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  • 1
    Publication Date: 2021-01-08
    Description: Enhanced laboratory-based surveillance of invasive meningococcal disease (IMD) in Italy was only assessed indirectly by numerically comparing surveillance data cases with hospital discharge records (HDR). In this study, we evaluated the completeness, timeliness and sensitivity of the IMD surveillance in Italy from 2015 to 2018. Completeness and timeliness were described at the national and subnational level. A capture-recapture analysis was conducted to evaluate the sensitivity and positive predictive value (PPV) using HDR as the external source with a combination of deterministic and probabilistic approaches. The characteristics of the unmatched vs. matched cases were compared using multivariable Poisson modeling. Overall, the completeness of data improved, except for specific variables. Timeliness of notifications also improved to a median of 4 days from onset to reporting. For the years 2015–2017, the sensitivity of the surveillance was estimated at 71.4% and the PPV at 77.5%, changing to 80.6% and 66.9% respectively after removing cases with a secondary meningitis diagnosis. We noted substantial sub-national differences. In 2018 sensitivity was 66.5% (135/203) and the PPV was 79.4% (135/170). The adjusted relative risk of being unmatched in 2015–2017 was higher in cases that were ≥60 years, had missing information or symptom onset in December. The IMD surveillance system overall performs well with completeness and timeliness improving in time. Specific challenges identified for individual variables should guide further improvement. Notwithstanding limitations posed by the comparison database, sensitivity and PPV are promising. The study highlights that promoting etiological ascertainment in people ≥60 years and addressing sub-national challenges are the main current challenges to address.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 2
    Publication Date: 2021-01-08
    Description: Antiretroviral treatment (ART) adherence is highlighted in management of patients living with human immunodeficiency virus. In South Korea, ART medication research has rarely been conducted due to the low economic burden associated with government-funded treatment. This cross-sectional study aimed to compare the pill burden impact between ART regimen compliance and HIV-RNA viral load suppression. Data were collected from 2008 to 2016 at a general hospital in South Korea. A total of 210 HIV/AIDS treatment-naïve patients were grouped as follows: single-tablet regimen (STR, one tablet/day), mild pill burden (two-four tablets/day), and heavy pill burden (≥ five tablets/day). Patients were analyzed according to gender, age at index date, medical insurance type, comorbidities, depression, HIV/AIDS disease burden as indicated by HIV-RNA viral load and CD4, and laboratory variables. In a multivariate logistic regression model, the STR group demonstrated adherence 5.10 times more often than the heavy pill burden group. Females and patients with an initial viral load of 500,000 or more were 0.090- and 0.040-fold less adherent to the ART regimen. Among these patients, 95% or more of the MPR group were 7.38 times more likely to have a lower limit of detection (LLOD) of viral load suppression. The highest initial viral load group was 0.090-fold less likely to have an LLOD than the reference group. These results suggest that a single-tablet regimen could improve medication adherence and the clinical virologic outcome. Therefore, general population research on ART adherence and polypharmacy is needed.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 3
    Publication Date: 2021-01-08
    Description: Auditory masking occurs when one sound is perceptually altered by the presence of another sound. Auditory masking in the frequency domain is known as simultaneous masking and in the time domain is known as temporal masking or non-simultaneous masking. This works presents a sound coding strategy that incorporates a temporal masking model to select the most relevant channels for stimulation in a cochlear implant (CI). A previous version of the strategy, termed psychoacoustic advanced combination encoder (PACE), only used a simultaneous masking model for the same purpose, for this reason the new strategy has been termed temporal-PACE (TPACE). We hypothesized that a sound coding strategy that focuses on stimulating the auditory nerve with pulses that are as masked as possible can improve speech intelligibility for CI users. The temporal masking model used within TPACE attenuates the simultaneous masking thresholds estimated by PACE over time. The attenuation is designed to fall exponentially with a strength determined by a single parameter, the temporal masking half-life T½. This parameter gives the time interval at which the simultaneous masking threshold is halved. The study group consisted of 24 postlingually deaf subjects with a minimum of six months experience after CI activation. A crossover design was used to compare four variants of the new temporal masking strategy TPACE (T½ ranging between 0.4 and 1.1 ms) with respect to the clinical MP3000 strategy, a commercial implementation of the PACE strategy, in two prospective, within-subject, repeated-measure experiments. The outcome measure was speech intelligibility in noise at 15 to 5 dB SNR. In two consecutive experiments, the TPACE with T½ of 0.5 ms obtained a speech performance increase of 11% and 10% with respect to the MP3000 (T½ = 0 ms), respectively. The improved speech test scores correlated with the clinical performance of the subjects: CI users with above-average outcome in their routine speech tests showed higher benefit with TPACE. It seems that the consideration of short-acting temporal masking can improve speech intelligibility in CI users. The half-live with the highest average speech perception benefit (0.5 ms) corresponds to time scales that are typical for neuronal refractory behavior.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 4
    Publication Date: 2021-01-08
    Description: An internal carotid artery (ICA) stenosis can potentially decrease the perfusion pressure to the brain. In this study, computational fluid dynamics (CFD) was used to study if there was a hemispheric pressure laterality between the contra- and ipsilateral middle cerebral artery (MCA) in patients with a symptomatic ICA stenosis. We further investigated if this MCA pressure laterality (ΔPMCA) was related to the hemispheric flow laterality (ΔQ) in the anterior circulation, i.e., ICA, proximal MCA and the proximal anterior cerebral artery (ACA). Twenty-eight patients (73±6 years, range 59–80 years, 21 men) with symptomatic ICA stenosis were included. Flow rates were measured using 4D flow MRI data (PC-VIPR) and vessel geometries were obtained from computed tomography angiography. The ΔPMCA was calculated from CFD, where patient-specific flow rates were applied at all input- and output boundaries. The ΔPMCA between the contra- and ipsilateral side was 6.4±8.3 mmHg (p
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 5
    Publication Date: 2021-01-07
    Description: Background Impaired perfusion indices signal potential microvascular dysfunction preceding atherosclerosis and other cardiometabolic pathologies. Post-occlusive reactive hyperemia (PORH), a vasodilatory response following a mechanically induced ischemia, is a transient increase in perfusion and can assess microvascular function. The greatest blood flow change corresponding to the first minute of hyperemia (represented by time-to-peak, hyperemic velocity, AUC within 1st min) has been shown to indicate microvascular dysfunction. However, the reproducibility of these temporal kinetic indices of the PORH response is unknown. Our aim was to examine the inter- and intra-day reproducibility and standardization of reactive hyperemia, with emphasis on the kinetic indices of PORH, using laser speckle contrast imaging (LSCI) technique. Methods and results Seventeen healthy adults (age = 24 ± 3 years) completed three PORH bouts over two lab visits. LSCI region of interest was a standardized 10 cm region on the dominant ventral forearm. A 5-min brachial artery occlusion period induced by inflating an arm cuff to 200 mmHg, preceded a 4-min hyperemic period. Inter- and intra-day reliability and reproducibility of cutaneous vascular conductance (LSCI flux / mean arterial pressure) were determined using intraclass correlation (ICC) and coefficient of variation (CV%). Maximal flow and area under the curve standardized to zero perfusion showed intra- and inter-day reliability (ICC 〉 0.70). Time to maximal flow (TMF) was not reproducible (inter-day CV = 18%). However, alternative kinetic indices such as 1-min AUC and overshoot rate-of-change (ORC), represented as a piecewise function (at 5s, 10s, 15s, and 20s into hyperemia), were reproducible (CV〈 11%). Biological zero was a reliable normalization point. Conclusion PORH measured with LSCI is a reliable assessment of microvascular function. However, TMF or its derived hyperemic velocity are not recommended for longitudinal assessment. Piecewise ORC and 1-min AUC are reliable alternatives to assess the kinetic response of PORH.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 6
    Publication Date: 2021-01-07
    Description: Algorithms are increasingly making decisions regarding what news articles should be shown to online users. In recent times, unhealthy outcomes from these systems have been highlighted including their vulnerability to amplifying small differences and offering less choice to readers. In this paper we present and study a new class of feedback models that exhibit a variety of self-organizing behaviors. In addition to showing important emergent properties, our model generalizes the popular “top-N news recommender systems” in a manner that provides media managers a mechanism to guide the emergent outcomes to mitigate potentially unhealthy outcomes driven by the self-organizing dynamics. We use complex adaptive systems framework to model the popularity evolution of news articles. In particular, we use agent-based simulation to model a reader’s behavior at the microscopic level and study the impact of various simulation hyperparameters on overall emergent phenomena. This simulation exercise enables us to show how the feedback model can be used as an alternative recommender to conventional top-N systems. Finally, we present a design framework for multi-objective evolutionary optimization that enables recommendation systems to co-evolve with the changing online news readership landscape.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 7
    Publication Date: 2021-01-07
    Description: Purpose To assess the signal composition of cone photoreceptors three-dimensionally in healthy retinas using adaptive optics optical coherence tomography (AO-OCT). Methods Study population. Twenty healthy eyes of ten subjects (age 23 to 67). Procedures. After routine ophthalmological assessments, eyes were examined using AO-OCT. Three-dimensional volumes were acquired at 2.5° and 6.5° foveal eccentricity in four main meridians (superior, nasal, inferior, temporal). Cone densities and signal compositions were investigated in four different planes: the cone inner segment outer segment junction (IS/OS), the cone outer segment combined with the IS/OS (ISOS+), the cone outer segment tips (COST) and full en-face plane (FEF) combining signals from all mentioned cone layers. Additionally, reliability of a simple semi-automated approach for assessment of cone density was tested. Main outcome measures. Cone density of IS/OS, IS/OS+, COST and FEF. Qualitative depiction and composition of each cone layer. Inter-rater agreement of cone density measurements. Results Mean overall cone density at all eccentricities was highest at the FEF plane (21.160/mm2), followed by COST (20.450/mm2), IS/OS+ (19.920/mm2) and IS/OS (19.530/mm2). The different meridians and eccentricities had a significant impact on cone density, with lower eccentricity resulting in higher cone densities (p≤.001), which were highest at the nasal, then temporal, then inferior and then superior meridian. Depiction of the cone mosaic differed between all 4 layers regarding signal size and packing density. Therefore, different cone layers showed evident but not complete signal overlap. Using the semi-automated technique for counting of cone signals achieved high inter-rater reliability (ICC 〉 .99). Conclusions In healthy individuals qualitative and quantitative changes in cone signals are found not only in different eccentricities and meridians, but also within different photoreceptor layers. The variation between cone planes has to be considered when assessing the integrity of cone photoreceptors in healthy and diseased eyes using adaptive optics technology.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 8
    Publication Date: 2021-01-07
    Description: Data Integrity Auditing (DIA) is a security service for verifying the integrity of outsourced data in Public Cloud Storage (PCS) by users or by Third-Party Auditors (TPAs) on behalf of the users. This paper proposes a novel DIA framework, called DIA-MTTP. The major novelty of the framework lies in that, while providing the DIA service in a PCS environment, it supports the use of third parties, but does not require full trust in the third parties. In achieving this property, a number of ideas also have been embedded in the design. These ideas include the use of multiple third parties and a hierarchical approach to their communication structure making the service more suited to resource-constrained user devices, the provision of two integrity assurance levels to balance the trade-off between security protection levels and the costs incurred, the application of a data deduplication measure to both new data and existing data updates to minimise the number of tags (re-)generated. In supporting the dynamic data and deduplication measure, a distributed data structure, called Multiple Mapping Tables (M2T), is proposed. Security analysis indicates that our framework is secure with the use of untrusted third parties. Performance evaluation indicates that our framework imposes less computational, communication and storage overheads than related works.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 9
    Publication Date: 2021-01-08
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 10
    Publication Date: 2021-01-08
    Description: Butterfly Optimization Algorithm (BOA) is a recent metaheuristics algorithm that mimics the behavior of butterflies in mating and foraging. In this paper, three improved versions of BOA have been developed to prevent the original algorithm from getting trapped in local optima and have a good balance between exploration and exploitation abilities. In the first version, Opposition-Based Strategy has been embedded in BOA while in the second Chaotic Local Search has been embedded. Both strategies: Opposition-based & Chaotic Local Search have been integrated to get the most optimal/near-optimal results. The proposed versions are compared against original Butterfly Optimization Algorithm (BOA), Grey Wolf Optimizer (GWO), Moth-flame Optimization (MFO), Particle warm Optimization (PSO), Sine Cosine Algorithm (SCA), and Whale Optimization Algorithm (WOA) using CEC 2014 benchmark functions and 4 different real-world engineering problems namely: welded beam engineering design, tension/compression spring, pressure vessel design, and Speed reducer design problem. Furthermore, the proposed approches have been applied to feature selection problem using 5 UCI datasets. The results show the superiority of the third version (CLSOBBOA) in achieving the best results in terms of speed and accuracy.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 11
    Publication Date: 2021-01-08
    Description: In December 2019, the outbreak of a new coronavirus-caused pneumonia (COVID-19) in Wuhan attracted close attention in China and the world. The Chinese government took strong national intervention measures on January 23 to control the spread of the epidemic. We are trying to show the impact of these controls on the spread of the epidemic. We proposed an SEIR(Susceptible-Exposed-Infectious-Removed) model to analyze the epidemic trend in Wuhan and use the AI model to analyze the epidemic trend in non-Wuhan areas. We found that if the closure was lifted, the outbreak in non-Wuhan areas of mainland China would double in size. Our SEIR and AI model was effective in predicting the COVID-19 epidemic peaks and sizes. The epidemic control measures taken by the Chinese government, especially the city closure measures, reduced the scale of the COVID-19 epidemic.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 12
    Publication Date: 2021-01-08
    Description: The prevalence of hypertension is increasing in low- and middle-income countries, however statistics are generally derived from cross sectional surveys that utilize different methodologies and population samples. We investigated blood pressure (BP) changes over 11–12 years in a large cohort of adults aged 50 years and older (n = 820) included in the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE Ghana) Wave 1 (2007/8) with follow up in Wave 3 (2019). Participants’ BP were measured in triplicate and a survey completed at both time points. Survey instruments collected information on sociodemographic characteristics, lifestyle, health behaviors and chronic conditions. While no significant difference was found in systolic BP between Waves 1 and 3, diastolic BP decreased by 9.7mmHg (mean = 88.6, 15.4 to 78.9, 13.6 respectively) and pulse pressure increased by 9.5mmHg (44.8, 13.7 to 54.3, 14.1). Awareness of hypertension increased by 37%, from (20% to 57%), but no differences were found for the proportion of hypertensives receiving treatment nor those that had controlled BP. Mixed effects modelling showed a decrease in diastolic BP was associated with increasing age, living in rural areas and having health insurance. Factors associated with an increased awareness of hypertension were residing in urban areas, having health insurance and increasing body mass index. While diagnosis of hypertension has improved over time in Ghana, there is an ongoing need to improve its treatment in older adults.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 13
    Publication Date: 2021-01-08
    Description: The tetraploid Avena species in the section Pachycarpa Baum, including A. insularis, A. maroccana, and A. murphyi, are thought to be involved in the evolution of hexaploid oats; however, their genome designations are still being debated. Repetitive DNA sequences play an important role in genome structuring and evolution, so understanding the chromosomal organization and distribution of these sequences in Avena species could provide valuable information concerning genome evolution in this genus. In this study, the chromosomal organizations and distributions of six repetitive DNA sequences (including three SSR motifs (TTC, AAC, CAG), one 5S rRNA gene fragment, and two oat A and C genome specific repeats) were investigated using non-denaturing fluorescence in situ hybridization (ND-FISH) in the three tetraploid species mentioned above and in two hexaploid oat species. Preferential distribution of the SSRs in centromeric regions was seen in the A and D genomes, whereas few signals were detected in the C genomes. Some intergenomic translocations were observed in the tetraploids; such translocations were also detected between the C and D genomes in the hexaploids. These results provide robust evidence for the presence of the D genome in all three tetraploids, strongly suggesting that the genomic constitution of these species is DC and not AC, as had been thought previously.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 14
    Publication Date: 2021-01-08
    Description: Sustainable Development Goal 3.1 calls for a reduction of the maternal mortality ratio to less than 70 per 100,000 live births by 2030. The most important cause of maternal mortality is post-partum haemorrhage (PPH). Oxytocin injections and misoprostol tablets are medicines of first choice for the management of PPH in low- and middle-income countries (LMICs). Unfortunately, both substances are chemically unstable, and previous studies have revealed serious quality problems of these medicines in LMICs. The present study is the first report on their quality in Rwanda. From 40 randomly selected health facilities (hospitals, health centers, retail pharmacies and private clinics) in different parts of Rwanda, as well as from six wholesalers and government stores, oxytocin injections and misoprostol tablets were collected. Oxytocin storage temperatures in the health facilities were monitored for six months using temperature data loggers, and found to correctly follow the storage requirements stated by the manufacturers (2–8°C, or room temperature) with few minor deviations. Oxytocin injections (57 samples, representing seven batches of four brands) were tested for their oxytocin content and pH value according to the United States Pharmacopeia. Twenty-four samples from three European manufacturers passed all tests. However, all nine samples of one batch of a Chinese manufacturer showed an excessive content of oxytocin (range 117.2–121.5% of the declared amount). Another batch of the same manufacturer showed extreme variations of the concentration of the preservative benzyl alcohol. Misoprostol tablets (25 samples, representing ten batches of six brands) were tested for content and dissolution according to the International Pharmacopoeia. Fifteen samples passed, but all 10 samples of two brands from India failed with extreme deviations, containing only 42.5–48.7% of the stated amount of misoprostol. In conclusion, oxytocin quality in Rwanda was better than reported from other African countries. However, two extremely substandard brands of misoprostol tablets were found. The Rwandan authorities reacted quickly and efficiently, and recalled these substandard medicines from the market. For oxytocin and misoprostol, with their well-known problems of quality and stability, procurement should possibly be restricted to medicines which are WHO-prequalified or which have been manufactured in countries with stringent regulatory authorities.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 15
    Publication Date: 2021-01-08
    Description: Drug repurposing for COVID-19 has several potential benefits including shorter development time, reduced costs and regulatory support for faster time to market for treatment that can alleviate the current pandemic. The current study used molecular docking, molecular dynamics and protein-protein interaction simulations to predict drugs from the Drug Bank that can bind to the SARS-CoV-2 spike protein interacting surface on the human angiotensin-converting enzyme 2 (hACE2) receptor. The study predicted a number of peptide-based drugs, including Sar9 Met (O2)11-Substance P and BV2, that might bind sufficiently to the hACE2 receptor to modulate the protein-protein interaction required for infection by the SARS-CoV-2 virus. Such drugs could be validated in vitro or in vivo as potential inhibitors of the interaction of SARS-CoV-2 spike protein with the human angiotensin-converting enzyme 2 (hACE2) in the airway. Exploration of the proposed and current pharmacological indications of the peptide drugs predicted as potential inhibitors of the interaction between the spike protein and hACE2 receptor revealed that some of the predicted peptide drugs have been investigated for the treatment of acute respiratory distress syndrome (ARDS), viral infection, inflammation and angioedema, and to stimulate the immune system, and potentiate antiviral agents against influenza virus. Furthermore, these predicted drug hits may be used as a basis to design new peptide or peptidomimetic drugs with better affinity and specificity for the hACE2 receptor that may prevent interaction between SARS-CoV-2 spike protein and hACE2 that is prerequisite to the infection by the SARS-CoV-2 virus.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 16
    Publication Date: 2021-01-07
    Description: Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. Methods Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New York Heart Association (NYHA) Class II, III, and IV) and depression (defined as a score of 10 or above on the PHQ-9 and confirmed by the MINI International Neuropsychiatric Interview for the DSM-5) selected from all patients at Cedars-Sinai Medical Center who are admitted with heart failure and all patients presenting to the outpatient programs of the Smidt Heart Institute at Cedars-Sinai Medical Center. We plan to randomize 416 patients to BA or MEDS, with an estimated 28% loss to follow-up/inability to collect follow-up data. Thus, we plan to include 150 in each group for a total of 300 participants from which data after randomization will be collected and analyzed. Conclusions The current trial is the first to compare the impact of BA and MEDS on depressive symptoms, quality of life, caregiver burden, morbidity, and mortality in patients with depression and advanced heart failure. The trial will provide novel results that will be disseminated and implemented into a wide range of current practice settings. Registration ClinicalTrials.Gov Identifier: NCT03688100.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 17
    Publication Date: 2021-01-07
    Description: Fumonisins (FBs) and zearalenone (ZEN) are mycotoxins which occur naturally in grains and cereals, especially maize, causing negative effects on animals and humans. Along with the need for constant monitoring, there is a growing demand for rapid, non-destructive methods. Among these, Near Infrared Spectroscopy (NIR) has made great headway for being an easy-to-use technology. NIR was applied in the present research to quantify the contamination level of total FBs, i.e., fumonisin B1+fumonisin B2 (FB1+FB2), and ZEN in Brazilian maize. From a total of six hundred and seventy-six samples, 236 were analyzed for FBs and 440 for ZEN. Three regression models were defined: one with 18 principal components (PCs) for FB1, one with 10 PCs for FB2, and one with 7 PCs for ZEN. Partial least square regression algorithm with full cross-validation was applied as internal validation. External validation was performed with 200 unknown samples (100 for FBs and 100 for ZEN). Correlation coefficient (R), determination coefficient (R2), root mean square error of prediction (RMSEP), standard error of prediction (SEP) and residual prediction deviation (RPD) for FBs and ZEN were, respectively: 0.809 and 0.991; 0.899 and 0.984; 659 and 69.4; 682 and 69.8; and 3.33 and 2.71. No significant difference was observed between predicted values using NIR and reference values obtained by Liquid Chromatography Coupled to Tandem Mass Spectrometry (LC-MS/MS), thus indicating the suitability of NIR to rapidly analyze a large numbers of maize samples for FBs and ZEN contamination. The external validation confirmed a fair potential of the model in predicting FB1+FB2 and ZEN concentration. This is the first study providing scientific knowledge on the determination of FBs and ZEN in Brazilian maize samples using NIR, which is confirmed as a reliable alternative methodology for the analysis of such toxins.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 18
    Publication Date: 2021-01-07
    Description: Natural environments, like soils or the mammalian gut, frequently contain microbial consortia competing within a niche, wherein many species contain genetically encoded mechanisms of interspecies competition. Recent computational work suggests that physical structures in the environment can stabilize local competition between species that would otherwise be subject to competitive exclusion under isotropic conditions. Here we employ Lotka-Volterra models to show that interfacial competition localizes to physical structures, stabilizing competitive ecological networks of many species, even with significant differences in the strength of competitive interactions between species. Within a limited range of parameter space, we show that for stable communities the length-scale of physical structure inversely correlates with the width of the distribution of competitive fitness, such that physical environments with finer structure can sustain a broader spectrum of interspecific competition. These results highlight the potentially stabilizing effects of physical structure on microbial communities and lay groundwork for engineering structures that stabilize and/or select for diverse communities of ecological, medical, or industrial utility.
    Print ISSN: 1553-734X
    Electronic ISSN: 1553-7358
    Topics: Biology , Computer Science
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  • 19
    Publication Date: 2021-01-08
    Description: Introduction It is expected that in unforeseen situations, nurses will provide appropriate medical interventions, using their expertise and skills to reduce the risks associated with the consequences of disasters. Consequently, it is crucial that they are properly prepared to respond to such difficult circumstances. This study aimed to identify the factors influencing the basic competences of nurses in disasters. Materials and methods The survey was directed to 468 nurses from all medical centres in Lublin. IBM SPSS Statistics version 23 was used for statistical analyses, frequency analysis, basic descriptive statistics and logistic regression analysis. The classical statistical significance level was adopted as α = 0.05. Results Based on the logistic regression analysis, it was found that work experience, workplace preparedness, as well as training and experience in disaster response are important predictors of preparedness. Conclusions These findings indicate that the nurses' core competencies for these incidents can be improved through education and training programmes which increase their preparedness for disasters. Nurses are among the most important groups of healthcare professionals facing a disaster and should be involved in all phases of disaster management, such as risk assessment and pre-disaster planning, response during crisis situations and risks’ mitigation throughout the reconstruction period.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 20
    Publication Date: 2021-01-08
    Description: Objective To analyze the effect of statins on cytokines levels in gingival crevicular fluid (GCF) and saliva and on clinical periodontal parameters of middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Methods Systemically healthy controls (C group, n = 62), T2DM patients not taking statins (D group, n = 57) and T2DM patients taking statins (S group, n = 24) were recruited. In each group, subjects (40–85 years) were subclassified into the h (periodontal health)group, the g (gingivitis)group or the p (periodontitis) group according to different periodontal conditions. 17 cytokines in gingival crevicular fluid (GCF) and saliva samples of each subject were measured utilizing the Luminex technology kit. Further, HbA1c (glycated hemoglobin), FPG (fasting plasma glucose), PD (probing depth), CAL (clinical attachment level), BOP (bleeding on probing), GI (gingival index) and PI (periodontal index) were recorded. Data distribution was tested through the Shapiro-Wilk test, upon which the Kruskal-Wallis test was applied followed by Mann-Whitney U test and Bonferroni’s correction. Results Levels of IFN-γ, IL-5, IL-10 and IL-13 in the saliva of the Dh group were significantly lower than those in the Ch group, while factor IL-4 was higher (p
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 21
    Publication Date: 2021-01-07
    Description: Although investigation of the brains of criminals began quite early in the history of psychophysiological research, little is known about brain plasticity of offenders with psychopathy. Building on our preliminary study reporting successful brain self-regulation using slow cortical potential (SCP) neurofeedback in offenders with psychopathy, we investigated the central nervous and autonomic peripheral changes occurring after brain self-regulation in a group of severe male offenders with psychopathy. Regarding the central nervous system, an overall suppression of the psychopathic overrepresentation of slow frequency bands was found, such as delta and theta band activity, after EEG neurofeedback. In addition, an increase in alpha band activity could be observed after the SCP self-regulation training. Electrodermal activity adaptively changed according to the regulation task, and this flexibility improved over training time. The results of this study point towards a constructive learning process and plasticity in neural and peripheral measures of offenders with psychopathy.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 22
    Publication Date: 2021-01-07
    Description: Antibiotic resistance is a rapidly increasing medical problem that severely limits the success of antibiotic treatments, and the identification of resistance determinants is key for surveillance and control of resistance dissemination. Horizontal transfer is the dominant mechanism for spread of resistance genes between bacteria but little is known about the original emergence of resistance genes. Here, we examined experimentally if random sequences can generate novel antibiotic resistance determinants de novo. By utilizing highly diverse expression libraries encoding random sequences to select for open reading frames that confer resistance to the last-resort antibiotic colistin in Escherichia coli, six de novo colistin resistance conferring peptides (Dcr) were identified. The peptides act via direct interactions with the sensor kinase PmrB (also termed BasS in E. coli), causing an activation of the PmrAB two-component system (TCS), modification of the lipid A domain of lipopolysaccharide and subsequent colistin resistance. This kinase-activation was extended to other TCS by generation of chimeric sensor kinases. Our results demonstrate that peptides with novel activities mediated via specific peptide-protein interactions in the transmembrane domain of a sensory transducer can be selected de novo, suggesting that the origination of such peptides from non-coding regions is conceivable. In addition, we identified a novel class of resistance determinants for a key antibiotic that is used as a last resort treatment for several significant pathogens. The high-level resistance provided at low expression levels, absence of significant growth defects and the functionality of Dcr peptides across different genera suggest that this class of peptides could potentially evolve as bona fide resistance determinants in natura.
    Print ISSN: 1553-7390
    Electronic ISSN: 1553-7404
    Topics: Biology
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  • 23
    Publication Date: 2021-01-07
    Description: Forest bathing is an outdoor activity, and it might be a promising preventive treatment for social problems involving stress. A vast number of studies confirm the positive effects of this activity on people’s health. Nevertheless, little is known about the influence of winter forest bathing when conducted in an environment with snow cover on the ground and trees. Thus, a crossover experiment was designed in this study, with the participation of twenty-two healthy university students from Finland. During the experiment, a short exposition by a forest environment or landscape with buildings (as a control) was applied. Participants self-reported their psychological relaxation before and after the exposition, and the results were analyzed and compared. The mood, emotions, restorativeness, and subjective vitality were recorded as indices reflecting the psychological relaxation effect. The negative mood indices decreased significantly after exposition by the snow-covered environment, but the positive ‘vigor’ indices did not increase or decrease significantly. The level of negative emotions increased after the exposition with the control environment. Likewise, positive emotions decreased after the interaction with the control. Restorativeness was significantly increased after the exposition by the experimental forest but decreased after the viewing of the control buildings. The size of the effect in terms of restorativeness was the highest in this experiment. The subjective vitality was lowered as affected by the control, but it did not increase or decrease after the exposition with the experimental forest. There is probably an effect from the slight interruption in the process from the influence of the forest greens on participants because their vigor and vitality did not increase after the exposition with this environment in the study. However, snow might influence the participants as a calming and emotion-lowering component of the environment, but this idea needs to be further explored with the involvement of participants from other countries who would be viewing forest environments with snow cover and whose psychological relaxation could be measured.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 24
    Publication Date: 2021-01-07
    Description: Objective To examine the risk of total knee arthroplasty (TKA) due to osteoarthritis associated with obesity defined by body mass index (BMI) or waist circumference (WC) and whether there is discordance between these measures in assessing this risk. Methods 36,784 participants from the Melbourne Collaborative Cohort Study with BMI and WC measured at 1990–1994 were included. Obesity was defined by BMI (≥30 kg/m2) or WC (men ≥102cm, women ≥88cm). The incidence of TKA between January 2001 and December 2018 was determined by linking participant records to the National Joint Replacement Registry. Results Over 15.4±4.8 years, 2,683 participants underwent TKA. There were 20.4% participants with BMI-defined obesity, 20.8% with WC-defined obesity, and 73.6% without obesity defined by either BMI or WC. Obesity was classified as non-obese (misclassified obesity) in 11.7% of participants if BMI or WC alone was used to define obesity. BMI-defined obesity (HR 2.69, 95%CI 2.48–2.92), WC-defined obesity (HR 2.28, 95%CI 2.10–2.48), and obesity defined by either BMI or WC (HR 2.53, 95%CI 2.33–2.74) were associated with an increased risk of TKA. Compared with those without obesity, participants with misclassified obesity had an increased risk of TKA (HR 2.06, 95%CI 1.85–2.30). 22.7% of TKA in the community can be attributable to BMI-defined obesity, and a further 3.3% of TKA can be identified if WC was also used to define obesity. Conclusions Both BMI and WC should be used to identify obese individuals who are at risk of TKA for osteoarthritis and should be targeted for prevention and treatment.
    Electronic ISSN: 1932-6203
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  • 25
    Publication Date: 2021-01-07
    Description: Social isolation has affected a large number of people and may lead to impairment of physical and mental health. Although stress resulting from social isolation may increase cancer progression, its interference on tumorigenesis is poorly known. In this study, we used a preclinical model to evaluate the effects of social isolation stress on chemically induced oral carcinogenesis. Sixty-two 21-day-old male Wistar rats were divided into isolated and grouped groups. After 90 days of age, the rats from both groups underwent oral carcinogenesis with 4-nitroquinoline 1-oxide (4NQO) for 20 weeks. All rats were assessed for depressive-like behavior and euthanized for oral squamous cell carcinoma (OSCC) diagnosis and measurement of inflammatory mediators in the tumor microenvironment. Social isolation stress increased the OSCC occurrence by 20.4% when compared to control. Isolated rats also showed higher tumor volume and cachexia than the grouped rats. Social isolation did not induce changes in the depressive-like behavior after carcinogenic induction. Tumors from stressed rats had increased levels of the inflammatory mediators, TNF-alpha, IL1-beta and MCP-1. The concentrations of TNF-alpha and MCP-1 were significantly increased in the large tumors from isolated animals. Higher tumor levels of TNF-alpha, IL-6, IL1-beta and MCP-1 were positively correlated with OSCC growth. This study provides the first evidence that social isolation stress may facilitate OSCC occurrence and tumor progression, an event accompanied by increased local levels of inflammatory mediators.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 26
    Publication Date: 2021-01-07
    Description: Objective Routinely collected health administrative data can be used to efficiently assess disease burden in large populations, but it is important to evaluate the validity of these data. The objective of this study was to develop and validate International Classification of Disease 10th revision (ICD -10) algorithms that identify laboratory-confirmed influenza or laboratory-confirmed respiratory syncytial virus (RSV) hospitalizations using population-based health administrative data from Ontario, Canada. Study design and setting Influenza and RSV laboratory data from the 2014–15, 2015–16, 2016–17 and 2017–18 respiratory virus seasons were obtained from the Ontario Laboratories Information System (OLIS) and were linked to hospital discharge abstract data to generate influenza and RSV reference cohorts. These reference cohorts were used to assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ICD-10 algorithms. To minimize misclassification in future studies, we prioritized specificity and PPV in selecting top-performing algorithms. Results 83,638 and 61,117 hospitalized patients were included in the influenza and RSV reference cohorts, respectively. The best influenza algorithm had a sensitivity of 73% (95% CI 72% to 74%), specificity of 99% (95% CI 99% to 99%), PPV of 94% (95% CI 94% to 95%), and NPV of 94% (95% CI 94% to 95%). The best RSV algorithm had a sensitivity of 69% (95% CI 68% to 70%), specificity of 99% (95% CI 99% to 99%), PPV of 91% (95% CI 90% to 91%) and NPV of 97% (95% CI 97% to 97%). Conclusion We identified two highly specific algorithms that best ascertain patients hospitalized with influenza or RSV. These algorithms may be applied to hospitalized patients if data on laboratory tests are not available, and will thereby improve the power of future epidemiologic studies of influenza, RSV, and potentially other severe acute respiratory infections.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 27
    Publication Date: 2021-01-07
    Description: Background and objectives A plethora of studies has investigated and compared social cognition in autism and schizophrenia ever since both conditions were first described in conjunction more than a century ago. Recent computational theories have proposed similar mechanistic explanations for various symptoms beyond social cognition. They are grounded in the idea of a general misestimation of uncertainty but so far, almost no studies have directly compared both conditions regarding uncertainty processing. The current study aimed to do so with a particular focus on estimation of volatility, i.e. the probability for the environment to change. Methods A probabilistic decision-making task and a visual working (meta-)memory task were administered to a sample of 86 participants (19 with a diagnosis of high-functioning autism, 21 with a diagnosis of schizophrenia, and 46 neurotypically developing individuals). Results While persons with schizophrenia showed lower visual working memory accuracy than neurotypical individuals, no significant group differences were found for metamemory or any of the probabilistic decision-making task variables. Nevertheless, exploratory analyses suggest that there may be an overestimation of volatility in subgroups of participants with autism and schizophrenia. Correlations revealed relationships between different variables reflecting (mis)estimation of uncertainty, visual working memory accuracy and metamemory. Limitations Limitations include the comparably small sample sizes of the autism and the schizophrenia group as well as the lack of cognitive ability and clinical symptom measures. Conclusions The results of the current study provide partial support for the notion of a general uncertainty misestimation account of autism and schizophrenia.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 28
    Publication Date: 2021-01-07
    Description: The virulence of Clostridioides difficile (formerly Clostridium difficile) is mainly caused by its two toxins A and B. Their formation is significantly regulated by metabolic processes. Here we investigated the influence of various sugars (glucose, fructose, mannose, trehalose), sugar derivatives (mannitol and xylitol) and L-lactate on toxin synthesis. Fructose, mannose, trehalose, mannitol and xylitol in the growth medium resulted in an up to 2.2-fold increase of secreted toxin. Low glucose concentration of 2 g/L increased the toxin concentration 1.4-fold compared to growth without glucose, while high glucose concentrations in the growth medium (5 and 10 g/L) led to up to 6.6-fold decrease in toxin formation. Transcriptomic and metabolic investigation of the low glucose effect pointed towards an inactive CcpA and Rex regulatory system. L-lactate (500 mg/L) significantly reduced extracellular toxin formation. Transcriptome analyses of the later process revealed the induction of the lactose utilization operon encoding lactate racemase (larA), electron confurcating lactate dehydrogenase (CDIF630erm_01321) and the corresponding electron transfer flavoprotein (etfAB). Metabolome analyses revealed L-lactate consumption and the formation of pyruvate. The involved electron confurcation process might be responsible for the also observed reduction of the NAD+/NADH ratio which in turn is apparently linked to reduced toxin release from the cell.
    Electronic ISSN: 1932-6203
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  • 29
    Publication Date: 2021-01-07
    Description: Amyloid fibrils are widely studied both as target in conformational disorders and as basis for the development of protein-based functional materials. The three Zr phthalocyanines bearing dehydroacetic acid residue (PcZr(L1)2) and its condensed derivatives (PcZr(L2)2 and PcZr(L3)2) as out-of-plane ligands were synthesized and their influence on insulin fibril formation was studied by amyloid-sensitive fluorescent dye based assay, scanning electron microscopy, fluorescent and absorption spectroscopies. The presence of Zr phthalocyanines was shown to modify the fibril formation. The morphology of fibrils formed in the presence of the Zr phthalocyanines differs from that of free insulin and depends on the structure of out-of-plane ligands. It is shown that free insulin mostly forms fibril clusters with the length of about 0.3–2.1 μm. The presence of Zr phthalocyanines leads to the formation of individual 0.4–2.8 μm-long fibrils with a reduced tendency to lateral aggregation and cluster formation (PcZr(L1)2), shorter 0.2–1.5 μm-long fibrils with the tendency to lateral aggregation without clusters (PcZr(L2)2), and fibril-like 0.2–1.0 μm-long structures (PcZr(L3)2). The strongest influence on fibrils morphology made by PcZr(L3)2 could be explained by the additional stacking of phenyl moiety of the ligand with aromatic amino acids in protein. The evidences of binding of studied Zr phthalocyanines to mature fibrils were shown by absorption spectroscopy (for PcZr(L1)2 and PcZr(L2)2) and fluorescent spectroscopy (for PcZr(L3)2). These complexes could be potentially used as external tools allowing the development of functional materials on protein fibrils basis.
    Electronic ISSN: 1932-6203
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  • 30
    Publication Date: 2021-01-07
    Description: Background Histopathologic factors predictive of nintedanib efficacy in idiopathic pulmonary fibrosis have not been studied. We aimed to describe the characteristics, focusing on histopathology, of idiopathic pulmonary fibrosis patients who did and did not respond to nintedanib. Methods This study retrospectively examined the clinicoradiopathologic features of 40 consecutive patients with surgical lung biopsy-confirmed idiopathic pulmonary fibrosis treated with nintedanib. Additionally, we compared the histopathologic scoring of 21 microscopic features between patients with functional or radiological progression and those with non-progression during 12 months of treatment. Results The histopathologic evaluation showed edematous changes in the interlobular septum as the only histologic finding observed more frequently in patients with both functional and radiological progression than in those without (58% vs. 14%, P = 0.007 and 50% vs. 0%, P = 0.003, respectively). Regarding per-year change, patients with edematous changes in the interlobular septum showed greater progression in median changes in spared area (-12%, interquartile range: [-25%–-5%], vs. -3% [-7%–0%], P = 0.004) and reticular shadow (7% [3%–13%], vs. 0% [0%–5%], P = 0.041) on computed tomography. Functional and radiological progression-free survival were shorter in patients with edematous changes in the interlobular septum than in those without (6.6 months, 95% confidence interval: [5.9–25.3], vs. event
    Electronic ISSN: 1932-6203
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  • 31
    Publication Date: 2021-01-07
    Description: Introduction Tuberculosis affects vulnerable groups to a greater degree, indigenous population among them. Objective To determine molecular epidemiology of clinical isolates of Mycobacterium tuberculosis circulating in an indigenous population through Spoligotyping and 24-loci MIRU-VNTR. Methodology A descriptive cross-sectional study was conducted in 23 indigenous communities of Puerto Nariño-Amazonas, Colombia. Recovered clinical isolates were genotyped. For genotyping analyzes global SITVIT2 database and the MIRU-VNTRplus web portal were used. Results 74 clinical isolates were recovered. Genotyping of clinical isolates by spoligotyping determined 5 different genotypes, all of them belonged to Euro-American lineage. By MIRU-VNTR typing, a total of 14 different genotypes were recorded. Furthermore, polyclonal infection was found in two patients from the same community. The combination of the two methodologies determined the presence of 19 genotypes, 8 formed clusters with 63 clinical isolates in total. Based on epidemiological information, it was possible to establish a potential chain of active transmission in 10/63 (15.9%) patients. Conclusions High genomic homogeneity was determined in the indigenous population suggesting possible chains of active transmission. The results obtained showed that specific genotypes circulating among the indigenous population of Colombia are significantly different from those found in the general population.
    Electronic ISSN: 1932-6203
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  • 32
    Publication Date: 2021-01-07
    Description: Children with Down syndrome have an approximately 10-fold increased risk of developing acute lymphoblastic leukemia and this risk is influenced by inherited genetic variation. Genome-wide association studies have identified IKZF1 as a strong acute lymphoblastic leukemia susceptibility locus in children both with and without Down syndrome, with association signals reported at rs4132601 in non-Down syndrome and rs58923657 in individuals with Down syndrome (r2 = 0.98 for these two loci). Expression quantitative trait locus analysis in non-Down syndrome lymphoblastoid cell lines has demonstrated an association between the rs4132601 risk allele and decreased IKZF1 mRNA levels. In this study, we provide further mechanistic evidence linking the region encompassing IKZF1-associated polymorphisms to pro-leukemogenic effects in both human lymphoblastoid cell lines and murine hematopoietic stem cells. CRISPR/Cas9-mediated deletion of the region encompassing the rs17133807 major allele (r2 with rs58923657 = 0.97) resulted in significant reduction of IKZF1 mRNA levels in lymphoblastoid cell lines, with a greater effect in Down syndrome versus non-Down syndrome cells. Since rs17133807 is highly conserved in mammals, we also evaluated the orthologous murine locus at rs263378223, in hematopoietic stem cells from the Dp16(1)Yey mouse model of Down syndrome as well as non-Down syndrome control mice. Homozygous deletion of the region encompassing rs263378223 resulted in significantly reduced Ikzf1 mRNA, confirming that this polymorphism maps to a strong murine Ikzf1 enhancer, and resulted in increased B-lymphoid colony growth and decreased B-lineage differentiation. Our results suggest that both the region encompassing rs17133807 and its conserved orthologous mouse locus have functional effects that may mediate increased leukemia susceptibility in both the Down syndrome and non-Down syndrome genetic backgrounds.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 33
    Publication Date: 2021-01-07
    Description: Liver stiffness is a reliable non-invasive predictor of Hepatic Venous Pressure Gradient (HVPG) above 10 mm Hg. However, it failed to predict higher thresholds of HVPG. Our aim was to investigate whether liver stiffness and selected previously published non-invasive blood biomarkers could predict higher HVPG thresholds in liver transplant candidates without ongoing alcohol use. One hundred and nine liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG measurement, liver stiffness measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France) and assessment of blood HVPG biomarkers (osteopontin, VCAM-1, IL-6, TNF-α, IL-1ra/IL-1F3 and ELF score). The correlation between liver stiffness and HVPG was linear up to 30 mm Hg of HVPG (r = 0.765, p 〈 0.0001). The regression lines had similar slopes for HVPG values below and above 16 mm Hg (p 〉 0.05) and the correlation in patients with HVPG
    Electronic ISSN: 1932-6203
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  • 34
    Publication Date: 2021-01-07
    Description: Epigenetics are known to be involved in various disorders, including neurobiological disorders like autism. Dietary factors such as folic acid can affect epigenetic marks using methylenetetrahydrofolate reductase (MTHFR) to metabolize folic acid to a one-carbon methyl group. As MTHFR mutations are frequent, it is curious as to whether excess folic acid, with or without functioning MTHFR, could affect gene expression, epigenetics, and neuromorphology. Here, we investigated gene expression and activity of epigenetic modifying enzymes, genome-wide DNA methylation, histone 3 modifications, and dendritic spine densities in SH-SY5Y cells with or without a knockdown of MTHFR and with or without an excess of folic acid. We found alterations to gene expression of epigenetic modifying enzymes, including those associated with disorders like autism. Grouping the epigenetic modifying enzymes by function indicated that gene expression was widely affected for genes that code for enzymes affecting DNA methylation, histone acetylation, histone methylation, histone phosphorylation, and histone ubiquitination when excess folic acid treatment occurred with or without the knockdown of MTHFR. MTHFR was significantly reduced upon excess folic acid treatment whether MTHFR was knocked-down or not. Further, methyl-CpG binding protein 2 expression was significantly decreased with excess folic acid treatment with and without proper MTHFR expression. Global DNA methylation decreased due to the knockdown alone while global hydroxymethylated DNA increased due to the knockdown alone. TET2 expression significantly increased with the MTHFR knockdown alone. Excess folic acid alone induced a decrease in TET3 expression. Excess folic acid induced an increase in dendritic spines without the MTHFR knockdown, but folic acid induced a decrease in dendritic spines when MTHFR was knocked-down. The knockdown alone also increased the dendritic spines significantly. Histone 3 acetylation at lysine 18 was significantly increased when excess folic acid was applied to cells with the MTHFR knockdown, as was histone 3 phosphorylation at serine 10. Broadly, our results indicate that excess folic acid, even with functioning MTHFR, could have detrimental effects on cells.
    Electronic ISSN: 1932-6203
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  • 35
    Publication Date: 2021-01-07
    Description: Background Digital devices and wearables allow for the measurement of a wide range of health-related parameters in a non-invasive manner, which may be particularly valuable in pediatrics. Incorporation of such parameters in clinical trials or care as digital endpoint could reduce the burden for children and their parents but requires clinical validation in the target population. This study aims to determine the tolerability, repeatability, and reference values of novel digital endpoints in healthy children. Methods Apparently healthy children (n = 175, 46% male) aged 2–16 were included. Subjects were monitored for 21 days using a home-monitoring platform with several devices (smartwatch, spirometer, thermometer, blood pressure monitor, scales). Endpoints were analyzed with a mixed effects model, assessing variables that explained within- and between-subject variability. Endpoints based on physical activity, heart rate, and sleep-related parameters were included in the analysis. For physical-activity-related endpoints, a sample size needed to detect a 15% increase was calculated. Findings Median compliance was 94%. Variability in each physical activity-related candidate endpoint was explained by age, sex, watch wear time, rain duration per day, average ambient temperature, and population density of the city of residence. Estimated sample sizes for candidate endpoints ranged from 33–110 per group. Daytime heart rate, nocturnal heart rate and sleep duration decreased as a function of age and were comparable to reference values published in the literature. Conclusions Wearable- and portable devices are tolerable for pediatric subjects. The raw data, models and reference values presented here can be used to guide further validation and, in the future, clinical trial designs involving the included measures.
    Electronic ISSN: 1932-6203
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  • 36
    Publication Date: 2021-01-07
    Description: Most research on power assist suits (PASs) that concerned PAS-human interactions has used human physical reactions as criteria to evaluate the mechanical function, however, with minimal emphasis on human reactions in response to PASs. In this study, we focused on the physiological responses of the upper limbs including muscle activity of the biceps brachii and the triceps brachii, co-activation, force steadiness (CV) and rated perceived exertion (RPE) to various patterns of bilateral assistive force, such as unilateral assistance (L0% & R67% [% = percentage of workload force, L = left arm, R = right arm], L67% & R0%, L0% & R33%, L33% & R0%), symmetrical (L0% & R0%, L33% & R33%, L67% & R67%) and asymmetrical bilateral assistance (L33% & R67%, L67% & R33%), during bilateral isometric force-matching tasks. The results showed a similar muscular response of the two arms to bilateral assistive conditions, and the muscle activity of the arm that was being observed decreased only when the assistive force that applied on itself increased, indicating that both arms may have adopted similar but independent motor control mechanisms to acclimate to the bilateral assistive forces. Comparison between the two unilateral assistances (L0% & R33% and L33% & R0%) and the two asymmetrical bilateral assistances (L33% & R67%, L67% & R33%) showed no significant differences in muscular responses, CV and RPE, indicating that bilateral assistances with bilateral interchanged assistive levels may be equally effective regardless of which arm the higher assistive force is applied to. Comparison between unilateral and symmetrical assistive conditions that have similar overall workloads (L67% & R0%, L33% & R33%, L0% & R67%) showed a lower CV and RPE score at symmetrical assistance compared with unilateral assistance, suggesting that assisting both arms with the same level simultaneously improves task performances compared with applying the assistive force to only one arm.
    Electronic ISSN: 1932-6203
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  • 37
    Publication Date: 2021-01-07
    Description: The CX3CL1/CX3CR1 axis mediates recruitment and extravasation of CX3CR1-expressing subsets of leukocytes and plays a pivotal role in the inflammation-driven pathology of cardiovascular disease. The cardiac immune response differs depending on the underlying causes. This suggests that for the development of successful immunomodulatory therapy in heart failure due to chronic pressure overload induced left ventricular (LV) hypertrophy, the underlying immune patterns must be examined. Here, the authors demonstrate that Fraktalkine-receptor CX3CR1 is a prerequisite for the development of cardiac hypertrophy and left ventricular dysfunction in a mouse model of transverse aortic constriction (TAC). The comparison of C57BL/6 mice with CX3CR1 deficient mice displayed reduced LV hypertrophy and preserved cardiac function in response to pressure overload in mice lacking CX3CR1. Moreover, the normal immune response following TAC induced pressure overload which is dominated by Ly6Clow macrophages changed to an early pro-inflammatory immune response driven by neutrophils, Ly6Chigh macrophages and altered cytokine expression pattern in CX3CR1 deficient mice. In this early inflammatory phase of LV hypertrophy Ly6Chigh monocytes infiltrated the heart in response to a C-C chemokine ligand 2 burst. CX3CR1 expression impacts the immune response in the development of LV hypertrophy and its absence has clear cardioprotective effects. Hence, suppression of CX3CR1 may be an important immunomodulatory therapeutic target to ameliorate pressure-overload induced heart failure.
    Electronic ISSN: 1932-6203
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  • 38
    Publication Date: 2021-01-07
    Description: Objectives Examine the effects of the COVID-19 pandemic on the mental health and loneliness in the general population. More specifically, the study focused on prevalence of anxiety and depression symptoms, the extent to which individuals with existing symptoms recovered or not, the prevalence of subtypes of loneliness, and the extent to which loneliness before and during this pandemic was associated with anxiety and depression symptoms. Methods Data was extracted from the longitudinal LISS panel, based on a probability sample of the Dutch population, with assessments on loneliness in October 2019 (T1) and June 2020 (T4), and anxiety and depression symptoms in November 2019 (T2), March 2020 (T3) and June 2020 (T4; Ntotal = 4,084). Loneliness was examined with the De Jong Gierveld Loneliness Scale and anxiety and depression symptoms with the Mental Health Inventory (MHI-5). Results Repeated measures multivariate logistic regression analyses (RMMLRA) showed a statistical significant lower prevalence of anxiety and depression symptoms after the outbreak (T4 = 15.3%) than before (T2 = 16.8%) and during the COVID-19 outbreak (T3 = 17.2%). According to the Reliable Change Index, the distribution of recovery categories (remission, improvement, unchanged and worsening symptoms) after the outbreak did not differ significantly from the distribution of these categories before the outbreak. RMMLRA revealed that the prevalence of emotional loneliness increased significantly after the outbreak (T1 = 18.4%, T4 = 24.8%). Among individuals who were not lonely before and after the outbreak the prevalence of symptoms decreased significantly (T2 = 7.0%, T4 = 4.4%) and, likewise, among those who were not lonely anymore after the outbreak (T2 = 21.5%, T4 = 14.5%). However, the prevalence of symptoms increased significantly among those who became lonely during the pandemic (T2 = 17.9%, T4 = 26.3%). Conclusions Findings suggest that this pandemic did not negatively affect the prevalence of anxiety and depression symptoms nor the normal recovery of symptoms among the general population during the first four months, but that emotional loneliness increased.
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  • 39
    Publication Date: 2021-01-07
    Electronic ISSN: 1932-6203
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  • 40
    Publication Date: 2021-01-07
    Description: Studies on sugar-sweetened beverage consumption patterns can help in the individual and population level management of chronic non-communicable diseases and other conditions. This study aimed to identify the association between health behavior patterns and the consumption of sugar-sweetened beverages among Brazilian adolescents from a nationally representative school-based study. A cross-sectional study analyzed data from 71,553 adolescents aged 12–17 years who attended public and private schools in Brazilian cities, from the Study of Cardiovascular Risk in Adolescents. Principal component analysis was performed to identify health behavior patterns, and ordered logistic regression was performed to identify the association between health behavior patterns and sugar-sweetened beverage consumption. Sugar-sweetened beverage consumption (mL/day) was used as the dependent variable. The analyses were performed using Stata software version 14.0 with a significance level of 0.05. Patterns 2 (alcoholic beverage and smoking habit) and 3 (ultra-processed food and screen time) of health behaviors and regularly purchasing snacks in the school cafeteria increased the odds of sugar-sweetened beverage consumption, while pattern 1 (water, unprocessed and minimally processed food and physical activity) decreased these odds. The adoption of healthy habits can indirectly stimulate the adoption of other habits beneficial to health. These results indicate the importance of adopting a set of regulatory measures to reduce sugar-sweetened beverage consumption.
    Electronic ISSN: 1932-6203
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  • 41
    Publication Date: 2021-01-07
    Description: The folds of the brain offer a particular challenge for the subarachnoid vascular grid. The primitive blood vessels that occupy this space, when the brain is flat, have to adapt to an everchanging geometry while constructing an efficient network. Surprisingly, the result is a non-redundant arterial system easily challenged by acute occlusions. Here, we generalize the optimal network building principles of a flat surface growing into a folded configuration and generate an ideal middle cerebral artery (MCA) configuration that can be directly compared with the normal brain anatomy. We then describe how the Sylvian fissure (the fold in which the MCA is buried) is formed during development and use our findings to account for the differences between the ideal and the actual shaping pattern of the MCA. Our results reveal that folding dynamics condition the development of arterial anastomosis yielding a network without loops and poor response to acute occlusions.
    Electronic ISSN: 1932-6203
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  • 42
    Publication Date: 2021-01-07
    Description: Characterizing the gut microbiota in terms of their capacity to interfere with drug metabolism is necessary to achieve drug efficacy and safety. Although examples of drug-microbiome interactions are well-documented, little has been reported about a computational pipeline for systematically identifying and characterizing bacterial enzymes that process particular classes of drugs. The goal of our study is to develop a computational approach that compiles drugs whose metabolism may be influenced by a particular class of microbial enzymes and that quantifies the variability in the collective level of those enzymes among individuals. The present paper describes this approach, with microbial β-glucuronidases as an example, which break down drug-glucuronide conjugates and reactivate the drugs or their metabolites. We identified 100 medications that may be metabolized by β-glucuronidases from the gut microbiome. These medications included morphine, estrogen, ibuprofen, midazolam, and their structural analogues. The analysis of metagenomic data available through the Sequence Read Archive (SRA) showed that the level of β-glucuronidase in the gut metagenomes was higher in males than in females, which provides a potential explanation for the sex-based differences in efficacy and toxicity for several drugs, reported in previous studies. Our analysis also showed that infant gut metagenomes at birth and 12 months of age have higher levels of β-glucuronidase than the metagenomes of their mothers and the implication of this observed variability was discussed in the context of breastfeeding as well as infant hyperbilirubinemia. Overall, despite important limitations discussed in this paper, our analysis provided useful insights on the role of the human gut metagenome in the variability in drug response among individuals. Importantly, this approach exploits drug and metagenome data available in public databases as well as open-source cheminformatics and bioinformatics tools to predict drug-metagenome interactions.
    Electronic ISSN: 1932-6203
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  • 43
    Publication Date: 2021-01-07
    Description: Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
    Electronic ISSN: 1932-6203
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  • 44
    Publication Date: 2021-01-07
    Description: Objectives Anti-IL-17/23 biologics are increasingly used to treat psoriasis. We aimed to elucidate characteristics of drug-induced interstitial pneumonia (DIIP) caused by anti-IL-17/23 biologics. Methods We retrospectively analyzed the clinical data of psoriasis patients treated with anti-IL-17/23 biologics. Chest CT was performed to evaluate DIIP. Serum KL-6 levels were measured before treatment (baseline) and during treatment. Results A total of 603 psoriasis patients were treated with anti-IL-17/23 biologics with mean follow-up of 21.1 months. Six patients developed DIIP at mean 14 months after initiation of the therapy. Older age, higher baseline KL-6 value and more frequent pre-existing IPs were associated with development of DIIP by univariate analysis. At the onset of DIIP, elevated serum KL-6 levels with concomitantly increased ground glass opacity (GGO) in Chest CT were demonstrated. DIIP was improved by only cessation of causative agents in five patients but steroid therapy was needed in one patient. Conclusions DIIP is a plausible complication of anti-IL-17/23 biologics. Age, baseline KL-6 level and underlying IP could be the risk factors for DIIP development. Serum KL-6 levels and chest CT are useful for not only predicting but also detecting DIIP caused by anti-IL-17/23 biologics.
    Electronic ISSN: 1932-6203
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  • 45
    Publication Date: 2021-01-07
    Description: Background Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined. Methods We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC). Results Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33μg/l [16–94] vs. 119μg/l [25–406]; p
    Electronic ISSN: 1932-6203
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  • 46
    Publication Date: 2021-01-07
    Description: With the rapid development of big data and artificial intelligence technology, computer-aided pulmonary nodule detection based on deep learning has achieved some successes. However, the sizes of pulmonary nodules vary greatly, and the pulmonary nodules have visual similarity with structures such as blood vessels and shadows around pulmonary nodules, which make the quick and accurate detection of pulmonary nodules in CT image still a challenging task. In this paper, we propose two kinds of 3D multi-scale deep convolution neural networks for nodule candidate detection and false positive reduction respectively. Among them, the nodule candidate detection network consists of two parts: 1) the backbone network part Res2SENet, which is used to extract multi-scale feature information of pulmonary nodules, it is composed of the multi-scale Res2Net modules of multiple available receptive fields at a granular level and the squeeze-and-excitation units; 2) the detection part, which uses a region proposal network structure to determine region candidates, and introduces context enhancement module and spatial attention module to improve detection performance. The false positive reduction network, also composed of the multi-scale Res2Net modules and the squeeze-and-excitation units, can further classify the nodule candidates generated by the nodule candidate detection network and screen out the ground truth positive nodules. Finally, the prediction probability generated by the nodule candidate detection network is weighted average with the prediction probability generated by the false positive reduction network to obtain the final results. The experimental results on the publicly available LUNA16 dataset showed that the proposed method has a superior ability to detect pulmonary nodules in CT images.
    Electronic ISSN: 1932-6203
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  • 47
    Publication Date: 2021-01-07
    Description: Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018). Main outcome measures We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates 〉1 demonstrate higher admission rates than expected and rates
    Electronic ISSN: 1932-6203
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  • 48
    Publication Date: 2021-01-04
    Description: The presented study evaluated effects of potassium nitrate (KNO3), ammonium nitrate (NH4 NO3) and ammonium chloride (NH4Cl) on the germination-related characteristics of 10 species from European dry acidic grasslands. Germination was studied under controlled laboratory conditions. The seeds were subjected to KNO3, NH4 NO3 and NH4Cl in four doses (1, 10, 50 and 100 mM) and to distilled water. Final germination percentage, index of germination velocity and index of germination synchrony were determined. Content of nitrogen in the soil probed from the site of seeds collection was also analyzed. Significant effects of type of the nitrogen compounds and their concentrations were observed. High concentrations of nitrogen-containing salts inhibited completion of germination in almost all species. Helichrysum arenarium and Hypericum perforatum showed preference for NH4+ over NO3‒, whereas Arnoseris minima, Alyssum montanum, Jasione montana and Spergula morisonii showed preference for NO3‒ over NH4+. Centaurea scabiosa, C. stoebe and Hypochaeris radicata had no preference and wide tolerance to the type of nitrogen-containing compound. Echium vulgare showed differential response hard for interpretation. A. montanum and J. montana showed stenotopic behavior in terms of nitrogen-related conditions. It is proposed that nitrogen-rich soil gaps favor establishment of more nitro-tolerant plant species (e.g. C. scabiosa, C. stoebe and H. radicata) as compared to nitrogen-poor ones.
    Electronic ISSN: 1932-6203
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  • 49
    Publication Date: 2021-01-04
    Description: The entomopathogenic fungus Metarhizium acridum in oil-based formulations (Green Muscle® (GM)) is a biopesticide for locust control lacking side-effects on biodiversity, unlike chemical insecticides. Under controlled conditions, GM-treated locusts and grasshoppers attract predators, a complementary advantage in locust control. We assessed avian predation on a population of desert locusts in northern Niger aerially sprayed operationally with GM with 107 g viable conidia ha-1. Populations of adult locusts and birds and vegetation greenness were assessed simultaneously along two transects from 12 days before until 23 days after treatment. Common kestrels Falco tinnunculus and lanners F. biarmicus were the predominant avian predators. Regurgitated pellets and prey remains were collected daily beneath “plucking posts” of kestrels. Locusts started dying five days post-spray and GM had its maximum effect one-two weeks after the spray, with 80% efficacy at day 21. After spraying, bird numbers increased significantly (P
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  • 50
    Publication Date: 2021-01-04
    Description: Introduction Taxes on sugar-sweetened beverages (SSBs) have gained support as a policy response to adverse health effects associated with SSB consumption. On July 1, 2017, Oakland, California, implemented a one-cent/ounce tax on SSBs with ≥25 calories/12 fluid ounces. This study estimated the long-term impact of the tax on taxed and untaxed beverage prices. Methods Data on 5,830 taxed and 5,146 untaxed beverage prices were obtained from 99 stores in Oakland and 111 stores in Sacramento (comparison site), California, in late May-June 2017 and June 2019. Linear regression difference-in-differences models were computed with store and product fixed effects, with robust standard errors clustered on store, weighted based on volume sold by beverage sweetener status, type, and size. Results Taxed beverage prices increased by 0.73 cents/ounce (95% CI = 0.47,1.00) on average in supermarkets and grocery stores in Oakland relative to Sacramento and 0.74 cents/ounce (95% CI = 0.39,1.09) in pharmacies, but did not change in convenience stores (-0.09 cents/ounce, 95% CI = -0.56,0.39). Untaxed beverage prices overall increased by 0.40 cents/ounce (95% CI = 0.05,0.75) in pharmacies but did not change in other store types. Prices of taxed individual-size soda specifically increased in all store types, by 0.91–2.39 cents/ounce (p
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  • 51
    Publication Date: 2021-01-04
    Description: Large amounts of effort have been invested in trying to understand how a single genome is able to specify the identity of hundreds of cell types. Inspired by some aspects of Caenorhabditis elegans biology, we implemented an in silico evolutionary strategy to produce gene regulatory networks (GRNs) that drive cell-specific gene expression patterns, mimicking the process of terminal cell differentiation. Dynamics of the gene regulatory networks are governed by a thermodynamic model of gene expression, which uses DNA sequences and transcription factor degenerate position weight matrixes as input. In a version of the model, we included chromatin accessibility. Experimentally, it has been determined that cell-specific and broadly expressed genes are regulated differently. In our in silico evolved GRNs, broadly expressed genes are regulated very redundantly and the architecture of their cis-regulatory modules is different, in accordance to what has been found in C. elegans and also in other systems. Finally, we found differences in topological positions in GRNs between these two classes of genes, which help to explain why broadly expressed genes are so resilient to mutations. Overall, our results offer an explanatory hypothesis on why broadly expressed genes are regulated so redundantly compared to cell-specific genes, which can be extrapolated to phenomena such as ChIP-seq HOT regions.
    Electronic ISSN: 1932-6203
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  • 52
    Publication Date: 2021-01-04
    Description: Dietary interventions such as intermittent fasting and the ketogenic diet have demonstrated neuroprotective effects in various models of neurological insult. However, there has been a lack of evaluation of these interventions from a surgical perspective despite their potential to augment reparative processes that occur following nerve injury. Thus, we sought to analyze the effects of these dietary regimens on nerve regeneration and repair by critical appraisal of the literature. Following PRISMA guidelines, a systematic review was performed to identify studies published between 1950 and 2020 that examined the impact of either the ketogenic diet or intermittent fasting on traumatic injuries to the spinal cord or peripheral nerves. Study characteristics and outcomes were analyzed for each included article. A total of 1,890 articles were reviewed, of which 11 studies met inclusion criteria. Each of these articles was then assessed based on a variety of qualitative parameters, including type of injury, diet composition, timing, duration, and outcome. In total, seven articles examined the ketogenic diet, while four examined intermittent fasting. Only three studies examined peripheral nerves. Neuroprotective effects manifested as either improved histological or functional benefits in most of the included studies. Overall, we conclude that intermittent fasting and the ketogenic diet may promote neuroprotection and facilitate the regeneration and repair of nerve fibers following injury; however, lack of consistency between the studies in terms of animal models, diet compositions, and timing of dietary interventions preclude synthesis of their outcomes as a whole.
    Electronic ISSN: 1932-6203
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  • 53
    Publication Date: 2021-01-04
    Description: People experience a healthy energy gained from the environment and an inner feeling, called the Qi experience. The flow experience has been a popular topic in Western studies, especially within the fields of psychology and health, and in all kinds of activities. Our current study used quantitative and qualitative methods to analyze the relationship between the Qi experience and the flow experience. After collecting data using open-ended questions, we integrated and connected the Qi experience into five orientations: (1) the feeling of Qi; (2) the mind; (3) Qi and consciousness; (4) physical, mental, and spiritual benefits; and (5) the feeling of Tao. The results revealed a high level of consistency between the flow experience and the Qi experience (r = 0.90, p
    Electronic ISSN: 1932-6203
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  • 54
    Publication Date: 2021-01-04
    Description: Fluoride pollution in water has attracted widespread concern worldwide. In this study, an Artemia eggshell-zirconium (Aes-Z) nanocomposite has been used for fluoride removal. Material characterization results showed that nano-ZrO2 was immobilized on the inner surface of the Artemia eggshell, and there was no pore blockage on the composite material. Various parameters influencing on the fluoride removal, including treatment time, composite dosage, pH, initial fluoride concentration, and other anions, were analyzed. The removal efficiency of the composite material was better than that of the single zirconia material. The removal percentage of fluoride reached 93% in 30 min with an initial fluoride concentration of 10 mg/L and a nanocomposite dosage of 8.0 g/L. The composite material had a high removal efficiency for fluoride in the pH region 4.0–10.0. The adsorption of fluoride was not influenced by the common anions (e.g., Cl-, SO42-, and NO3-) in water. The regeneration revealed that the Aes-Z composite material could be reused and remove fluoride effectively in four cycles. The pseudo-second-order rate model adequately represented the adsorption kinetics of the Aes-Z composite material. A possible, defluoridation mechanism of the Aes-Z composite material was also proposed. This study demonstrates that Aes-Z is a promising adsorbent material for fluoride removal.
    Electronic ISSN: 1932-6203
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  • 55
    Publication Date: 2021-01-05
    Description: Coronavirus disease 2019 (COVID-19) is a highly contagious illness that spreads rapidly through human-to-human transmission. On March 5, the government of Palestine declared a state of emergency in order to curb the spread of the virus, a declaration that it extended for a fifth time on July 5th. The degree to which a population complies with corresponding safety measures is surely affected by the people’s knowledge, attitudes and practices (KAP) towards the disease. To explore this hypothesis, we gathered data from 1,731 Palestinians between April 19thand May 1st, 2020 through a KAP questionnaire. The participant pool represented a stratified sample of Palestinians living across a number of governorates in the Gaza Strip and the West Bank, with 36.5% from Gaza and (63.5%) from the West Bank. Gender was almost equally distributed within the sample with (51%) men respondents and (49%) women respondent. The questionnaire included 17 questions about participants’ knowledge and awareness of COVID–19, 17 questions regarding the safety measures they had taken in the wake of the outbreak and 3 questions asking them to assess the efficacy of the government’s response to the pandemic. Our data shows that 79% of the respondents have good awareness about transmission of the virus, 55.6% were knowledgeable of the symptoms exhibited by an infected individual, 81% were aware of the preventative measures and 82% demonstrated awareness of the risk groups. Most participants complied with preventative measures (77%) and 62% the study participants agreed that stricter measures have to be enforced by the government to limit the spread of the virus. Our study revealed that younger participants and people with higher educational level demonstrated more awareness of the virus. Also, Women were reported to be more aware of preventative measures and to have complied more with good practices. We report that residents of the West Bank have complied more with the right practices when compared to residents of Gaza. Based on the results of this study, we conclude that health education programs aimed at improving the public’s understanding of COVID-19 are important in helping the population maintain appropriate practices and should be target people with lower educational level, and that findings such as those discussed in this report may provide valuable feedback to lawmakers working to stop the spread of the virus.
    Electronic ISSN: 1932-6203
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  • 56
    Publication Date: 2021-01-05
    Description: Background Despite the joy of parenting, the burden of daily caregiving for children with autism spectrum disorders (ASD) can be overwhelming and constant. Parents can expect to provide enduring care for their children with ASD. Given that the majority of individuals with autism spectrum disorders (ASD) remain in their family homes well into adulthood, often the need for assistance with activities of daily living (ADLs) is placed on parents. Providing ongoing support to adult children who have difficulty with completing ADLs can increase parental caregiving demands. Therefore, the purpose of this study was to examine the relationship between the ability of adults with ASD to perform ADLs with parental perceptions of caregiver burden. Methods Quantitative analysis of cross-sectional multi-state data gathered electronically using Qualtrics from 320 aging parents of adults with ASD was conducted. Regression models were fit to examine the association of ADL challenges with total caregiver burden and its four domains (emotional, financial, time dependence, and developmental). Results Parental perceptions of caregiver burden decreased, particularly time dependence and developmental burden, when adult children were less dependent in ADLs, even after adjusting for parental health and behavioral challenges. Conclusions Findings support the need for family-centered interventions to improve the capacity of adults with ASD to perform ADLs independently.
    Electronic ISSN: 1932-6203
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  • 57
    Publication Date: 2021-01-05
    Description: Introduction While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19. Methods All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0–8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1–8 being positive. The patients’ initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0–4 and 5–8 being used to assess association with clinical outcomes. Results A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5–8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136–1.616]) and highest CXR-SS (1.390 [1.143–1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5–8 (2.532 [1.109–5.782]) and highest CXR-SS 5–8 (3.386 [1.405–8.159]). Lastly, age (1.060 [1.009–1.113]), initial CXR-SS (1.278 [1.010–1.617]) and ICU-Int (5.047 [1.731–14.710]), were found to be independent predictors of mortality in our patients. Conclusion In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.
    Electronic ISSN: 1932-6203
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  • 58
    Publication Date: 2021-01-06
    Description: Surveillance of infectious diseases in livestock is traditionally carried out at the farms, which are the typical units of epidemiological investigations and interventions. In Central and Western Europe, high-quality, long-term time series of animal transports have become available and this opens the possibility to new approaches like sentinel surveillance. By comparing a sentinel surveillance scheme based on markets to one based on farms, the primary aim of this paper is to identify the smallest set of sentinel holdings that would reliably and timely detect emergent disease outbreaks in Swiss cattle. Using a data-driven approach, we simulate the spread of infectious diseases according to the reported or available daily cattle transport data in Switzerland over a four year period. Investigating the efficiency of surveillance at either market or farm level, we find that the most efficient early warning surveillance system [the smallest set of sentinels that timely and reliably detect outbreaks (small outbreaks at detection, short detection delays)] would be based on the former, rather than the latter. We show that a detection probability of 86% can be achieved by monitoring all 137 markets in the network. Additional 250 farm sentinels—selected according to their risk—need to be placed under surveillance so that the probability of first hitting one of these farm sentinels is at least as high as the probability of first hitting a market. Combining all markets and 1000 farms with highest risk of infection, these two levels together will lead to a detection probability of 99%. We conclude that the design of animal surveillance systems greatly benefits from the use of the existing abundant and detailed animal transport data especially in the case of highly dynamic cattle transport networks. Sentinel surveillance approaches can be tailored to complement existing farm risk-based and syndromic surveillance approaches.
    Electronic ISSN: 1932-6203
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  • 59
    Publication Date: 2021-01-06
    Description: Intrinsically disordered regions (IDRs) are prevalent in the eukaryotic proteome. Common functional roles of IDRs include forming flexible linkers or undergoing allosteric folding-upon-binding. Recent studies have suggested an additional functional role for IDRs: generating steric pressure on the plasma membrane during endocytosis, via molecular crowding. However, in order to accomplish useful functions, such crowding needs to be regulated in space (e.g., endocytic hotspots) and time (e.g., during vesicle formation). In this work, we explore binding-induced regulation of IDR steric volume. We simulate the IDRs of two proteins from Clathrin-mediated endocytosis (CME) to see if their conformational spaces are regulated via binding-induced expansion. Using Monte-Carlo computational modeling of excluded volumes, we generate large conformational ensembles (3 million) for the IDRs of Epsin and Eps15 and dock the conformers to the alpha subunit of Adaptor Protein 2 (AP2α), their CME binding partner. Our results show that as more molecules of AP2α are bound, the Epsin-derived ensemble shows a significant increase in global dimensions, measured as the radius of Gyration (RG) and the end-to-end distance (EED). Unlike Epsin, Eps15-derived conformers that permit AP2α binding at one motif were found to be more likely to accommodate binding of AP2α at other motifs, suggesting a tendency toward co-accessibility of binding motifs. Co-accessibility was not observed for any pair of binding motifs in Epsin. Thus, we speculate that the disordered regions of Epsin and Eps15 perform different roles during CME, with accessibility in Eps15 allowing it to act as a recruiter of AP2α molecules, while binding-induced expansion of the Epsin disordered region could impose steric pressure and remodel the plasma membrane during vesicle formation.
    Print ISSN: 1553-734X
    Electronic ISSN: 1553-7358
    Topics: Biology , Computer Science
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  • 60
    Publication Date: 2021-01-06
    Description: The participation of automated software agents known as social bots within online social network (OSN) engagements continues to grow at an immense pace. Choruses of concern speculate as to the impact social bots have within online communications as evidence shows that an increasing number of individuals are turning to OSNs as a primary source for information. This automated interaction proliferation within OSNs has led to the emergence of social bot detection efforts to better understand the extent and behavior of social bots. While rapidly evolving and continually improving, current social bot detection efforts are quite varied in their design and performance characteristics. Therefore, social bot research efforts that rely upon only a single bot detection source will produce very limited results. Our study expands beyond the limitation of current social bot detection research by introducing an ensemble bot detection coverage framework that harnesses the power of multiple detection sources to detect a wider variety of bots within a given OSN corpus of Twitter data. To test this framework, we focused on identifying social bot activity within OSN interactions taking place on Twitter related to the 2018 U.S. Midterm Election by using three available bot detection sources. This approach clearly showed that minimal overlap existed between the bot accounts detected within the same tweet corpus. Our findings suggest that social bot research efforts must incorporate multiple detection sources to account for the variety of social bots operating in OSNs, while incorporating improved or new detection methods to keep pace with the constant evolution of bot complexity.
    Electronic ISSN: 1932-6203
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  • 61
    Publication Date: 2021-01-06
    Description: Bipartite projections are used in a wide range of network contexts including politics (bill co-sponsorship), genetics (gene co-expression), economics (executive board co-membership), and innovation (patent co-authorship). However, because bipartite projections are always weighted graphs, which are inherently challenging to analyze and visualize, it is often useful to examine the ‘backbone,’ an unweighted subgraph containing only the most significant edges. In this paper, we introduce the R package backbone for extracting the backbone of weighted bipartite projections, and use bill sponsorship data from the 114th session of the United States Senate to demonstrate its functionality.
    Electronic ISSN: 1932-6203
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  • 62
    Publication Date: 2021-01-06
    Description: Under pressure, motor actions, such as those required in public speech, surgery, or musical performance, can be compromised, even when these have been well-trained. The latter is often referred to as 'choking' under pressure. Although multifaceted problems mediate such performance failure in anxiogenic situations, such as compromised motor dexterity and cognitive disruption, the fundamental set of abnormalities characterizing choking under pressure and how these abnormalities are related have not been elucidated. Here, we attempted, first, to classify behavioural, psychological, and physiological abnormalities associated with choking under pressure in musicians and, second, to identify their relationship based on datasets derived from a questionnaire with 258 pianist respondents. Explorative factor analysis demonstrated eight functional abnormalities related to the musicians' choking, such as attention to the audience, erroneous motor actions, perceptual confusion, and failure of memory recall, which however did not include exaggerated attention to the performance. This suggests distraction of attention away from skill execution, which may underlie the spoiled performance under pressure. A structural equation analysis further inferred causal relationships among them. For instance, while failure of memory recall was influenced by passive behaviours manifesting under pressure, erroneous motor actions during performance were influenced by feeling rushed and a loss of body control. In addition, some specific personal traits, such as neuroticism, public self-consciousness, and a lack of confidence, were associated with the extent to which pressure brought about these abnormalities. These findings suggest that distinct psycho-behavioural abnormalities and personal traits underlie the detrimental effects of pressure on musical performance.
    Electronic ISSN: 1932-6203
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    Publication Date: 2021-01-06
    Description: Objectives Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors. Design Scoping review. Search strategy Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis. Results Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8–40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended. Conclusions This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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    Publication Date: 2021-01-06
    Description: Based on a geocoded registry of more than four million residents of Santiago, Chile, we build two surname-based networks that reveal the city’s population structure. The first network is formed from paternal and maternal surname pairs. The second network is formed from the isonymic distances between the city’s neighborhoods. These networks uncover the city’s main ethnic groups and their spatial distribution. We match the networks to a socioeconomic index, and find that surnames of high socioeconomic status tend to cluster, be more diverse, and occupy a well-defined quarter of the city. The results are suggestive of a high degree of urban segregation in Santiago.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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    Publication Date: 2021-01-06
    Description: With COVID-19 N95 shortages, frontline medical personnel are forced to reuse this disposable–but sophisticated–multilayer respirator. Widely used to decontaminate nonporous surfaces, UV-C light has demonstrated germicidal efficacy on porous, non-planar N95 respirators when all surfaces receive ≥1.0 J/cm2 dose. Of utmost importance across disciplines, translation of empirical evidence to implementation relies upon UV-C measurements frequently confounded by radiometer complexities. To enable rigorous on-respirator measurements, we introduce a photochromic indicator dose quantification technique for: (1) UV-C treatment design and (2) in-process UV-C dose validation. While addressing outstanding indicator limitations of qualitative readout and insufficient dynamic range, our methodology establishes that color-changing dosimetry can achieve the necessary accuracy (〉90%), uncertainty (95%) required for UV-C dose measurements. In a measurement infeasible with radiometers, we observe a striking ~20× dose variation over N95s within one decontamination system. Furthermore, we adapt consumer electronics for accessible quantitative readout and use optical attenuators to extend indicator dynamic range 〉10× to quantify doses relevant for N95 decontamination. By transforming photochromic indicators into quantitative dosimeters, we illuminate critical considerations for both photochromic indicators themselves and UV-C decontamination processes.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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    Publication Date: 2021-01-06
    Description: The assessment and prediction of regional water quality are fundamental inputs to environmental planning and watershed ecological management. This paper explored spatiotemporal changes in the correlation of water quality parameters (WQPs) and land-use types (LUTs) in a reticular river network area. Water samples of 44 sampling sites were collected every quarter from 2016 to 2018 and evaluated for dissolved oxygen (DO), total phosphorus (TP), ammonia nitrogen (NH3-N), and permanganate index (CODMn). A redundancy analysis (RDA) and stepwise multiple linear regression (SMLR) were applied to analyze the land-use type impacts on seasonal WQPs at five buffer scales (100, 200, 500, 800, and 1000 m). The Kruskal–Wallis test results revealed significant seasonal differences in NH3-N, TP, CODMn, and DO. The area percentages of farmland, water area and built-up land in the study area were 38.96%, 22.75% and16.20%, respectively, for a combined total area percentage of nearly 80%. Our study showed that orchard land had an especially favorable influence on WQPs. Land-use type impacts on WQPs were more significant during the dry season than the wet season. The total variation explained by LUTs regarding WQPs at the 1 km buffer scale was slightly stronger than at smaller buffer scales. Built-up land had a negative effect on WQPs, but orchard and forest-grassland had a positive effect on WQPs. The effects of water area and farmland on WQPs were complex on different buffer scales. These findings are helpful for improving regional water resource management and environmental planning.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 68
    Publication Date: 2021-01-06
    Description: Learning transfer is widely present in the learning of all kinds of knowledge, skills and social norms, and is one of the important phenomena of learning, and the reasonable use of transfer is conducive to improving the learning effect of students and the quality of teaching. This study starts from the data of college students' academic performance, takes real students' academic performance as a sample, measures the relevance of courses through students' academic performance, constructs various networks of learning transfer, and studies the topology and evolution of the networks to clarify the essential laws of learning transfer and put forward suggestions for the optimization of teaching strategies. Finally, using complex network analysis to analyze and mine the data on college students' academic performance, the article quantifies the overall structure of the courses and their hidden connections in a global and dynamic manner, and discovers the inheritance relationship between the courses, the clustering characteristics and the basic pattern of learning transfer. It also provides a platform for exploring the differences in the course structure of different majors and the learning transfer of male and female students.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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  • 69
    Publication Date: 2021-01-06
    Description: Objectives This study encompassed fall-related deaths, including those who died prior to medical care, that were admitted to multiple healthcare institutions, regardless of whether they died at home, in long-term care, or in hospice. The common element was that all deaths resulted directly or indirectly from injuries sustained during a fall, regardless of the temporal relationship. This comprehensive approach provides an unusual illustration of the clinical sequence of fall–related deaths. Understanding this pathway lays the groundwork for identification of gaps in healthcare needs. Design This is a retrospective study of 2014 fall-related deaths recorded by one medical examiner’s office (n = 511) within a larger dataset of all trauma related deaths (n = 1848). Decedent demographic characteristics and fall-related variables associated with the deaths were coded and described. Results Of those falling, 483 (94.5%) were from heights less than 10 feet and 394 (77.1%) were aged 65+. The largest proportion of deaths (n = 267, 52.3%) occurred post-discharge from an acute care setting. Of those who had a documented prior fall, 216 (42.3%) had a history of one fall while 31 (6.1%) had ≥2 falls prior to their fatal incident. For the 267 post-acute care deaths, 440 healthcare admissions were involved in their care. Of 267 deaths occurring post-acute care, 129 (48.3%) were readmitted within 30 days. Preventability, defined as opportunities for improvement in care that may have influenced the outcome, was assessed. Of the 1848 trauma deaths, 511 (27.7%) were due to falls of which 361 (70.6%) were determined to be preventable or potentially preventable. Conclusion Our data show that readmissions and repeated falls are frequent events in the clinical sequence of fall fatalities. Efforts to prevent fall-related readmissions should be a top priority for improving fall outcomes and increasing the quality of life among those at risk of falling.
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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    Publication Date: 2021-01-06
    Electronic ISSN: 1932-6203
    Topics: Medicine , Natural Sciences in General
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