bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world evaluation of a computed tomography-first triage strategy for suspected coronavirus disease 2019 in emergency outpatients in Japan: an observational cohort study
Authors: Miyake Shigeta , Higurashi Takuma , Jono Takashi , Akimoto Taisuke , Ogawa Fumihiro , Oi Yasufumi , Tanaka Katsushi , Hara Yu , Kobayashi Nobuaki , Kato Hideaki , Yamashiro Tsuneo , Utsunomiya Daisuke , Nakajima Atsushi , Yamamoto Tetsuya , Maeda Shin , Kaneko Takeshi , Takeuchi Ichiro 
Published: October 2020

Abstract
Background: Coronavirus disease 2019 (COVID-19) continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with COVID-19 symptoms are suspected of disease. Computed tomography (CT) in patients with suspected COVID-19 may be reasonable for triaging, and CT-first triage strategies have been proposed. However, clinical evaluation of a CT-first triage protocol is lacking. The aim of this study is to investigate the real-world efficacy and limitations of a CT-first triage strategy in patients with suspected COVID-19.Methods: This was a single-center cohort study evaluating outpatients with suspected COVID-19 who underwent a medical examination at Yokohama City University Hospital and who were prospectively registered between 9 February and 5 May 2020. We treated patients according to the CT-first triage protocol. CT findings were classified into five categories according to the COVID-19 Reporting and Data System (CO-RADS). With the CT-first triage protocol, patients with a suspicious clinical history, symptoms, or suspicious findings on chest CT were allocated to the COVID-19 suspected group. The primary outcome was efficacy of the CT-first triage protocol for outpatients with suspected COVID-19. We conducted additional analyses of the isolation time of outpatients with suspected COVID-19 and reached final diagnoses.Results: In total, 108 outpatients with suspected COVID-19 were examined at our hospital. Forty-eight patients (44.9%) were categorized as CO-RADS 1, 26 patients (24.3%) as CO-RADS 2, 14 patients (13.1%) as CO-RADS 3, 6 patients (5.6%) as CO-RADS 4, and 13 patients (12.1%) as CO-RADS 5. One patient was excluded because of pregnancy. Using the CT-first triage protocol, 48 (44.9%) patients were suspected of having COVID-19. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group not suspected of having COVID-19 were diagnosed with COVID-19 during follow up. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our CT-first triage protocol was acceptable for triaging outpatients with suspected COVID-19. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is limited.
Caring for older dependent people in low and middle-income countries: the effect of age on mental health in caregivers
Authors: Phetsitong Ruttana , Vapattawong Patama , Mayston Rosie , Prince Martin , Chua Kia-Chong 
Published: October 2020

Abstract
Background: Older people worldwide are living with chronic health problems, of whom 80% are from low and middle-income countries. Caregiver stress is a complex interplay of health and socio-economic factors with older caregivers; however, the effects of caregiver age upon their mental health have not been well-described. This study aimed to examine whether caregiver age predicts their mental health outcomes in terms of psychological morbidity and care burden in Latin America and China. Methods: The present study was based on cross-sectional baseline data of seven low and middle-income countries: Cuba, the Dominican Republic, Peru, Venezuela, Mexico, China, and Puerto Rico. Data were collected between February 2003 and June 2009 by the 10/66 Dementia Research Group. Data from 1348 households where the caregiver provided care for one older person in the household were included in the current analysis. Psychological morbidity was assessed through the Self-Reporting Questionnaire. The Zarit Burden Inventory was used to measure the levels of care burden of caregivers. Multivariate logistic regression was used to investigate the effects of caregiver age upon psychological morbidity and care burden. Meta-analysis was performed to obtain a pooled estimate of overall odd ratios and 95% confidence intervals of the analyses from the different countries, using the inverse-variance weighted fixed-effect method.Results: The prevalence of households with older caregivers is almost at the same level as that of households with younger caregivers in Puerto Rico and China. The models unadjusted and adjusted for all potential covariates (household size, number of household assets, caregiver sex, caregiver marital status, caregiver education, cognitive impairment of older person, functional dependency of older person, behavioural problems of older person, and caregiving hours) showed that there was no statistically significant difference in psychological morbidity and care burden between older caregivers and non-older caregivers across countries. The adjusted pooled estimates, however, indicated lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41–0.93, I2 = 0.0%).Conclusions: Older caregivers are at lower risk of mental health problem than younger caregivers. This information may help to provide a greater understanding for service support, policy makers, and health care providers.
Can a multifactorial geriatric assessment predict older adult´s adherence to a fall prevention program?
Authors: Varanda Renata dos Ramos , Ishigaki Erika Yukie , Magalhães Maria Aquimara Zambone , Passos Adson da Silva , Leme Luiz Eugenio , Paschoal Sergio Marcio P , Perracini Monica Rodrigues 
Published: October 2020

Abstract
BackgroundThere is evidence in the literature of the effectiveness of multifactorial interventions in reducing the occurrence of falls in elderly residents in the community. However, low adherence to prevention programs is cited in the literature as a recurring problem, questioning the effectiveness and sustainability of these programs. The aim of this study is to compare subgroups of fallers with different levels of adherence to a multifactorial fall prevention program in terms of a broad range of sociodemographic, medical, disability, physical functioning, and psychological measures in a multifactorial geriatric assessment, and identify which of these measures explain optimal adherence.MethodsA prospective study conducted with two hundred and fifty-seven community-dwelling people aged ≥ 60 years who participated in a multifactorial fall prevention program. All participants underwent assessments on sociodemographic, medical, disability, physical functioning, and psychological measures. The presence on weekly sessions over 12 weeks was used to ascertain adherence. Subgroups of participants with low, moderate and high adherence were determined by k-means cluster analysis, and were compared regarding variables of interest. A multivariate regression analysis was conducted to identify participants with an optimal adherence (median; ≥ 10 sessions). ResultsParticipants with low (1 up to 4), moderate (5 up to 8) and high adherence (≥ 9 sessions) corresponded to 13.2%, 19.5% and 67.3%, respectively. Of all measures, only the low perceived risk of falling was able to discriminate subgroups of adherence. Multivariate regression analyses adjusted for covariates identified that older people with optimal adherence were less likely to be depressed and were more likely to present a higher score in a global cognition measure. Conclusions Implementation strategies should be undertaken to understand the views and beliefs of older people with low perceived risk of falling and offer person-centered rationale to increase engagement. Treating and closely monitoring older adults with depression early in the pathway of care for falls prevention so as to optimize enablers may promote adherence to programs.
A Chromosome-level Assembly of a Wild Castor Genome Provides New Insights into Adaptive Evolution in a Tropical Desert
Authors: Lu Jianjun , Cheng Pan , Fan Wei , Liu Wanfei , Zhao Huayan , Li Donghai , Sen Wang , Hu Lianlian , He Bing , Qian Kun , Qin Rui , Lin Qiang , Lü Shiyou , Cui Peng 
Published: October 2020

Abstract
Wild castor grows in the high-altitude tropical desert of the African Plateau, a region that has high ultraviolet radiation, strong light and extremely dry conditions. Some genes or alleles persist in the wild castor genome to prevent the species being vanished at extreme condition, but usually be decayed under domestication due to the relaxation of natural selection. To investigate the potential genetic basis of adaptation to both highland and tropical deserts, we generated a chromosome-level genome sequence of the wild castor accession WT05 with scaffold and contig N50 sizes of 31.93Mb and 8.96Mb, respectively. Compared with cultivated castor and other Euphorbiaceae plants, wild castor exhibits positive selection and gene family expansion for genes involved in DNA repair, photosynthesis and abiotic stress responses. Genetic variations associated with positive selection were identified in several key genes, such as LIG1, DDB2, and RECG1, involved in nucleotide excision repair. Moreover, a study of genomic diversity among wild and cultivated accessions revealed genomic regions containing selection signatures associated with the adaptation to extreme environments. The identification of the genes and alleles with selection signatures provide insights into the genetic mechanisms underlying the adaptation of wild castor to the high-altitude tropical desert, and would serve as targets for directing improvement of modern castor varieties.
Analysis of the Challenges and Problems in the Development of Public Health System in Beijing, China
Authors: Mao Ayan , Chu Cordia , Yang Yujie , Meng Yueli , Qiu Wuqi 
Published: October 2020

Abstract
Background: To discern the main problems of Beijing’s public health service system, in order to provide suggestions to modernize the public health system and to enforce the implementation of the “Health Beijing 2030” plan. Methods: We carried out a quantitative study mostly based on interviews. There are over 40 directors and scholars who came from public health institutions and government sectors or organization that related to the public health work in Beijing were interviewed. The interview records were summary analyzed on key issues in accordance with the interview outline. Results: The challenges for the system include the change of structure of the population, the impact of the changing spectrum of diseases and changing environmental factors, and macro-institutional changes. The main problems include structure of the public health system, capacity of public health staff, systems for information management and legal framework for public health. On this basis, several relevant policy recommendations are put forward. Conclusion: To improve the public health system, the Beijing municipal government should design and construction of a system planning and perfecting their investment mechanism on public health. Stability of personnel and encouragement of innovation in scientific research and reliable health information strategies are also urgent needed.
Effectiveness of the sequential 4-channel NMES compared with conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study
Authors: Seo Kyoung-Ho , Jang Joonyoung , Jang Eun Gyeong , Park Yulhyun , Lee So Young , Kim Bo Ryun , Park Donghwi , Park Sungwon , Hwang Hyeoncheol , Kim Nam Hun , Oh Byung-Mo , Seo Han Gil , Lee Jun Chang , Ryu Ju Seok 
Published: October 2020

Abstract
Background: To date, conventional swallowing therapies and 2-channel NMES are standard treatments for dysphagia. The precise mechanism of 2-channel neuromuscular electrical stimulation (NMES) treatment has yet to be determined, and controversy remains over the efficacy. The sequential 4-channel NMES was newly developed based on the normal contractile sequence of swallowing-related muscles. Objective: To evaluate and compare the rehabilitative effectiveness of sequential 4-channel NMES with that of conventional 2-channel NMES.Methods: In this prospective randomized case-control study, 23 subjects with dysphagia were enrolled. Twelve subjects with 4-channel NMES group and eleven subjects with 2-channel NMES group completed the intervention. Pretreatment and posttreatment evaluations were performed with the videofluoroscopic dysphagia scale (VDS), penetration-aspiration scale (PAS), MD Anderson dysphagia inventory (MDADI), functional oral intake scale (FOIS), and Likert scale.Results: The sequential 4-channel NMES group significantly improved the VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical scale) compared with pretreatment data. The 2-channel NMES group significantly improved the VDS (oral, pharyngeal, and total) and MDADI (emotional, physical scale), but not the PAS and FOIS compared with pretreatment data. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS.Conclusions: Sequential 4-channel NMES activating the suprahyoid, thyrohyoid, and other infrahyoid muscles with proper interval time can be a new effective treatment for dysphagia.Trial registration : clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1
Ultrasound Assessment of Entheses and Correlations Between Disease Activity and Ultrasound Scores in Ankylosing Spondylitis: A Cross Sectional Study
Authors: XIE HAIQIN , ZHOU GENGMIN , WEN BO , LUO HAIYU , ZHANG YUSEN , DONG QIAN , ZHONG JIANQIU , LV JIYANG , ZHANG WEIWEI , LV HENG , SUN DESHENG , Wang Qingwen , LI LIU 
Published: October 2020

Abstract
Background: An increasing number of studies have applied ultrasound (US) to evaluate enthesitis in spondyloarthritis. However, there is no clear agreement on which sites should be evaluated for enthesitis. Furthermore, there are different opinions on whether US can monitor disease activity. The objectives of this study were to evaluate the common involvement of entheses and correlations between disease activity and US scores in ankylosing spondylitis (AS).Methods: A cross-sectional, monocentric, and controlled study was performed. US was used to scan 34 entheses per person and the Madrid sonography enthesitis index (MASEI) score was used. US scores were used to evaluate the elemental lesions of hypoechogenicity, thickness, erosion, calcification, bursitis, and Doppler signal. Disease activity was assessed by Disease Activity Score–C reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).Results: 104 patients with AS and 50 control subjects were included. A total of 5236 entheses were assessed. Compared with the control subjects, only three entheses – the Achilles tendon (AT), sternoclavicular joint (SCJ), and costochondral joint (CCJ) – showed significant differences in the AS group (p < 0.05). Patients with high disease activity (ASDAS-CRP ≥ 2.1) had higher scores than patients with low activity (ASDAS-CRP < 2.1) in erosion (p = 0.02). Patients who were categorized in very high disease activity (ASDAS-CRP ≥ 3.5) had a higher score in erosion (p = 0.02). The erosion score was moderately associated with ASDAS-CRP and BASDAI (r = 0.44, r = 0.21).Conclusions: The commonly involved entheses were the AT, SCJ, and CCJ in AS. Erosion occurred more often in patients with disease activity or high activity. Erosion would be more useful for monitoring disease activity in AS.
Vancomycin resistant enterococci gut Colonization and its associated factors among HIV infected patients on anti-Retro viral therapy in Ethiopia
Authors: Regasa Belayneh , Solomon Zerihun , Tesfaye Mheret 
Published: October 2020

Abstract
BackgroundThe emergence of vancomycin resistant Enterococci (VRE) has alarmed the global infectious diseases community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the prevalence of vancomycin resistant Enterococci gut colonization and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART).MethodsInstitution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. P-value <0.05 was considered as significant.ResultsAmong a total of 200 study participants, colonization of Enterococci spp was isolated on 123 (61.50%) respondents. Among these isolates, the prevalence of vancomycin resistant Enterococci colonization was 11.4% [95% CI: (6.0-17.0)]. Enterococci isolates tested against commonly prescribed antibiotics showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibiotic exposure for more than two weeks [AOR=7.35; 95% CI: (1.2144.64)] and hospitalization in the last six months [AOR=5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci gut colonization.ConclusionHigh prevalence of vancomycin resistant Enterococci gut colonization was found. Previous exposure to antibiotics for more than two weeks and previous hospitalization for more than six months were significant factors for vancomycin resistant Enterococci colonization. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.
SARS-CoV-2 Identification in Saliva: Are We Interpreting the Results Correctly?
Authors: Ramirez-Hinojosa Juan Pablo , Rodriguez-Sanchez Yunuen , Romero-Gonzalez Angel Kaleb , Chavez-Gutierrez Marisol , Gonzalez-Arenas Nelly Raquel , Ibarra-Arce Aurora , Arroyo-Escalante Sara , Zavaleta-Villa Beatriz , Monteros-Perez Luz Elena Espinosa de los , Olivo-Diaz Angelica , Hernandez-Castro Rigoberto , Suarez-Roa Lourdes , Prado-Calleros Hector , Sierra-Martinez Octavio , Avila-Ramirez Guillermina , Flisser Ana , Maravilla Pablo , Romero-Valdovinos Mirza 
Published: October 2020

Abstract
BackgroundIn the present study, we obtained cycle threshold (Ct) values by qRT-PCR and compared them with clinical and laboratory data from saliva specimens of inpatients with COVID-19 and asymptomatic health workers (AHW).MethodsSaliva specimens from inpatients with COVID-19 and AHW were studied by qRT-PCR using three sets of primers for the N (N1, N2, and N3) gene of SARS-CoV-2. The Ct values obtained were compared with the clinical and laboratory data.ResultsData from 58 inpatients (37 critically ill patients and 21 patients with severe disease) and 105 AHW were analysed. In our system, the limit of viral detection corresponded to a Ct =46.5; therefore, our analysis focused on comparing the positivity rate obtained when using Ct <40 as the cut-off with that obtained using Ct <46 as the cut-off. The positivity rate was increased when the Ct cut-off of 46 was used as the criterion, yielding a sensitivity of 87.9% for patients and a sensitivity of 43% for AHW. The bivariate analysis revealed an association between Ct <40 for N2 and mechanical ventilation assistance among patients (p=0.013). In addition, the serological values of alanine transaminase (ALT), aspartate-transaminase (AST), lactate dehydrogenase (LDH), ferritin and creatine kinase–MB (CK-MB) showed significant correlations with the Ct values of N1 and N3.ConclusionDue to the intrinsic characteristics of the qRT-PCR process, obtaining amplification curves implies the presence of an active viral replication process, while Ct values may correlate with some clinical data. Our results support the claim that physicians should be informed of the Ct values obtained during the amplification of viral markers, as well as the Ct values that correspond to the limit of detection for viral RNA, which vary according to the characteristics of each system and amplification protocol used.
Development and Validation of an Immune Microenvironment Based Prognostic Signature and Signal Pathways in Prostate Cancer
Authors: Zhao Qi , Cheng Yingying , Ren Yujie , Li Xianfa , Xiong Ying 
Published: October 2020

Abstract
Background: The study of the PCa immune microenvironment has brought new opportunities for the clinical diagnosis and treatment of PCa, but the current study has failed to obtain satisfactory results. We aim to develop a generalized, individualized immune prognostic signature that can improve the survival rate of patients.Methods: We collected a total of 591 sample data from the TCGA and GEO cohorts, and evaluated the abundance and distribution of immune cell members in the mixed cell population in the gene expression matrix by CIBERSORT, ESTIMATE, ssGSEA, and other methods. Calculate the TMB value of the mutant gene to evaluate the reliability of PCa for immunotherapy. Besides, the genes related to the immune microenvironment and mutation load of PCa are obtained, and the target genes are obtained by the intersection with the immune-related genes in the ImmPort database. And perform pan-cancer analysis of the target gene to evaluate the immunological commonality and biological pathways in a variety of cancers. Finally, a Western blot experiment was used to explore the mechanism of the target gene in PCa immune microenvironment.Results: We found that M0, M2, and Mast cell sresting differed significantly between prostate cancer and normal tissue and that patients with low plasma cell abundance were more likely to develop lymph node metastasis. LTF, as a core gene, is closely related to changes in the immune microenvironment of PCa, and its low expression in tumors promotes primary immune deficiency, cancer development, and enrichment in the JAK/STAT signaling pathway. Cell experiments found that LTF overexpression reduces tumor-derived GM-CSF secretion by inhibiting JAK/STAT pathway, achieving the purpose of regulating tumor immune microenvironment and inhibiting PCa cell proliferation and migration.Conclusions: The proposed clinical-immune signature and core gene is the most promising biomarkers for improving the overall survival rate of PCa. It has been verified that overexpression of LTF reduces the secretion of tumor-derived GM-CSF by inhibiting the JAK/STAT pathway.