeability, and magnetization of the synthesized ferrites was investigated. The structural properties, morphology, and magnetic properties were characterized via X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), energy dispersive spectroscopy (EDS), LCR meter and alternative gradient force magnetometer (AGFM). XRD study shows the formation of a single-phase cubic spinel structure. Also, the average crystallite size was found to increase from 6 nm to 11 nm with increasing the Zn2+, Mg2+, and Cu2+ doping ratio from 0.0 to 0.7. Moreover, FE-SEM results were indicated the presence of nanosized spherical shape of prepared particles with agglomeration. The lattice constant and the particle size were found to increase with the increase in Zinc, magnesium, and copper. The values of initial permeability and magnetization were increased to a maximum value of 76 H/M and 71.37 emu/g for x = 0.7 sample. Furthermore, coercivity was found to decrease with increasing Zinc, magnesium, and copper concentration, which is useful for power applications. The variations of initial permeability and magnetization as a function of average particle size were discussed and were compared with previous works. The results were indicated the increase in initial permeability and magnetization with the enhancement of average particle size. The constancy in permeability throughout the frequency range studied from 10 kHz to1 MHz was indicated the compositional stability and quality of the samples. The results were indicated that the ferrites with high initial permeability can be an excellent choice as magnetic cores.
Risk factors for Hyperhomocysteinemia for Specific MTHFR C677T Genotypes and Gender in Chinese Population.
Authors: Xiang Hang , Xiang Tianyuan , Yan Muyang , Yu Sheng , Horwedel Matthew John , Zeng Qiang , Li Yang
Published: August 2020

Background­-- Our previous studies have identified that both gender and genotype of MTHFR C677T were independent variables for plasma homocysteine (Hcy) levels. Based on these results, we want to further explore their systemic information, in order to find specific risk factors for each genetic group, which might be used as predictors or targeting markers for lowering Hcy levels. Patients and Methods­--This cross section study was performed through November 2017 to July 2019. A total of 4534 adults aged 20-75y were selected for this study, and all of them underwent a physical examinations and MTHFR C677T genotyping. Results--The average of Hcy level was higher in TT genotype than CC and CT genotypes (P=0.000). Multiple linear regression analysis found that except the common protective factors (folate and Vit B12) and risk factor (Cr), each group has it specific risk factors for HHcy---female-CT (age, SBP and Hb), female-TT (SBP and AST); male-CC (age, AST and Hb), male-CT (age and AST) and male-TT (SBP, AST and Hb).Conclusion--The plasma Hcy level was influenced by different risk factors for specific gender and genotype. These risk factors might be useful for prediction or prevention of HHcy in the future.
Real-Time Prediction of AKI Among Middle-Aged and Older in ICU: A Retrospective and Machine Learning Study
Authors: Wang Hui , Deng Fuxing , Zhang Buyao , Zhao Shuangping
Published: August 2020

BackgroundAcute Kidney Injury (AKI), a major public health problem，is responsible for two-thirds of intensive care unit patients’ cost, and aging is an independent risk factor for AKI and its associated mortality and morbidity. The early recognition of AKI helps ICU caregivers to guide fluid treatment and titrate the dosing of the nephrotoxic drug. Therefore, it is desirable to build models to predict their position. The study is to build models based machine learning to predict AKI stage after 24 hours and 48 hours among middle-aged and older patients respectively in ICU. Methods and FindingsWe used two real-world databases to build and test models. The Medical Information Mart for Intensive Care (MIMIC-III v1.4) database for training, funded by National Institutes of Health (NIIH) built by the Computational Physiology Laboratory of MIT, Beth Israel Dikon Medical Center, and Philips Medical. The eICU Collaborative Research Database (eICU-CRD v 2.0) for the test is open-access, de-identified data sets of patients admitted to ICUs. 26316 patients in the overall cohort were generally older (median age ranging from 57 to 79) and 54% were male. Here we present three models, using the support vector machine (SVM), Long short-term memory (LSTM), and convolutional LSTM ConvLSTM respectively. the ConvLSTM model had the best performance in the test data set, and it has good ability and surpasses any previous model to predict whether older patients have AKI or not. The area under the receiver operating characteristic curve (AUC) of 24-hour prediction AKI is 99.79%, 48-hours AKI 99.43% during the hospital. we demonstrate that deep learning can handle lots of variables which may be predictors and that the algorithm achieved robust and excellent performance.ConclusionsTo our knowledge, this study is the first to use large-scale data collected from electronic health record（EHR）to prove the contribution of big data and deep learning methods to the real-time prediction of AKI prognosis in middle-aged and elderly patients. The model performance is better than any previous models. This work provides novel evidence to change clinical practice and precise personalized interventions.