bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis
Authors: Gu Shuyan , Shi Lizheng , Shao Hui , Wang Xiaoyong , Hu Xiaoqian , Gu Yuxuan , Dong Hengjin 
Published: December 2020

AbstractBackgroundClinical guidelines recommend a stepped-escalation treatment strategy for type 2 diabetes (T2DM). Across multiple treatment strategies varying in efficacy and costs, no clinical or economic studies directly compared them. This study aims to estimate and compare the cost-effectiveness of 10 commonly used pharmacologic combination strategies for T2DM.MethodsBased on Chinese guideline and practice, 10 three-stepwise add-on strategies were identified, which start with metformin, then switch to metformin plus one oral drug (i.e., sulfonylurea, thiazolidinedione, α-glucosidase inhibitor, glinide, or DPP-4 inhibitor) as second line, and finally switch to metformin plus one injection (i.e., insulin or GLP-1 receptor agonist) as third line. A cohort of 10,000 Chinese patients with newly diagnosed T2DM was established. From a healthcare system perspective, the Cardiff model was used to estimate the cost-effectiveness of the strategies, with clinical data sourced from a systematic review and indirect treatment comparison of 324 trials, costs from claims data of 1164 T2DM patients, and utilities from an EQ-5D study. Outcome measures include costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs).ResultsOver 40-year simulation, the costs accumulated for a patient ranged from $7661 with strategy 1 to $14,273 with strategy 10, while the QALY gains ranged from 13.965 with strategy 1 to 14.117 with strategy 8. Strategy 7 was dominant over seven strategies (strategies 2~6, 9~10) with higher QALYs but lower costs. Additionally, at a willingness-to-pay threshold of $30,787/QALY (i.e., 3 times GDP/capita for China), strategy 7 was cost-effective compared with strategy 1 (ICER of strategy 7 vs. 1, $3371/QALY) and strategy 8 (ICER of strategy 8 vs. 7, $132,790/QALY). Ranking the strategies by ICERs and NMBs, strategy 7 provided the best value for money when compared to all other strategies, followed by strategies 5, 9, 8, 1, 3, 6, 10, 2, and 4. Scenario analyses showed that patients insist on pharmacologic treatments increased their QALYs (0.456~0.653) at an acceptable range of cost increase (ICERs, $1450/QALY~$12,360/QALY) or even at cost saving compared with those not receive treatments.ConclusionsThis study provides evidence-based references for diabetes management. Our findings can be used to design the essential drug formulary, infer clinical practice, and help the decision-maker design reimbursement policy.
Endothelial shear stress enhancements: a potential solution for critically ill Covid-19 patients
Authors: Nour Sayed 
Published: December 2020

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

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

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

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

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

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

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

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

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

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

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

Conclusions
This study not only presents an essential preprocessing approach for improving diagnostic power of HD-sEMG, but also helps to develop a standard sEMG preprocessing pipeline, thus promoting its widespread application.
A comprehensive comparison of four methods for extracting lipids from Arabidopsis tissues
Authors: Kehelpannala Cheka , Rupasinghe Thusitha W. T. , Hennessy Thomas , Bradley David , Ebert Berit , Roessner Ute 
Published: December 2020

AbstractBackgroundThe plant lipidome is highly complex, and the composition of lipids in different tissues as well as their specific functions in plant development, growth and stress responses have yet to be fully elucidated. To do this, efficient lipid extraction protocols which deliver target compounds in solution at concentrations adequate for subsequent detection, quantitation and analysis through spectroscopic methods are required. To date, numerous methods are used to extract lipids from plant tissues. However, a comprehensive analysis of the efficiency and reproducibility of these methods to extract multiple lipid classes from diverse tissues of a plant has not been undertaken.ResultsIn this study, we report the comparison of four different lipid extraction procedures in order to determine the most effective lipid extraction protocol to extract lipids from different tissues of the model plantArabidopsis thaliana.ConclusionWhile particular methods were best suited to extract different lipid classes from diverse Arabidopsis tissues, overall a single-step extraction method with a 24 h extraction period, which uses a mixture of chloroform, isopropanol, methanol and water, was the most efficient, reproducible and the least labor-intensive to extract a broad range of lipids for untargeted lipidomic analysis of Arabidopsis tissues. This method extracted a broad range of lipids from leaves, stems, siliques, roots, seeds, seedlings and flowers of Arabidopsis. In addition, appropriate methods for targeted lipid analysis of specific lipids from particular Arabidopsis tissues were also identified.
A city-level comparison of fossil-fuel and industry processes-induced CO2 emissions over the Beijing-Tianjin-Hebei region from eight emission inventories
Authors: Han Pengfei , Zeng Ning , Oda Tomohiro , Zhang Wen , Lin Xiaohui , Liu Di , Cai Qixiang , Ma Xiaolin , Meng Wenjun , Wang Guocheng , Wang Rong , Zheng Bo 
Published: December 2020

Abstract
Background
Quantifying CO2 emissions from cities is of great importance because cities contribute more than 70% of the global total CO2 emissions. As the largest urbanized megalopolis region in northern China, the Beijing-Tianjin-Hebei (Jing-Jin-Ji, JJJ) region (population: 112.7 million) is under considerable pressure to reduce carbon emissions. Despite the several emission inventories covering the JJJ region, a comprehensive evaluation of the CO2 emissions at the prefectural city scale in JJJ is still limited, and this information is crucial to implementing mitigation strategies.

Results
Here, we collected and analyzed 8 published emission inventories to assess the emissions and uncertainty at the JJJ city level. The results showed that a large discrepancy existed in the JJJ emissions among downscaled country-level emission inventories, with total emissions ranging from 657 to 1132 Mt CO2 (or 849 ± 214 for mean ± standard deviation (SD)) in 2012, while emission estimates based on provincial-level data estimated emissions to be 1038 and 1056 Mt. Compared to the mean emissions of city-data-based inventories (989 Mt), provincial-data-based inventories were 6% higher, and national-data-based inventories were 14% lower. Emissions from national-data-based inventories were 53–75% lower in the high-emitting industrial cities of Tangshan and Handan, while they were 47–160% higher in Beijing and Tianjin than those from city-data-based inventories. Spatially, the emissions pattern was consistent with the distribution of urban areas, and urban emissions in Beijing contributed 50–70% of the total emissions. Higher emissions from Beijing and Tianjin resulted in lower estimates of prefectural cities in Hebei for some national inventories.

Conclusions
National-level data-based emission inventories produce large differences in JJJ prefectural city-level emission estimates. The city-level statistics data-based inventories produced more consistent estimates. The consistent spatial distribution patterns recognized by these inventories (such as high emissions in southern Beijing, central Tianjin and Tangshan) potentially indicate areas with robust emission estimates. This result could be useful in the efficient deployment of monitoring instruments, and if proven by such measurements, it will increase our confidence in inventories and provide support for policy makers trying to reduce emissions in key regions.
Analysis of news media reports of suicides and attempted suicides during the COVID-19 lockdown in India
Authors: Pathare Soumitra , Vijayakumar Lakshmi , Fernandes Tanya Nicole , Shastri Manisha , Kapoor Arjun , Pandit Deepa , Lohumi Isha , Ray Somidha , Kulkarni Arti , Korde Palak 
Published: December 2020

AbstractBackgroundBased on previous experience there is justifiable concern about suicidal behaviour and news media reporting of it during COVID-19 pandemic.MethodsThis study used a systematic search of online news media reports (versions of newspapers, magazine and other digital publications) of suicidal behaviour during India’s COVID-19 lockdown and compared it to corresponding dates in 2019. Data was gathered using a uniform search strategy from 56 online news media publications 24 March to 3 May for the years 2019 and 2020 using keywords, suicide, attempted suicide, hangs self and kills self. Demographic variables and methods used for suicide were compared for suicide and attempts between the 2 years using chi-squared tests (χ2).ResultsThere were online news media reports of 369 cases of suicides and attempted suicides during COVID lockdown vs 220 reports in 2019, a 67.7% increase in online news media reports of suicidal behaviour. Compared to 2019, suicides reported during lockdown were significantly older (30 vs 50 years, p < 0.05), men (71.2% vs 58.7%; p < 0.01), married (77.7% vs 49%; p < 0.01) and employed (82.9% vs 59.5%; p < 0.01). During the lockdown, significantly more suicides were by hanging (64.4% vs 42%), while poisoning (8.5% vs 21.5%) and jumping in front of a train (2% vs 9.4%) (p < 0.05) were significantly reduced. Comparison of COVID and non-COVID groups showed that online news media reports of COVID cases of suicide and attempted suicide were significantly more likely to be men (84.7% vs 60.4%; p < 0.01), older (31–50 years 52.9% vs 25.8%; p < 0.01) employed (91.5% vs 64.3%; p < 0.01), had poor mental (40.1% vs 20.8%; p < 0.01) and poor physical health (24.8% vs 7.9%;11.8, p < 0.01).ConclusionIncrease in online news media reports of suicides and attempts during COVID-19 lockdown may indicate an increase in journalists’ awareness about suicide or more sensational media reporting or may be a proxy indicator of a real community increase in suicidal behaviour. It is difficult to attribute changes in demographic profile and methods used only to changes in journalists’ reporting behaviour and should be further explored. We therefore call upon the Government of India to urgently release national suicide data to help devise a comprehensive suicide prevention strategy to address COVID-19 suicidal behaviour.
Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation
Authors: Fadiga Lúcia , Saraiva Joana , Catarino Diana , Frade João , Melo Miguel , Paiva Isabel 
Published: December 2020

Abstract
Introduction
Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA.

Methods
We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed.

Results
We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR–15) for T1DM and 42 years (IQR–15) for LADA (p = 0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p < 0.001). The mean BMI at diagnosis was 24.1 kg/m2 in T1DM group and 26.1 kg/m2 in LADA group (p = 0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p = 0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p < 0.001). The median daily insulin dose was 40 IU for T1DM (0.58 IU/kg) and 33.5 IU for LADA (0.57 IU/kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p = 0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p = 0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p = 0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration.

Conclusion
Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.
A fractional order approach to modeling and simulations of the novel COVID-19
Authors: Owusu-Mensah Isaac , Akinyemi Lanre , Oduro Bismark , Iyiola Olaniyi S. 
Published: December 2020

AbstractThe novel coronavirus (SARS-CoV-2), or COVID-19, has emerged and spread at fast speed globally; the disease has become an unprecedented threat to public health worldwide. It is one of the greatest public health challenges in modern times, with no proven cure or vaccine. In this paper, our focus is on a fractional order approach to modeling and simulations of the novel COVID-19. We introduce a fractional type susceptible–exposed–infected–recovered (SEIR) model to gain insight into the ongoing pandemic. Our proposed model incorporates transmission rate, testing rates, and transition rate (from asymptomatic to symptomatic population groups) for a holistic study of the coronavirus disease. The impacts of these parameters on the dynamics of the solution profiles for the disease are simulated and discussed in detail. Furthermore, across all the different parameters, the effects of the fractional order derivative are also simulated and discussed in detail. Various simulations carried out enable us gain deep insights into the dynamics of the spread of COVID-19. The simulation results confirm that fractional calculus is an appropriate tool in modeling the spread of a complex infectious disease such as the novel COVID-19. In the absence of vaccine and treatment, our analysis strongly supports the significance reduction in the transmission rate as a valuable strategy to curb the spread of the virus. Our results suggest that tracing and moving testing up has an important benefit. It reduces the number of infected individuals in the general public and thereby reduces the spread of the pandemic. Once the infected individuals are identified and isolated, the interaction between susceptible and infected individuals diminishes and transmission reduces. Furthermore, aggressive testing is also highly recommended.