bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceived strategies to reduce traumatic childbirth amongst Iranian childbearing women: a qualitative study
Authors: Taheri Mahshid , Taghizadeh Ziba , Jafari Nahid , Takian Amirhossein
Published: June 2020

Background

Psychological birth trauma (PBT), mainly due to overlooking maternal mental health, is a common and high prevalence public health problem in low-resource settings. Preventing PBT is a good indicator of the realization of human rights in healthcare. This work reports the results of a qualitative study that aimed to identify perceived strategies of PBT prevention among childbearing women in Iran.

Methods

We conducted semi-structured in-depth interviews with 22 mothers with history of traumatic childbirth, two mothers with positive childbirth experience, two spouses, and eight health professionals between April and June 2017. We used purposive sampling method to recruit traumatized mothers, while health experts were selected based on their relevant expertise and experience. Our initial literature review identified eight categories, using which we developed our interview guide and conducted the content analysis approach.

Results

With the maximum possible purification, we reached 50 thematic codes. The strategies to prevent PBT are generally summarized in four major themes and 13 categories: 1) skill-builder knowledge [Birth preparedness, Mothers’ empowerment in maintaining mental health, Understanding the importance of mental care in maternity services], 2) responsible caregiving [Support loop, Good behavior of the caregivers, Deepening trust, Struggle with medicalization of childbirth, Labour pain relief, Special services for maternal mental health], 3) the alliance of prenatal and antenatal care [Continuity of care, Coordination of prenatal and antenatal caregivers], and 4) reconstruction of the structures [Efficient management, Rebuilding physical structures].

Conclusions

This is a comprehensive approach towards PBT prevention, which can guide future efforts to reduce PBT at the clinical level and open further avenues for future studies. We recommend policy makers to consider the integration of multilevel and multidimensional PBT prevention interventions, simultaneously within maternity care services packages for promotion of mental health.
Whole-brain irradiation with hippocampal sparing and dose escalation on metastases: neurocognitive testing and biological imaging (HIPPORAD) – a phase II prospective randomized multicenter trial (NOA-14, ARO 2015–3, DKTK-ROG)
Authors: Grosu Anca-Ligia , Frings Lars , Bentsalo Iryna , Oehlke Oliver , Brenner Franziska , Bilger Angelika , Fennell Jamina Tara , Rothe Thomas , Schneider-Fuchs Sabine , Graf Erika , Schmoor Claudia , Beck Jürgen , Becker Gerhild , Bock Michael , Egger Karl , Urbach Horst , Lahmann Claas , Popp Ilinca
Published: June 2020

Background

Whole brain radiation therapy (WBRT) is the standard therapy for multiple brain metastases. However, WBRT has a poor local tumor control and is associated with a decline in neurocognitive function (NCF). Aim of this trial is to assess the efficacy and safety of a new treatment method, the WBRT with hippocampus avoidance (HA) combined with the simultaneous integrated boost (SIB) on metastases/resection cavities (HA-WBRT+SIB).

Methods

This is a prospective, randomized, two-arm phase II multicenter trial comparing the impact of HA on NCF after HA-WBRT+SIB versus WBRT+SIB in patients with multiple brain metastases. The study design is double-blinded. One hundred thirty two patients are to be randomized with a 1:1 allocation ratio. Patients between 18 and 80 years old are recruited, with at least 4 brain metastases of solid tumors and at least one, but not exceeding 10 metastases ≥5 mm. Patients must be in good physical condition and have no metastases/resection cavities in or within 7 mm of the hippocampus. Patients with dementia, meningeal disease, cerebral lymphomas, germ cell tumors, or small cell carcinomas are excluded. Previous irradiation and resection of metastases, as well as the number and size of metastases to be boosted have to comply with certain restrictions. Patients are randomized between the two treatment arms: HA-WBRT+SIB and WBRT+SIB. WBRT is to be performed with 30 Gy in 12 daily fractions and the SIB with 51 Gy/42 Gy in 12 daily fractions on 95% of volume for metastases/resection cavities. In the experimental arm, the dose to the hippocampi is restricted to 9 Gy in 98% of the volume and 17Gy in 2% of the volume. NCF testing is scheduled before WBRT, after 3 (primary endpoint), 9, 18 months and yearly thereafter. Clinical and imaging follow-ups are performed 6 and 12 weeks after WBRT, after 3, 9, 18 months and yearly thereafter.

Discussion

This is a protocol of a randomized phase II trial designed to test a new strategy of WBRT for preventing cognitive decline and increasing tumor control in patients with multiple brain metastases.

Trial registration

The HIPPORAD trial is registered with the German Clinical Trials Registry (DRKS00004598, registered 2 June 2016).
The development and validation of a radiomic nomogram for the preoperative prediction of lung adenocarcinoma
Authors: Liu Qin , Huang Yan , Chen Huai , Liu Yanwen , Liang Ruihong , Zeng Qingsi
Published: June 2020

Background

Accurate diagnosis of early lung cancer from small pulmonary nodules (SPN) is challenging in clinical setting. We aimed to develop a radiomic nomogram to differentiate lung adenocarcinoma from benign SPN.

Methods

This retrospective study included a total of 210 pathologically confirmed SPN (≤ 10 mm) from 197 patients, which were randomly divided into a training dataset (n = 147; malignant nodules,n = 94) and a validation dataset (n = 63; malignant nodules,n = 39). Radiomic features were extracted from the cancerous volumes of interest on contrast-enhanced CT images. The least absolute shrinkage and selection operator (LASSO) regression was used for data dimension reduction, feature selection, and radiomic signature building. Using multivariable logistic regression analysis, a radiomic nomogram was developed incorporating the radiomic signature and the conventional CT signs observed by radiologists. Discrimination and calibration of the radiomic nomogram were evaluated.

Results

The radiomic signature consisting of five radiomic features achieved an AUC of 0.853 (95% confidence interval [CI]: 0.735–0.970), accuracy of 81.0%, sensitivity of 82.9%, and specificity of 77.3%. The two conventional CT signs achieved an AUC of 0.833 (95% CI: 0.707–0.958), accuracy of 65.1%, sensitivity of 53.7%, and specificity of 86.4%. The radiomic nomogram incorporating the radiomic signature and conventional CT signs showed an improved AUC of 0.857 (95% CI: 0.723–0.991), accuracy of 84.1%, sensitivity of 85.4%, and specificity of 81.8%. The radiomic nomogram had good calibration power.

Conclusion

The radiomic nomogram might has the potential to be used as a non-invasive tool for individual prediction of SPN preoperatively. It might facilitate decision-making and improve the management of SPN in the clinical setting.
Immunohistochemical expression of vitamin D receptor and forkhead box P3 in classic Hodgkin lymphoma: correlation with clinical and pathologic findings
Authors: Gupta Gaurav K. , Agrawal Tanupriya , Pilichowska Monika
Published: June 2020

Background

Expression of forkhead box P3 (FOXP3), a key regulator of T-cell function, in the tumor immune microenvironment is related to survival in classic Hodgkin lymphoma (CHL). Vitamin D receptor (VDR), a transcription factor agonists have been shown to induce FOXP3 expression in T-cells and enhance recruitment of these cells to the inflammatory sites. VDR expression is CHL has been described. However, there is no data on expression of VDR in context of quantity of FOXP3 positive cells in CHL.

Methods

We examined and correlated immunohistochemical expression of VDR and FOXP3 along with clinical and pathology findings in 29 cases of CHL.

Results

VDR was expressed in Hodgkin Reed-Sternberg (HRS) cells and background lymphocytes and FOXP3 was expressed in background lymphocytes. 82% of CHL cases, regardless of the subtype, expressed VDR and in majority of the cases, VDR expression was directly proportional to the quantity of FOXP3 expressing lymphocytes in the tumor microenvironment. In cases with higher clinical stage (III/IV), only 28.5% of cases diffusely expressed VDR and FOXP3 compared to 71.4% showing focal positivity. Whereas in cases with lower clinical stages (I/II), the expression pattern of VDR and FOXP3 was almost similar (41.6% diffuse versus 33.3% focal). Interestingly, focal VDR and FOXP3 expression pattern was significantly higher among males. Mixed cellularity cases showed predilection for focal VDR and FOXP3 expression (80% cases); whereas nodular sclerosis subtype had focal and diffuse VDR and FOXP3 expression patterns in similar proportion. Cases with diffuse VDR and FOXP3 expression were less likely to have bone marrow involvement. Epstein Barr virus- encoded small RNA (EBER) positive cases were predominantly focally positive (80%) for VDR and FOXP3.

Conclusions

In summary, quantity of FOXP3 positive T-cells in CHL microenvironment seems to correlate with VDR expression. Clinical stage show a trend of inverse correlation with expression of VDR and quantity of FOXP3 positive T-cells. These findings suggest that VDR could be a possible prognostic and therapeutic target in CHL.
Single-institutional outcome-analysis of low-dose stereotactic body radiation therapy (SBRT) of adrenal gland metastases
Authors: Voglhuber Theresa , Kessel Kerstin A. , Oechsner Markus , Vogel Marco M. E. , Gschwend Jürgen E. , Combs Stephanie E.
Published: June 2020

Background

Adrenal gland metastases are a common diagnostic finding in various tumor diseases. Due to the increased use of imaging methods, they are diagnosed more frequently, especially in asymptomatic patients. SBRT has emerged as a new, alternative treatment option in the field of radiation oncology. In the past, it was often used for treating inoperable lung, liver, prostate, and brain tumors. Meanwhile, it is also an established keystone in the treatment of oligometastatic diseases. This retrospective study aims to evaluate the effect of low-dose SBRT in patients with adrenal metastases.

Methods

We analyzed a group of 31 patients with 34 adrenal gland lesions treated with low-dose SBRT between July 2006 and July 2019. Treatment-planning was performed through contrast-enhanced CT, followed by image-guided stereotactic radiotherapy using cone-beam CT. The applied cumulative median dose was 35 Gy; the median single dose was 7 Gy. We focused on local control (LC), progression-free survival (PFS), overall survival (OS), as well as acute and late toxicity.

Results

Seven adrenal gland metastases (20.6%) experienced local failure, 80.6% of the patients faced a distant progression. Fourteen patients were still alive. Median follow-up for all patients was 9.8 months and for patients alive 14.4 months. No treatment-related side-effects >grade 2 occurred. Of all, 48.4% suffered from acute gastrointestinal disorders; 32.3% reported acute fatigue, throbbing pain in the renal area, and mild adrenal insufficiency. Altogether, 19.4% of the patients faced late-toxicities, which were as follows: Grade 1: 12.9% gastrointestinal disorders, 3.2% fatigue, Grade 2: 9.7% fatigue, 6.5% headache, 3.2% loss of weight. The 1-year OS and probability of LF were 64 and 25.9%, respectively.

Conclusion

Low-dose SBRT has proven as an effective and safe method with promising outcomes for treating adrenal metastases. There appeared no high-grade toxicities >grade 2, and 79.4% of treated metastases were progression-free. Thus, SBRT should be considered as a therapy option for adrenal metastases as an individual therapeutic concept in the interdisciplinary discussion as an alternative to surgical or systemic treatment.
DAily time use, Physical Activity, quality of care and interpersonal relationships in patients with Schizophrenia spectrum disorders (DiAPASon): an Italian multicentre study
Authors: de Girolamo Giovanni , Rocchetti Matteo , Benzi Ilaria Maria Antonietta , Agosta Sara , Casiraghi Letizia , Ferrari Clarissa , De Franceschi Nicola , Macis Ambra , Pogliaghi Silvia , Starace Fabrizio
Published: June 2020

Background

Schizophrenia spectrum disorders (SSD) are ranked among the leading causes of disabilities worldwide. Many people with SSD spend most of their daily time being inactive, and this is related to the severity of negative symptoms. Here, we present the 3-year DiAPAson project aimed at (1) evaluating the daily time use among patients with SSD living in Residential Facilities (RFs) compared to outpatients with SSD and to the general population (Study 1); (2) evaluating the quality of staff-patient relationships, its association with specific patient outcomes and the quality of care provided in RFs (Study 2); and (3) assessing daily activity patterns in residential patients, outpatients with SSD and healthy controls using real-time methodologies (Study 3).

Methods

Study 1 will include 300 patients with SSD living in RFs and 300 outpatients; data obtained in these clinical populations will be compared with normative data obtained by the National Institute of Statistics (ISTAT) in the national survey on daily time use. Time use assessments will consist of daily diaries asking participants to retrospectively report time spent in different activities.

In Study 2, a series of questionnaires will be administered to 300 residential patients (recruited for Study 1) to evaluate the quality of care and staff-patient relationships, level of well-being and burnout of RFs’ staff, and quality of RFs using a European standardized questionnaire (QuIRC-SA).

In Study 3, the daily time use will be evaluated in a subgroup of 50 residential patients, 50 outpatients and 50 healthy controls using the Experience Sampling Method approach (participants will complete a brief questionnaire -about time use, mood and perceived energy- on a smartphone 8 times a day for 1 week) to compare retrospective and real-time reports. Moreover, their level of physical activity, sleep patterns, and energy expenditure will be monitored through a multi-sensor device.

Discussion

This project is highly innovative because it combines different types of assessments (i.e., retrospective and real-time reports; multi-sensor monitoring) to trace an accurate picture of daily time use and levels of physical activity that will help identify the best therapeutic options promoting daily activities and physical exercise in patients with SSD.

Trial registration

ISRCTN registry IDISRCTN21141466.
Impacts of stigma and discrimination in the workplace on people living with psychosis
Authors: Hampson M. E. , Watt B. D. , Hicks R. E.
Published: June 2020

Background

Employment holds many benefits for people living with psychosis. However, significant barriers to employment for this cohort appear to exist, notably stigma and discrimination against people living with serious mental health conditions. We asked: Would a qualitative sample including multiple stakeholder groups reveal similar results and if so, what would be the main impacts of such stigma and discrimination?

Method

This analysis used data from a qualitative study that had employed focus groups and interviews to investigate the employment barriers and support needs of people living with psychosis, including views of the multiple stakeholders (those living with mental health conditions, health professionals, care-givers, employments consultants and community members and employers).

Results

The impacts of workplace stigma and discrimination on people living with psychosis included work avoidance, reluctance to disclose mental health conditions to employers, work-related stress, and reduced longevity of employment.

Conclusions

Significant impacts from such stigma and discrimination were found in this study. The findings indicate a need to provide support mechanisms and to change the culture of workplaces to improve employment opportunities and outcomes for people living with psychosis.
Age-period-cohort analysis of kidney cancer deaths attributable to high body-mass index in China and U.S. adults
Authors: Liu Xiaoxue , Yu Yong , Wang Minsheng , Wang Fang , Mubarik Sumaira , Wang Yafeng , Meng Runtang , Yu Chuanhua
Published: June 2020

Background

Statistical data on burden of kidney cancer and the relavant risk factors are valuable for policy-making. This study aims to estimate kidney cancer deaths and high body-mass index (BMI) attributable to the deaths by gender and age group in China adults, compared with U.S.

Methods

We extracted kidney cancer data (1990–2017) about the age-standardized rates using the comparative risk assessment framework of the 2017 Global Burden of Disease study. We performed an age-period-cohort (APC) analysis to estimate trends of kidney cancer mortality attributable to high BMI.

Results

During 1990–2017, age-standardized mortality rate of kidney cancer was increasing in China but decreasing in U.S. The mortality attributable to high BMI in China showed a general increasing trend, while that in U.S. men was increasing and tended to be stable in women since 1995. APC analysis showed a similar pattern of age effect between China and U.S. adults, which substantially increased from 20 to 24 to 90–94 age group. Differently, the period effect rapidly increased in China than U.S. adults during 1990–2017. The cohort effect peaked in the earlier cohort born in 1902–1906 in China, and it declined consistently in U.S. with exception of 1902–1906 and 1907–1911 birth cohort.

Conclusions

The kidney cancer deaths attributable to high BMI, and period effect have been generally increasing in China adults, compared with U.S. adults in which the trend tends to be stable in recent years. The rapid aging may also intensify the increasing trend of kidney cancer death in China. Effective measures should be conducted on body weight control and care for kidney cancer prevention.
The effects of integrating work-related factors and improving cooperation in musculoskeletal physical therapy practice: protocol for the ‘WORK TO BE DONE’ cluster randomised controlled trial
Authors: Hutting Nathan , Oswald Wiebke , Nijhuis - van der Sanden Maria W.G. , Filart Monique , Raaijmakers Tamara , Bieleman Hendrik J. , Staal J. Bart , Heerkens Yvonne F.
Published: June 2020

Background

Musculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient’s work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health.

Methods/design

This trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and skills in terms of integrating work participation into the patients’ care. Data are gathered at baseline (T0), at four months (T1) and eight months (T2) follow-up. Most outcomes will be assessed with validated patient-reported questionnaires. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, sick leave (absenteeism), estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as patients.

Discussion

The trial is expected to result in a more effective physical therapy process for working patients with MSDs. This will lead to a substantial reduction of costs: lower costs thanks to a more effective physical therapy process and lower costs due to less or shorter sick leave and decreased presenteeism.

Trial registration

Netherlands Trial Register, registration number: NL8518, date of registration 9 April 2020, URL registration: https://www.trialregister.nl/trial/8518
Substantial decrease in paediatric lower extremity fracture rates in German hospitals in 2017 compared with 2002: an epidemiological study
Authors: Gonser Christoph Emanuel , Bahrs Christian , Hemmann Philipp , Körner Daniel
Published: June 2020

Background

There are no recent studies on the frequency of paediatric lower extremity fractures in Germany. The aims of this study were to report fracture rates of paediatric lower extremity fractures treated in German hospitals in 2002 and 2017 and to detect changes over time as well as to evaluate the gender and age distribution for each fracture location.

Methods

Data from the German National Hospital Discharge Registry, which covers over 99% of all German hospitals, were used for this study. The absolute frequencies and incidence of lower extremity fractures as well as age at the time of fracture and gender were included in the data. The population was subdivided into four age groups: 0–4, 5–9, 10–14, and 15–19 years. The boy: girl ratio (BGR) for all fracture locations was calculated by dividing the absolute frequency of boys by that of girls. The fracture incidence in 2017 was compared with 2002 by calculating the incidence rate ratio (IRR).

Results

The total number of fractures decreased by 39.9% from 2002 to 2017. The most common fracture locations in 2002 were femoral shaft, tibial shaft, distal tibia, and lateral and medial malleolus; the absolute number of all these fractures was lower in 2017 than in 2002 in all age groups. The incidence of hip and thigh fractures, knee and lower leg fractures, and foot fractures decreased by 39.0, 41.1, and 33.3%. Proximal tibial fractures increased both in absolute numbers and in incidence in the age groups 0–4, 10–14, and 15–19 years (IRR ≥ 1.1). The overall BGR was 2.3 in 2002 and 2.0 in 2017, indicating that the number of girls relative to that of boys who suffered a lower extremity fracture was higher in 2017 than in 2002. Furthermore, the BGR of all fracture locations increased with age in both years.

Conclusions

The number of paediatric lower extremity fractures treated in German hospitals in 2017 was significantly lower than that in 2002. However, the fracture frequency in girls decreased to a lesser extent than that in boys. The incidence of proximal tibial fractures increased.
Program on high value cost-conscious education in intensive care: Educational program on prediction of outcome and cost awareness on Intensive Care admission
Authors: van Wagenberg L. , Beurskens C. J. P. , Stegeman I. , Müller M. C. A.
Published: June 2020

Background

Intensive Care (ICU) involves extended and long lasting support of vital functions and organs. However, current training programs of ICU residents mainly focus on extended support of vital functions and barely involve training on cost-awareness and outcome. We incorporated an educational program on high-value cost-conscious care for residents and fellows on our ICU and measured the effect of education.

Methods

A cohort study with factorial survey design, in which ICU residents and fellows were asked to evaluate clinical vignettes, was performed on the mixed surgical-medical ICU of the Amsterdam University Medical Centre. Residents were offered an educational program focusing on outcome and costs of ICU care. Before and after the program they filled out a questionnaire, which consisted of 23 vignettes, in which known predictors of outcome of community acquired pneumonia (CAP), pancreatitis, acute respiratory distress syndrome (ARDS) and cardiac arrest were presented, together with varying patient factors (age, body mass index (BMI), acute kidney failure (AKI) and haemato-oncological malignancy). Participants were asked to either admit the patient or estimate mortality.

Results

BMI, haemato-oncological malignancy and severity of pancreatitis were discriminative for admission to ICU in clinical vignettes on pancreatitis and CAP. After education, only severity of pancreatitis was judged as discriminative. Before the intervention only location of cardiac arrest (in- vs out of hospital) was distinctive for mortality, afterwards this changed to presence of haemato-oncological malignancy.

Conclusion

We incorporated an educational program on high-value cost-conscious care in the training of ICU physicians. Based on our vignette study, we conclude that the improvement of knowledge of costs and prognosis after this program was limited.
Nurses’ intention to leave their job and associated factors in Bahir Dar, Amhara Region, Ethiopia, 2017
Authors: Ayalew Emiru , Workineh Yinager
Published: June 2020

Background

Intention to leave is an employee’s plan of tendency to leave the current working institute to find an alternative job in the near future. Even though nurses are the backbone of patient caring, there was no study done on intention to leave their job in North West Ethiopia. Therefore, the aim of this study was to assess nurses’ intention to leave their job and associated factors in Bahir Dar, North West Ethiopia, 2017.

Methods

An institutional-based cross-sectional study was conducted from 1st March to 30th March 2017. After proportional sample size allocation, 210 participants were selected by simple random sampling method. Data were collected by using a self-administered structured questionnaire. Statistical Package for Social Science version 23.0 was used to enter, clean, code and analyze the collected data. The association between independent and dependent variables was assessed by using bivariable and multivariable logistic regression model. Factors that had statistically significant association with the dependent variable (P < 0.05) were identified as significant in the multivariable logistic regression analysis.

Result

From a total of 210 nurses, 191 of them were participating in this study making a response rate of 90.95%. From all nurses, 64.4%of them were employed in the hospital. In this study, nurses’ overall intention to leave their job was 64.9% (95% CI: [57.6, 71.2]). Nurses’ intention to leave their job was determined by disagree in recognition (AOR = 4.83; 95%CI: [1.73, 13.50]), and work itself (AOR = 31.30; 95%CI: [7.16, 136.78]).

Conclusion

Nurses’ intention to leave their job in the current study was high. The contributing factors for this problem were disagree in recognition at work and work itself. Hence, we recommended that hospital and health center managers should maintain recognition at work and work itself to retain nurses.
Exploring the role of managers in the development of a safety culture in seven French healthcare facilities: a qualitative study
Authors: Quenon Jean-Luc , Vacher Anthony , Faget Marc , Levif-Lecourt Marie , Roberts Tamara , Fucks Isabelle , Promé-Visinoni Myriam , Cadot Christine , Bousigue Jean-Yves , Quintard Bruno , Parneix Pierre , Pourin Catherine
Published: June 2020

Background

Numerous studies have been conducted over the past 15 years to assess safety culture within healthcare facilities; in general, these studies have shown the pivotal role that managers play in its development. However, little is known about what healthcare managers actually do to support this development, and how caregivers and managers represent managers’role. Thus the objectives of this study were to explore: i) caregivers and managers’ perceptions and representations of safety, ii) the role of managers in the development of safety culture as perceived by themselves and by caregivers, iii) managers’ activities related to the development of safety culture.

Methods

An exploratory, multicentre, qualitative study was conducted from May 2014 to March 2015 in seven healthcare facilities in France. Semi-structured interviews were conducted with managers (frontline, middle and top level) and caregivers (doctors, nurses and nurse assistants) and on-site observations of two managers were carried out in all facilities. A thematic analysis of semi-structured interviews was performed. Observed activities were categorised using Luthans’ typology of managerial activities.

Results

Participants in semi-structured interviews (44 managers and 21 caregivers) expressed positive perceptions of the level of safety in their facility. Support from frontline management was particularly appreciated, while support from top managers was identified as an area for improvement. Six main categories of safety-related activities were both observed among managers and regularly expressed by participants. However, caregivers’ expectations of their managers and managerial perceptions of these expectations only partially overlapped.

Conclusions

The present study highlights current categories of managerial activities that foster safety culture, and points out an important gap between caregivers’ expectations of their managers, and managerial perceptions of these expectations. The findings underline the need to allow more time for managers and caregivers to talk about safety issues. The results could be used to develop training programs to help healthcare managers to understand their role in the development of safety culture.
Immunoreactivity to metal and silica associates with sarcoidosis in Dutch patients
Authors: Beijer E. , Meek B. , Bossuyt X. , Peters S. , Vermeulen R. C. H. , Kromhout H. , Veltkamp M.
Published: June 2020

Background

Involvement of metals or silica in the pathogenesis of sarcoidosis has been suggested by several case reports and specific epidemiological studies. However, the combination of occupational exposure and an immunological reaction has not been studied before in a group of sarcoidosis patients and non-sarcoidosis controls.

Methods

In 256 sarcoidosis patients and 73 control patients with obstructive sleep apnea, exposure to metal and silica was assessed using a questionnaire consisting of a complete occupational history subsequently linked to job-exposure matrices. Next, immunoreactivity to aluminium, beryllium, zirconium and silica was determined in 33 sarcoidosis and 19 control patients using a lymphocyte proliferation test.

Results

In sarcoidosis, 83 out 256 patients (32.4%) had occupational exposure to metals or silica, compared to 24.7% in the control group (p = 0.21). A significantly higher percentage of the sarcoidosis patients tested showed immunoreactivity to metals or silica compared to the control group (21.2 and 0% respectively, p = 0.039).

Conclusions

Immunoreactivity to silica and metals was only found in sarcoidosis patients, supporting the hypothesis that these antigens may be involved in the pathogenesis of a distinct subgroup of sarcoidosis patients. This indicates that when searching for causative agents in sarcoidosis patients, besides beryllium, also zirconium, aluminium and silica deserve clinical investigation.
Preoperative systemic immune-inflammation index predicts prognosis of patients with non-metastatic renal cell carcinoma: a propensity score-matched analysis
Authors: Hu Xu , Shao Yan-Xiang , Yang Zhi-Qiang , Dou Wei-Chao , Xiong San-Chao , Li Xiang
Published: June 2020

Background

A novel systemic immune-inflammation index (SII), based on the neutrophils, lymphocytes and platelet counts, is associated with the prognosis of several cancers. The present study evaluates the prognostic significance of SII in non-metastatic renal cell carcinoma (RCC).

Method

The present study retrospectively reviewed the medical record of patients with non-metastatic RCC who underwent nephrectomy between 2010 and 2013. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cut-off value. In addition, the propensity score matching (PSM) was performed with a matching ratio of 1:1. Univariate and multivariate Cox proportional hazards models were used to identify the prognostic factors. The results were reported by hazard ratio (HR) with 95% confidence interval (95% CI).

Results

A total of 646 patients were included in the final analysis. High SII group (> 529) was significantly associated with older age (P = 0.014), larger tumor (P < 0.001), higher pathological T stage (P < 0.001), higher tumor grade (P < 0.001) and more tumor necrosis (P < 0.001). Multivariate Cox regression analysis demonstrated that the higher preoperative SII was significantly associated with worse overall survival (OS) (HR = 2.26; 95% CI 1.44–3.54; P < 0.001) and cancer-specific survival (CSS) (HR = 2.17; 95% CI 1.33–3.55; P = 0.002). After PSM, elevated preoperative SII was an independent predictor of poor OS (HR = 1.78; 95% CI 1.1–2.87; P = 0.018) and CSS (HR = 1.8; 95% CI 1.07–3.03; P = 0.027).

Conclusion

In conclusion, preoperative SII is associated with adverse factors for RCC. Furthermore, higher preoperative SII is an independent predictor of poor OS and CSS in surgically treated patients with non-metastatic RCC. More prospective and large scale studies are warranted to validate our findings.
Surveillance of genetic markers associated with Plasmodium falciparum resistance to artemisinin-based combination therapy in Pakistan, 2018–2019
Authors: Khan Abdul Qader , Pernaute-Lau Leyre , Khattak Aamer Ali , Luijcx Sanna , Aydin-Schmidt Berit , Hussain Mubashir , Khan Taj Ali , Mufti Farees Uddin , Morris Ulrika
Published: June 2020

Background

The spread of artemisinin resistance in the Greater Mekong Subregion of Southeast Asia poses a significant threat for current anti-malarial treatment guidelines globally. The aim of this study was to assess the current prevalence of molecular markers of drug resistance in Plasmodium falciparum in the four provinces with the highest malaria burden in Pakistan, after introducing artemether–lumefantrine as first-line treatment in 2017.

Methods

Samples were collected during routine malaria surveillance in Punjab, Sindh, Baluchistan, and Khyber Pakhtunkhwa provinces of Pakistan between January 2018 and February 2019. Plasmodium falciparum infections were confirmed by rapid diagnostic test or microscopy. Plasmodium falciparum positive isolates (n = 179) were screened by Sanger sequencing for single nucleotide polymorphisms (SNPs) in the P. falciparum kelch 13 (pfk13) propeller domain and in P. falciparum coronin (pfcoronin). SNPs in P. falciparum multidrug resistance 1 (pfmdr1) N86Y, Y184F, D1246Y and P. falciparum chloroquine resistance transporter (pfcrt) K76T were genotyped by PCR-restriction fragment length polymorphism.

Results

No artemisinin resistance associated SNPs were identified in the pfk13 propeller domain or in pfcoronin. The pfmdr1 N86, 184F, D1246 and pfcrt K76 alleles associated with reduced lumefantrine sensitivity were present in 83.8% (150/179), 16.9% (29/172), 100.0% (173/173), and 8.4% (15/179) of all infections, respectively. The chloroquine resistance associated pfcrt 76T allele was present in 98.3% (176/179) of infections.

Conclusion

This study provides an update on the current prevalence of molecular markers associated with reduced P. falciparum sensitivity to artemether and/or lumefantrine in Pakistan, including a first baseline assessment of polymorphisms in pfcoronin. No mutations associated with artemisinin resistance were observed in pfk13 or pfcoronin. However, the prevalence of the pfmdr1 N86 and D1246 alleles, that have been associated with decreased susceptibility to lumefantrine, remain high. Although clinical and molecular data suggest that the current malaria treatment guidelines for P. falciparum are presently effective in Pakistan, close monitoring for artemisinin and lumefantrine resistance will be critical to ensure early detection and enhanced containment of emerging ACT resistance spreading across from Southeast Asia.
Mechanism of RNA modification N6-methyladenosine in human cancer
Authors: Zhou Zijian , Lv Jiancheng , Yu Hao , Han Jie , Yang Xiao , Feng Dexiang , Wu Qikai , Yuan Baorui , Lu Qiang , Yang Haiwei
Published: June 2020

Since the breakthrough discoveries of DNA and histone modifications, the field of RNA modifications has gained increasing interest in the scientific community. The discovery of N6-methyladenosine (m6A), a predominantly internal epigenetic modification in eukaryotes mRNA, heralded the creation of the field of epi-transcriptomics. This post-transcriptional RNA modification is dynamic and reversible, and is regulated by methylases, demethylases and proteins that preferentially recognize m6A modifications. Altered m6A levels affect RNA processing, degradation and translation, thereby disrupting gene expression and key cellular processes, ultimately resulting in tumor initiation and progression. Furthermore, inhibitors and regulators of m6A-related factors have been explored as therapeutic approaches for treating cancer. In the present review, the mechanisms of m6A RNA modification, the clinicopathological relevance of m6A alterations, the type and frequency of alterations and the multiple functions it regulates in different types of cancer are discussed.
Distribution of bone thickness in the human mandibular ramus – a CBCT-based study
Authors: Kronseder K. , Runte C. , Kleinheinz J. , Jung S. , Dirksen D.
Published: June 2020

Background

The bone thickness of the human mandibular ramus is an important parameter in mandibular surgeries. The aim of this study was to systematically measure the bicortical bone thickness, the ramus dimensions and the position of the lingula. The measurements were tested on significant correlations to the patients’ parameters.

Methods

Based on CBCT scans 150 rami were reconstructed as 3D polygon surfaces. An anatomical grid was adapted to the ramus surface to mark the bone thickness measurement points and to achieve comparability between the measurements on different mandibles. The bone thickness, ramus height, ramus width and the gonion angle were measured. A cluster analysis was performed with these parameters to identify clinically relevant groups with anatomical similarities.

Results

The median distribution of the bone thickness was calculated and visualized in a pseudo-colour map. The mean ramus height was 44.78 mm, the mean width was 31.31 mm and the mean gonion angle was 124.8°. The average distance from the lingula to the dorsal tangent was 53% of the total width and its distance to the caudal tangent was 65% of the total height. Significant correlations between the bone thickness and the ramus proportions could be identified. Age and sex had no significant influence on the mean bone thickness. The measured rami could be divided into two groups by cluster analysis.

Conclusion

The dimensions of the human mandibular ramus can be determined from 3D reconstructed surface models from CBCT scans. Measurements could be made comparable by applying an anatomically oriented grid. A cluster analysis allowed the differentiation of two groups with different bone thickness distributions and geometries, which can be used for the optimization of osteosynthesis systems and their precision of adaptation to different ramus morphologies.
Early recognition of tomato gray leaf spot disease based on MobileNetv2-YOLOv3 model
Authors: Liu Jun , Wang Xuewei
Published: June 2020

Background

Tomato gray leaf spot is a worldwide disease, especially in warm and humid areas. The continuous expansion of greenhouse tomato cultivation area and the frequent introduction of foreign varieties in recent years have increased the severity of the epidemic hazards of this disease in some tomato planting bases annually. This disease is a newly developed one. Thus, farmers generally lack prevention and control experience and measures in production; the disease is often misdiagnosed or not prevented and controlled timely; this condition results in tomato production reduction or crop failure, which causes severe economic losses to farmers. Therefore, tomato gray leaf spot disease should be identified in the early stage, which will be important in avoiding or reducing the economic loss caused by the disease. The advent of the era of big data has facilitated the use of machine learning method in disease identification. Therefore, deep learning method is proposed to realise the early recognition of tomato gray leaf spot. Tomato growers need to develop the app of image detection mobile terminal of tomato gray leaf spot disease to realise real-time detection of this disease.

Results

This study proposes an early recognition method of tomato leaf spot based on MobileNetv2-YOLOv3 model to achieve a good balance between the accuracy and real-time detection of tomato gray leaf spot. This method improves the accuracy of the regression box of tomato gray leaf spot recognition by introducing the GIoU bounding box regression loss function. A MobileNetv2-YOLOv3 lightweight network model, which uses MobileNetv2 as the backbone network of the model, is proposed to facilitate the migration to the mobile terminal. The pre-training method combining mixup training and transfer learning is used to improve the generalisation ability of the model. The images captured under four different conditions are statistically analysed. The recognition effect of the models is evaluated by the F1 score and the AP value, and the experiment is compared with Faster-RCNN and SSD models. Experimental results show that the recognition effect of the proposed model is significantly improved. In the test dataset of images captured under the background of sufficient light without leaf shelter, the F1 score and AP value are 94.13% and 92.53%, and the average IOU value is 89.92%. In all the test sets, the F1 score and AP value are 93.24% and 91.32%, and the average IOU value is 86.98%. The object detection speed can reach 246 frames/s on GPU, the extrapolation speed for a single 416 × 416 picture is 16.9 ms, the detection speed on CPU can reach 22 frames/s, the extrapolation speed is 80.9 ms and the memory occupied by the model is 28 MB.

Conclusions

The proposed recognition method has the advantages of low memory consumption, high recognition accuracy and fast recognition speed. This method is a new solution for the early prediction of tomato leaf spot and a new idea for the intelligent diagnosis of tomato leaf spot.
Comparative study of the tibial tubercle-trochlear groove distance measured in two ways and tibial tubercle-posterior cruciate ligament distance in patients with patellofemoral instability
Authors: Shu Lei , Ni Qubo , Yang Xu , Chen Biao , Wang Hua , Chen Liaobin
Published: June 2020

Background

A comparative analysis of the strengths and weaknesses of three different methods for radiologic evaluation of patellofemoral instability (PFI).

Methods

Computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 47 patients with or without PFI. The tibial tubercle-trochlear groove (TT-TG) distance was measured by two observers through conventional CT and three-dimensional CT reconstruction (TDR-TT-TG) respectively and the tibial tubercle-posterior cruciate ligament (TT-PCL) distance with MRI. The intraclass correlation coefficient (ICC) was used to evaluate the interobserver reliability. In addition, the differences of three measurements between different patients were compared. The consistency of TT-TG and TDR-TT-TG was analyzed by the Bland-Altman method.

Results

The ICCs of three measurements were high between two observers; the results were TT-TG (ICC = 0.852), TDR-TT-TG (ICC = 0.864), and TT-PCL (ICC = 0.758). The values of PFI patients were significantly higher than those of non-PFI patients, and the mean TT-TG, TDR-TT-TG, and TT-PCL distance in patients with PFI were 19.0 ± 3.8 mm, 19.0 ± 3.7 mm, and 25.1 ± 3.6 mm, respectively. There was no statistically significant difference between the TT-TG distance and the TDR-TT-TG distance, we found no significant difference. The Bland-Altman analysis showed that the TDR-TT-TG distance was in good agreement with the TT-TG distance.

Conclusion

All three methods can be used to assess PFI; the TDR-TT-TG measurement method has superior operability and better interobserver consistency. It may be an alternative method to the conventional TT-TG distance measurement.
CB2 improves power of cell detection in droplet-based single-cell RNA sequencing data
Authors: Ni Zijian , Chen Shuyang , Brown Jared , Kendziorski Christina
Published: June 2020

An important challenge in pre-processing data from droplet-based single-cell RNA sequencing protocols is distinguishing barcodes associated with real cells from those binding background reads. Existing methods test barcodes individually and consequently do not leverage the strong cell-to-cell correlation present in most datasets. To improve cell detection, we introduce CB2, a cluster-based approach for distinguishing real cells from background barcodes. As demonstrated in simulated and case study datasets, CB2 has increased power for identifying real cells which allows for the identification of novel subpopulations and improves the precision of downstream analyses.
Correction to: Trastuzumab, pertuzumab, and eribulin mesylate versus trastuzumab, pertuzumab, and a taxane as a first-line or second-line treatment for HER2-positive, locally advanced or metastatic breast cancer: study protocol for a randomized controlled, non-inferiority, phase III trial in Japan (JBCRG-M06/EMERALD)
Authors: Yamashita Toshinari , Masuda Norikazu , Saji Shigehira , Araki Kazuhiro , Ito Yoshinori , Takano Toshimi , Takahashi Masato , Tsurutani Junji , Koizumi Kei , Kitada Masahiro , Kojima Yasuyuki , Sagara Yasuaki , Tada Hiroshi , Iwasa Tsutomu , Kadoya Takayuki , Iwatani Tsuguo , Hasegawa Hiroki , Morita Satoshi , Ohno Shinji
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.