bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual Reality as a Measure to Reduce Stress of Night-Shift Anesthesiologists: Study Protocol for a Cross-Over Design Trial
Authors: Chen Chaojin , Chen Liubing , Shen Ning , Luo Chenfang , Wang Ren , Fang Hongyi , Zhang Qi , Hei Ziqing 
Published: November 2020

Abstract
Background: Because of the severe deficiency of global anesthesia workforce, anesthesiologists are forced to face work overload and more night shifts, which can disturbe the biological rhythm and cause major stress and depression, causing negative even devastating outcomes for both themselves and the patients eventually. Virtual reality (VR) as a new measure to reduce stress and pain for patients, has been widely used in biomedical fields.The purpose of the study is to evaluate the potential effectiveness of VR technology in reducing the stress of night-shift anesthesiologists.Methods: In this randomized controlled, cross-over design, single-center clinical trial, a total of 30 anesthesiologists are enrolled and randomized in a 1:1 allocation to either the VR immersion group (intervention group) or the routine night-shift group (control group) with a washout of 1 week. Anesthesiologists in the intervention group undergo VR immersion for twice while anesthesiologists in the control group will not watch VR videos during the night shift. The primary outcome is the difference between two groups about the score of NASA-TLX scale. Secondary outcomes include the score of CPSS, VAS and MFI-20 scales, satisfaction degree of the participants, heart rate (HR), blood pressure (BP), the incidence of arrhythmia as well as incidence of chest tightness, headache, palpitations.Discussion: It is unknown whether the use of VR technology during the night shift can reduce the stress of night-shift anesthesiologists. With the widely use of VR technology, a positive result of the trial could spur the hospital to apply the technology to reduce the stress of night shift doctors in every department as well as offer a relatively relaxed working environment.Trial registration: ChiCTR2000031025 on March 21, 2020.
Connected Diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya.
Authors: Duijn Shannen Van , Siteyi Angela , Smith Sherzel , Milimo Emmanuel , Stijvers Leon , Oguttu Monica , Amollo Michael , Okeyo Edward , Dayo Lilyana , Kwambai Titus , Onyango Dickens , de Wit Tobias Rinke 
Published: November 2020

Abstract
Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu.Methods: Our intervention was performed Oct 2017 – Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews.Results: In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4% to 30.2% between providers, significantly more amongst the poor (p< 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6%-63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT.Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.
Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: The first experience from Makassar Telemedicine Program, Indonesia
Authors: Mappangara Idar , Qanitha Andriany , Uiterwaal Cuno S. P. M. , Henriques Jose P. S. , de Mol Bastianus A. J. M. 
Published: November 2020

Abstract
Background: Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultation.Methods: ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of study period to assess the patient outcomes. Results: Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p<0.01), while older age (>55 years) was associated with ischemic or arrhythmic ECGs (p<0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p<0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 hours following the tele-ECG consultation. Conclusions: Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs for immediate triage, resulting in higher rate of early hospitalization for indicated patients.
A systematic review assessing the under-representation of elderly adults in COVID-19 trials
Authors: Prendki Virginie , Tau Noam , Avni Tomer , Falcone Marco , Huttner Angela , Kaiser Laurent , Paul Mical , Leibovici-Weissmann Yaara , Yahav Dafna 
Published: November 2020

Abstract
BackgroundCoronavirus disease (COVID-19) has caused a pandemic threatening millions of people worldwide. Yet studies specifically assessing the geriatric population are scarce. We aimed to examine the participation of elderly patients in therapeutic or prophylactic trials on COVID-19.MethodsIn this review, randomized controlled trials (RCTs; n=12) comparing therapeutic or prophylactic interventions registered on preprint repositories and/or published since December 2019 were analyzed. We searched in PubMed, leading journals websites, and preprint repositories for RCTs and large observational studies. We aimed to describe the age of included patients, the presence of an upper age limit and of adjusted analyses on age, any exclusion criteria that could limit participation of elderly adults such as comorbidities, cognitive impairment, limitation of life expectancy; and the assessment of long-term outcomes such as the need of rehabilitation or institutionalization. Mean participant ages were reported and compared with observational studies.ResultsTwelve RCTs assessing drug therapy for COVID-19 were included. Mean age of patients included in RCTs was 56.3 years. An upper age limit was applied in three published trials (25%) and in 200/650 (31%) trials registered at clinicaltrials.gov. One trial reported a subgroup analysis in patients ≥65. Patients were excluded for liver-function abnormalities in eight trials, renal disease in six, cardiac disease or risk of torsade de pointes in five, and four for cognitive or mental criteria, which are frequent comorbidities in the oldest patients. Only three trials allowed a family member to provide consent. Patients enrolled in RCTs were on average 20 years younger than those included in large (n≥1000) observational studies. Seven studies had as their primary outcome a clinical endpoint, but none reported cognitive, functional or quality of life outcomes or need for rehabilitation or long-term care facility placement.ConclusionsElderly patients are clearly underrepresented in RCTs, although they comprise the population hardest hit by the COVID-19 pandemic. Long-term outcomes such as the need of rehabilitation or institutionalization were not reported. Future investigations should target specifically this vulnerable population.
A 4-gene signature predicts prognosis of uterine serous carcinoma
Authors: Chen Hui , Li Lingjun , Qin Ping , Xiong Hanzhen , Chen Ruichao , Zhang Minfen , Jiang Qingping 
Published: November 2020

Abstract
Background: Uterine serous carcinoma (USC) is an aggressive type of endometrial cancer that accounts for up to 40% of endometrial cancer deaths, creating an urgent need for prognostic biomarkers. Methods: USC RNA-Seq data and corresponding patients’ clinical records were obtained from The Cancer Genome Atlas and Genotype-Tissue Expression datasets. Univariate cox, Lasso, and Multivariate cox regression analyses were conducted to forge a prognostic signature. Multivariable and univariable cox regression analysis and ROC curve evaluated the prediction efficiency both in the training and testing sets. Results: We uncovered 1385 genes dysregulated in 110 cases of USC tissue relative to 113 cases of normal uterine tissue. Functional enrichment analysis of these genes revealed the involvement of various cancer-related pathways in USC. A novel 4‐gene signature (KRT23, CXCL1, SOX9 and ABCA10) of USC prognosis was finally forged by serial regression analyses. Overall patient survival (OS) and recurrence-free survival (RFS) were significantly lower in the high-risk group relative to the low-risk group in both the training and testing sets. The area under the ROC curve of the 4-gene signature was highest among clinicopathological features in predicting OS and RFS. The 4-gene signature was found to be an independent prognostic indicator in USC and was a superior predictor of OS in early stage of USC. Conclusions: Our findings highlight the potential of the 4-gene signature as a guide for personalized USC treatment.
Risk factors for postoperative delirium and subsyndromal delirium in older surgical patients in the surgical ward: a prospective observational study
Authors: Kanno Maya , Doi Mana , Kubota Kazumi , Kanoya Yuka 
Published: November 2020

Abstract
Background: Postoperative delirium (POD) among older patients is a common, serious disease and is associated with a high incidence of negative outcomes. For early detection of POD and subsyndromal delirium (SSD), this study was conducted to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward.Methods: This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Both POD and SSD were assessed by using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for POD and SSD.Results: A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD and SSD. The use of bed sensors (odds ratio 10.2, p=.001) were identified as risk factors for POD and SSD.Conclusions: Our study shows that the use of bed sensors might be related to the development of POD and SSD among older patients in surgical wards.
Development and validation of models to predict cesarean delivery among low-risk nulliparous women at term: a retrospective study in China
Authors: Sun Fangcan , Han Bing , Wu Fangfang , Shen Qianqian , Shen Minhong , Chen Youguo 
Published: November 2020

Abstract
Background A prediction algorithm to identify women with high risk of an emergency cesarean could help reduce morbidity and mortality associated with labor. The objective of the present study was to derive and validate a simple model to predict intrapartum cesarean delivery for low-risk nulliparous women in Chinese population.Methods We conducted a retrospective cohort study of low-risk nulliparous women with singleton, term, cephalic pregnancies. A predictive model for cesarean delivery was derived using univariate and multivariable logistic regression from the hospital of the First Affiliated Hospital of Soochow University. External validation of the prediction model was then performed using the data from Sihong county People’s Hospital. A new nomogram was established based on the development cohort to predict the cesarean. The ROC curve, calibration plot and decision curve analysis were used to assess the predictive performance.Results The intrapartum cesarean delivery rates in the development cohort and the external validation cohort were 8.79% (576/6,551) and 7.82% (599/7,657). Multivariable logistic regression analysis showed that maternal age, height, BMI, weight gained during pregnancy, gestational age, induction method, meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. We had established two prediction models according to fetal sex was involved or not. The AUC was 0.782 and 0.774, respectively. The two prediction models were well-calibrated with Hosmer-Lemeshow test P=0.263 and P=0.817, respectively. Decision curve analysis demonstrated that two models had clinical application value, and they provided greatest net benefit between threshold probabilities of 4% to 60%. And internal validation using Bootstrap method demonstrated similar discriminatory ability. We external validated the model involving fetal sex, for which the AUC was 0.775, while the slope and intercept of the calibration plot were 0.979 and 0.004, respectively. On the external validation set, another model had an AUC of 0.775 and a calibration slope of 1.007. The online web server was constructed based on the nomogram for convenient clinical use.Conclusions Both two models established by these factors have good prediction efficiency and high accuracy, which can provide the reference for clinicians to guide pregnant women to choose an appropriate delivery mode.
Use of intravenous sodium bicarbonate in neonatal intensive care units in Italy: a nationwide survey.
Authors: Massenzi Luca , Aufieri Roberto , Donno Silvia , Agostino Rocco , Dotta Andrea 
Published: November 2020

Abstract
Background: Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods: A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results: The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8% and 32.5% of the NICUs). Conclusion: This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.
Expression patterns of ciliopathy genes ARL3 and CEP120 reveal roles in multisystem development
Authors: Powell L , Barroso-Gil M , Clowry Gavin J , Devlin Laura A , Molinari Elisa , Ramsbottom Simon A , Miles Colin G , Sayer John 
Published: November 2020

Abstract
Background: Joubert syndrome and related disorders (JSRD) and Jeune syndrome are multisystem ciliopathy disorders with overlapping phenotypes. There are a growing number of genetic causes for these rare syndromes, including the recently described genes ARL3 and CEP120.Methods: We sought to explore the developmental expression patterns of ARL3 and CEP120 in humans to gain additional understanding of these genetic conditions. We used an RNA in situ detection technique called RNAscope to characterise ARL3 and CEP120 expression patterns in human embryos and foetuses in collaboration with the MRC-Wellcome Trust Human Developmental Biology Resource.Results: Both ARL3 and CEP120 are expressed in early human brain development, including the cerebellum and in the developing retina and kidney, consistent with the clinical phenotypes seen with pathogenic variants in these genes.Conclusions: This study provides insights into the potential pathogenesis of JSRD by uncovering the spatial expression of two JSRD-causative genes during normal human development.
Effects of texture properties of semi-solid food on the sensory test for pharyngeal swallowing effort in the older adults
Authors: Park Jin-Woo , Lee Seul , Yoo Byoungseung , Nam Kiyeon 
Published: November 2020

Abstract
Background: Increasing viscosity can reduce the risk of aspiration into the airway, but excessively thickened food may require more force and effort. We assumed that semi-solid foods with similar viscosities will behave differently in the oropharynx and there might exist the possibility that properties other than viscosity may have clinical relevance. This study aimed to find out the texture of semi-solid foods that affects the effort of pharyngeal swallow in the older adults. Methods: Nine kinds of semi-solid foods not requiring mastication were selected for texture profile analysis (TPA), and included whipped cream, mayonnaise, soft tofu, mango pudding, boiled mashed pumpkin, boiled mashed potatoes, boiled mashed sweet potatoes, red bean paste, and peanut butter. Hardness, adhesiveness and cohesiveness of each food were measured three times by using the rheometer. A blinded sensory test using a 9-point hedonic scale was also conducted in eighteen older adults people to investigate how much effort was required to swallow food, and how much of the food remained in the pharynx after swallowing. The correlation between texture and sensory outcome was statistically analyzed.Results: Foods that belonged to the same viscosity category showed different texture values, and the participants also rated different scores respectively. Only adhesiveness among three properties was significantly correlated with the sensory test. (r= 0.882, p=0.002 for difficult to swallow, r=0.879, p=0.002 for sense of residue).Conclusions: Adhesiveness was the most important property of the semi-solid foods, requiring most efforts in pharyngeal swallow in the older adults. If we select and provide food having low adhesiveness value in the same viscosity category, there might be the possibility to make it easier to swallow in older adults.
The Effect of Salinity on Enterocytozoon hepatopenaei Infection in Penaeus vannamei Under Experimental Conditions
Authors: Aranguren Luis Fernando , Alghamdi Faris , De Belder Katrien , Lin J. , Mai Hung N. , Millabas Jasmine , Alrehaili Y. , Alazwari Anwer , Algetham Saif , Dhar Arun K. 
Published: November 2020

Abstract
Background: Enterocytozoon hepatopenaei (EHP) is an enteric pathogen that affects Penaeus vannamei and Penaeus monodon shrimp in many SE Asian countries. In the western hemisphere, EHP was reported for the first time in 2016 in farmed P. vannamei in Venezuela. Anecdotal evidence suggests that EHP is more prevalent in grow-out ponds where the salinity is high (>15 parts per thousand (ppt)) compared to grow-out ponds with low salinities (<5 ppt). Considering that P. vannamei is an euryhaline species, we were interested in knowing if EHP can propagate in P. vannamei in low salinities.Results: In this study, we described an experimental infection using fecal strings as a source inoculum. Specific Pathogen Free (SPF) P. vannamei were maintained at three different salinities (2 ppt, 15 ppt, and 30 ppt) while continuously challenged using feces from known EHP-infected P. vannamei over a period of three weeks. The fecal strings, used as a source of EHP inocula in the challenges, was sufficient to elicit an infection in shrimp maintained at the three salinities. The infectivity of EHP in shrimp reared at 2 ppt, 15 ppt, and 30 ppt salinities was confirmed by PCR and histopathology. The prevalence and the severity of the EHP infection was higher at 30 ppt than at 2 ppt and 15 ppt.Conclusion: The data suggests that fecal strings are a reliable source of EHP inoculum to conduct experimental challenges via the fecal-oral route. An EHP infection can occur at a salinity as low as 2 ppt, however, the prevalence and the severity of the EHP infection is higher at a salinity of 30 ppt.