Physical Activity Behavior Before, During, and After COVID-19 Restrictions: Longitudinal Smartphone-Tracking Study of Adults in the United Kingdom

BACKGROUND

The COVID-19 pandemic led to the implementation of worldwide restrictive measures to reduce social contact and viral spread. These measures have been reported to have a negative effect on physical activity (PA). Studies of PA during the pandemic have primarily used self-reported data. The single academic study that used tracked data did not report on demographics.

OBJECTIVE

This study aimed to explore patterns of smartphone-tracked activity before, during, and immediately after lockdown in the United Kingdom, and examine differences by sociodemographic characteristics and prior levels of PA.

METHODS

Tracked longitudinal weekly minutes of PA were captured using the BetterPoints smartphone app between January and June 2020. Data were plotted by week, demographics, and activity levels at baseline. Nonparametric tests of difference were used to assess mean and median weekly minutes of activity at significant points before and during the lockdown, and as the lockdown was eased. Changes over time by demographics (age, gender, Index of Multiple Deprivation, baseline activity levels) were examined using generalized estimating equations (GEEs).

RESULTS

There were 5395 users with a mean age of 41 years (SD 12) and 61% (n=3274) were female. At baseline, 26% (n=1422) of users were inactive, 23% (n=1240) were fairly active, and 51% (n=2733) were active. There was a relatively even spread across deprivation deciles (31% [n=1693] in the least deprived deciles and 23% in the most [n=1261]). We found significant changes in PA from the week before the first case of COVID-19 was announced (baseline) to the week that social distancing restrictions were relaxed (Friedman test: χ22=2331, P<.001). By the first full week of lockdown, the median change in PA was 57 minutes less than baseline. This represents a 37% reduction in weekly minutes of PA. Overall, 63% of people decreased their level of activity between baseline and the first week of COVID-19 restrictions. Younger people showed more PA before lockdown but the least PA after lockdown. In contrast, those aged >65 years appeared to remain more active throughout and increased their activity levels as soon as lockdown was eased. Levels of PA among those classed as active at baseline showed a larger drop compared with those considered to be fairly active or inactive. Socioeconomic group and gender did not appear to be associated with changes in PA.

CONCLUSIONS

Our tracked PA data suggests a significant drop in PA during the United Kingdom's COVID-19 lockdown. Significant differences by age group and prior PA levels suggests that the government's response to COVID-19 needs to be sensitive to these individual differences and the government should react accordingly. Specifically, it should consider the impact on younger age groups, encourage everyone to increase their PA, and not assume that people will recover prior levels of PA on their own.

Continuous and Patterned Conducting Polymer Coatings on Diverse Substrates: Rapid Fabrication by Oxidant-Intermediated Surface Polymerization and Application in Flexible Devices

Conducting polymer coatings and patterns are the most important forms of these materials for many practical applications, but a simple and efficient approach to these forms remains challenging. Herein, we report a universal oxidant-intermediated surface polymerization (OISP) for the fabrication of conducting polymer coatings and patterns on various substrates. A coating or pattern composed of densely packed colloidal V₂O₅·nH₂O nanowires is deposited on the substrate via spin coating, dip coating, or printing, which is converted into a conducting polymer one after in situ oxidation polymerization. The polymerization occurs selectively on the V₂O₅·nH₂O coatings, and high-quality polypyrrole, polyaniline, and poly(3,4-ethylenedioxythiophene) coatings and patterns on planar and curved polymeric, metallic, and ceramic substrates are obtained in a fast reaction rate similar to the electrochemical polymerization. The mechanistic study reveals that the method relies on the excellent processability and formability of V₂O₅·nH₂O nanowires, which is further explained by their large aspect ratio and surface activity. A flexible gas sensor array comprising three individual sensors made of different conducting polymers is fabricated using oxidant-intermediated surface polymerization, and it is successfully used to distinguish various analyte vapors. The method developed here will provide a powerful tool for the fabrication of conducting polymer-based devices.

Analyzing Femorotibial Cartilage Thickness Using Anatomically Standardized Maps: Reproducibility and Reference Data

Alterations in cartilage thickness (CTh) are a hallmark of knee osteoarthritis, which remain difficult to characterize at high resolution, even with modern magnetic resonance imaging (MRI), due to a paucity of standardization tools. This study aimed to assess a computational anatomy method producing standardized two-dimensional femorotibial CTh maps. The method was assessed with twenty knees, processed following three common experimental scenarios. Cartilage thickness maps were obtained for the femorotibial cartilages by reconstructing bone and cartilage mesh models in tree-dimension, calculating three-dimensional CTh maps, and anatomically standardizing the maps. The intra-operator accuracy (median (interquartile range, IQR) of -0.006 (0.045) mm), precision (0.152 (0.070) mm), entropy (7.02 (0.71) and agreement (0.975 (0.020))) results suggested that the method is adequate to capture the spatial variations in CTh and compare knees at varying osteoarthritis stages. The lower inter-operator precision (0.496 (0.132) mm) and agreement (0.808 (0.108)) indicate a possible loss of sensitivity to detect differences in a setting with multiple operators. The results confirmed the promising potential of anatomically standardized maps, with the lower inter-operator reproducibility stressing the need to coordinate operators. This study also provided essential reference data and indications for future research using CTh maps.

Prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients

Self-medication is common with dermatology patients. Yet, studies on this phenomenon are few. The pattern and reasons for self-medication are not clear. The objective of this study was to document the prevalence, pattern, source of drug information, and reasons for self-medication among dermatology patients. This was a prospective cross-sectional study of 468 adult dermatology patients over a 9-month period. A self-administered questionnaire was administered to all new patients to the dermatology outpatient clinic. The questionnaire had questions on sociodemographic data, self-medication, what specifically was used by the patients, source of information, and reasons for self-medication. Data were analyzed using the SPSS 22.0. Statistics such as means, medians, and frequencies. t test and chi-square test are presented. The mean age of the patients was 37.9 ± 16.3. The prevalence of self-medication was 63.7%. The pattern of self-medication was herbal only in 11.7%, western medication only in 45.6%, and western and herbal in 42.6%. Reason for self-medication was easy accessibility in 54%, difficulty seeing a doctor in 16.8%, and difficulty accessing medical care in 13.8%. Source of drug information was Pharmacist in 46.3% and friend in 26.5%. Self-medication was significant in males and in those with inflammatory diseases. Self-medication was common and this was due to ready accessibility of drugs and poor access to doctors. Self-medication was common in males and in those who have inflammatory diseases. The pattern of self-medication was dependent on age and the level of education. Source of information on drugs was pharmacists, friends, and family.

Exploring the Pattern Associated With Longitudinal Changes of β-Amyloid Deposition During Cognitively Normal Healthy Aging

The aim of this study was to determine a pattern associated with longitudinal changes of β-amyloid (Aβ) deposition during cognitively normal(CN) healthy aging. We used ¹⁸F-florbetapir (AV-45) PET images of the brains of 207 cognitively normal subjects (CN1), obtained through the Alzheimer's Disease Neuroimaging Initiative (ADNI), to identify the healthy aging pattern and 76 cognitively normal healthy subjects (CN2), obtained through the Xuanwu Hospital of Capital Medical University, Beijing, China, to verify it. A voxel-based correlation analysis of standardized uptake value ratio (SUVR) map image and age was conducted using the DPABI (Data Processing & Analysis of Brain Imaging) software to identify the pattern. The sum of squares due to errors (SSE), R-square (R²) and the root-mean-square error (RMSE) were calculated to assess the quality of curve fitting. Among them, R² was proposed as the coherence coefficient, which was as an index to assess the correlation between SUVR value of the pattern and subjects' age. The pattern characterized by age-associated longitudinal changes of Aβ deposition was mainly distributed in the right middle and inferior temporal gyrus, the right temporal pole: middle temporal gyrus, the right inferior occipital gyrus, the right inferior frontal gyrus (triangular portion), and the right precentral gyrus. There were a significant positive correlation between the SUVR value of the pattern and age for each CN group (CN1: R² = 0.120, p < 0.001 for quadratic model; CN2: R² = 0.152, p = 0.002 for quadratic model). These findings suggest a pattern of changes in Aβ deposition that can be used to distinguish physiological changes from pathophysiological changes, constituting a new method for elucidating the neuropathological mechanism of Alzheimer's disease.

Does diet play a role in the prevention and management of depression among adolescents? A narrative review

BACKGROUND

Depression is one of the major causes of illness and disability, while suicide is the second leading cause of death amongst adolescents. Although many factors determine the mental health of an individual, diet has been gaining popularity as a key modifiable factor in the prevention and management of depression. Nutritional Psychiatry is an emerging field where researchers suggest that the food we consume influences our mental well-being.

AIM

This review aims to explore the significance of diet, nutrient deficiencies, imbalances, and unhealthy dietary patterns in the prevention and management of unipolar depression or major depressive disorder among adolescents.

METHODS

Electronic databases such as PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE were searched using keywords such as "mental health," "depression," "adolescents," "diet," "dietary pattern," and pertinent articles (N = 68) were retrieved and reviewed.

RESULTS

The Mediterranean and traditional diets rich in complex carbohydrates, omega-3 fatty acids, B-group vitamins and several amino acids have shown negative correlation with the incidence of depression. On the other hand, Western dietary patterns (sweetened beverages, processed/ junk food, and foods rich in saturated fatty acids), along with low consumption of fruits and vegetables have been linked to an increased risk of depression among adolescents.

CONCLUSION

Dietary modification can prove to be a cost-effective strategy for the prevention and treatment of depression among adolescents. Diet and nutrition need to be recognized as key modifiable targets for the prevention of mental disorders and nutritional medicine should be considered as an integral part of psychiatric treatment.

Clinical Profile of Pediatric Burn Patients in Burn Care Unit of Halibet Hospital in 2018: Asmara, Eritrea

Background

Pediatric burn injuries result in severe and long-term complications in the developing world, especially in sub-Saharan Africa. Accurate data on burn injuries are either unavailable or incomplete in Eritrea.

Objective

The objective of this study was to define the clinical characteristics of pediatric burn injuries in the Burn Care Unit of Halibet hospital in 2018 in Asmara, Eritrea.

Methods

The study design was a retrospective cross-sectional descriptive study. The medical records of pediatric patients aged 15 years and below admitted to the Burn Care Unit of Halibet hospital between January 2018 and December 2018 were assessed.

Results

In the study period, 524 children with burn injuries were admitted to the Unit. The mean age of the study group was 4.2±3.7 years. Nearly 75% of the patients were in the age group 1–5 years. In 95.3% of the patients, scalds were the most common type of burn with burn injury occurring mostly indoor in 98.1% of cases. The average length of hospital stay was 4.6±8.4 days with a median of 1 day. In 94.8% of the patients, the body surface area involved was 1–10%, and the most body part involved was the extremity in 80.7% of the cases. Patients with body surface involvement >10% and who came from rural areas stayed longer in hospital and those with scald burns have a shorter hospital stay. Patients with body surface area involvement >10% and who came from rural areas also have more complications.

Conclusion

The most affected age group were 1–5 years old children with scalds being the most common type of burns with injury occurring mostly indoors in this population. Teaching parents about household safety, seeking early medical attention, and raising public awareness could decrease the incidence of burn injury in children.

Modeling and Testing of Flexible Structures with Selected Planar Patterns Used in Biomedical Applications

Flexible structures (FS) are thin shells with a pattern of holes. The stiffness of the structure in the normal direction is reduced by the shape of gaps rather than by the choice of the material based on mechanical properties such as Young's modulus. This paper presents virtual prototyping of 3D printed flexible structures with selected planar patterns using laboratory testing and computer modeling. The objective of this work is to develop a non-linear computational model evaluating the structure's stiffness and its experimental verification; in addition, we aimed to identify the best of the proposed patterns with respect to its stiffness: load-bearing capacity ratio. Following validation, the validated computational model is used for a parametric study of selected patterns. Nylon-Polyamide 12-was chosen for the purposes of this study as an appropriate flexible material suitable for 3D printing. At the end of the work, a computational model of the selected structure with modeling of load-bearing capacity is presented. The obtained results can be used in the design of external biomedical applications such as orthoses, prostheses, cranial remoulding helmets padding, or a new type of adaptive cushions. This paper is an extension of the conference paper: "Modeling and Testing of 3D Printed Flexible Structures with Three-pointed Star Pattern Used in Biomedical Applications" by authors Repa et al.

Prevalence and patterns of multi-morbidity in the productive age group of 30-69 years: A cross-sectional study in Pathanamthitta District, Kerala

Background: Multi-morbidity is the coexistence of multiple chronic conditions in individuals. With advancing epidemiological and demographic transitions, the burden of multi-morbidity is expected to increase India.

Methods: A cross-sectional representative survey was conducted among 410 participants aged 30-69 years in Pathanamthitta District, Kerala to assess the prevalence of multi-morbidity. A multi-stage cluster sampling method was employed to identify households for the survey. We interviewed all eligible participants in the selected households. A structured interview schedule was used to assess socio-demographic variables, behavioral risk factors and prevailing clinical conditions. We used the PHQ-9 questionnaire for depression screening. Further, we conducted active measurements of both blood sugar and blood pressure. Multiple logistic regression was used to identify variables associated with multi-morbidity.

Results: Overall, the prevalence of multi-morbidity was 45.4% (95% CI: 40.5-50.3%). Nearly a quarter of the study participants (25.4%) reported only one chronic condition (21.3-29.9%). Further, 30.7% (26.3-35.5), 10.7% (7.9-14.2), 3.7% (2.1-6.0) and 0.2% reported two, three, four and five chronic conditions, respectively. At least one person with multi-morbidity was present in around seven out of ten households (72%, 95% CI: 65-78%). Further, one in five households (22%, 95% CI: 16.7-28.9%) reported more than one person with multi-morbidity. Diabetes and hypertension was the most frequent dyad (30.9%, 95% CI: 26.5-35.7%), followed by hypertension and depression (7.8%, 95% CI: 5.5-10.9%). Diabetes, hypertension and ischemic heart disease was the common triad in males (8.5%, 95% CI: 4.8-14.1%), while it was diabetes, hypertension and depression (6.9%, 95% CI: 4.2-11.1%) in females. Age, sex, and employment status were associated with multi-morbidity.

Conclusion: Multi-morbidity is prevalent in one of two participants in the productive age group of 30-69 years. Further, seven of ten households have at least one person with multi-morbidity. The high burden of multi-morbidity calls for integrated management strategies for multiple chronic conditions.

Prevalence and patterns of multi-morbidity in the productive age group of 30-69 years: A cross-sectional study in Pathanamthitta District, Kerala

Background: Multi-morbidity is the coexistence of multiple chronic conditions in individuals. With advancing epidemiological and demographic transitions, the burden of multi-morbidity is expected to increase India. Methods: A cross-sectional representative survey was conducted among 410 participants aged 30-69 years in Pathanamthitta District, Kerala to assess the prevalence of multi-morbidity. A multi-stage cluster sampling method was employed to identify households for the survey. We interviewed all eligible participants in the selected households. A structured interview schedule was used to assess socio-demographic variables, behavioral risk factors and prevailing clinical conditions. We used the PHQ-9 questionnaire for depression screening. Further, we conducted active measurements of both blood sugar and blood pressure. Multiple logistic regression was used to identify variables associated with multi-morbidity. Results: Overall, the prevalence of multi-morbidity was 45.4% (95% CI: 40.5-50.3%). Nearly a quarter of the study participants (25.4%) reported only one chronic condition (21.3-29.9%). Further, 30.7% (26.3-35.5), 10.7% (7.9-14.2), 3.7% (2.1-6.0) and 0.2% reported two, three, four and five chronic conditions, respectively. At least one person with multi-morbidity was present in around seven out of ten households (72%, 95% CI: 65-78%). Further, one in five households (22%, 95% CI: 16.7-28.9%) reported more than one person with multi-morbidity. Diabetes and hypertension was the most frequent dyad (30.9%, 95% CI: 26.5-35.7%), followed by hypertension and depression (7.8%, 95% CI: 5.5-10.9%). Diabetes, hypertension and ischemic heart disease was the common triad in males (8.5%, 95% CI: 4.8-14.1%), while it was diabetes, hypertension and depression (6.9%, 95% CI: 4.2-11.1%) in females. Age, sex, and employment status were associated with multi-morbidity. Conclusion: Multi-morbidity is prevalent in one of two participants in the productive age group of 30-69 years. Further, seven of ten households have at least one person with multi-morbidity. The high burden of multi-morbidity calls for integrated management strategies for multiple chronic conditions.

Asymmetrically Patterned Cellulose Nanofibers/Graphene Oxide Composite Film for Humidity Sensing and Moist-Induced Electricity Generation

The exploration of advanced functional materials from natural resources is significantly important to green and sustainable development. Herein, we design an ultrafast humidity-driven bending response system using asymmetrically patterned cellulose nanofiber (CNF)/graphene oxide (GO) composite films. The CNF/GO composite films are fabricated by vacuum-assisted filtration, followed by a surface imprinting technique. The results reveal that the composite films possess excellent linear response to humidity change and cycle stability in the relative humidity (RH) range from 25 to 85%. The curvature of the film varies from 0.012 to 0.260 cm^-1 as the RH changes from 25 to 85%, and the response time is only 3-5 s. The outstanding humidity response is attributed to the addition of GO that actively interacts with water, enhancing the flexibility and humidity sensitivity of the composite films. In addition, asymmetrical patterning improves the water transfer rate by confinement and renders an easy deformation of composite films under the same stress. Molecular dynamics simulation and finite element analysis are used to further elucidate the mechanism therein. Furthermore, this CNF/GO composite film is also an effective hygroelectric generator, with an output voltage as high as 286 mV. This smart CNF/GO film with responsive humidity-driven deformation shows potential applications as a biomimetic leaf, a proximity sensor, and a moisture-driven electricity generator. This work inspires a new approach of smart material design with nanocellulose and GO and promotes their further applications.

Posterior Displacement and Angulation of Displaced Lateral Clavicle Fractures: A 3-Dimensional Analysis

Background:

The management of lateral clavicle fractures is often challenging because of difficulties in identifying displacement patterns that indicate an unstable fracture.

Hypothesis:

The aim of this study was to evaluate displacement patterns through analysis using 3-dimensional (3D) rendering software for displaced lateral clavicle fractures. We hypothesized that most displaced lateral clavicle fractures would have posterior displacement and angulation as well as superior displacement of the medial fragment.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Radiographs of 37 displaced lateral clavicle fractures were imported into the 3D rendering software to reconstruct the fracture model. For the computational simulation of fracture reduction, the medial fragment was manipulated and returned into place using the software’s moving tools. Two corresponding points were marked between the medial and lateral fragments to measure 3D spatial location in the x-axis (shortening), y-axis (horizontal displacement), and z-axis (vertical displacement). The displacement angle on the cranial view was also measured based on the medial end of the clavicle.

Results:

There were 32 cases (86.5%) of superior displacement of the medial fragment (mean, 5.8 mm; range, –6.5 to 19.0 mm), 35 cases (94.6%) of posterior displacement of the medial fracture fragment (mean, 8.8 mm; range, –3.2 to 18.3 mm), and 23 cases (62.2%) of distraction of the fracture site (mean, 2.1 mm; range, –9.2 to 12.2 mm). All 37 patients revealed posterior angulation of the fracture site (mean, 8.9°; range, 2.2°-39.4°).

Conclusion:

Most displaced lateral clavicle fractures have posterior displacement and angulation as well as superior displacement of the medial fragment. Our results revealed that 3D evaluation of lateral clavicle fracture displacement patterns is useful for assessing fracture stability and making treatment decisions.

Disclosure of human immunodeficiency virus status to children: Pattern followed by parents and caregivers

Background

Disclosure of human immunodeficiency virus (HIV) status may be perceived as simply the process of revealing a person’s HIV status, whether positive or negative. Despite the emerging evidence of the benefits of disclosure, who, when and what to disclose to a HIV-infected child remains a challenge.

Aim

This article reports on the patterns of HIV status disclosure to the infected children by their parents and caregivers.

Setting

The study was conducted in the outpatient clinic of one referral hospital offering comprehensive HIV care in the Lubombo region, eSwatini.

Methods

A qualitative descriptive design was followed. Data were collected through semi-structured individual interviews with a purposive sample of 13 parents and caregivers whose children were on antiretroviral treatment and collecting treatment from the specific outpatient clinic. Audio recorded data were transcribed verbatim, thematic content analysis was done and used to organise and present the findings.

Results

Four themes that emerged in relation to the topic of patterns of disclosure were disclosure of HIV status as a process rather than an event, a proposed person to disclose the HIV status to the child, the appropriate age to disclose HIV status to a child and type and amount of information to give in relation to the HIV status. The proposed person to disclose the HIV status to the infected child was the parent or caregiver involved as the primary carer of the child. There was no agreeable appropriate age to disclose HIV status to an infected child and the type and amount of information to disclose varied with the individuals depending on what prompted disclosure.

Conclusion

Human immunodeficiency virus disclosure to children demands parents’ and caregivers’ participation and their knowledge of child development.

A Paradigm Shift in Nuclear Chromatin Interpretation: From Qualitative Intuitive Recognition to Quantitative Texture Analysis of Breast Cancer Cell Nuclei

Assessing the pattern of nuclear chromatin is essential for pathological investigations. However, the interpretation of nuclear pattern is subjective. In this study, we performed the texture analysis of nuclear chromatin in breast cancer samples to determine the nuclear pleomorphism score thereof. We used three different algorithms for extracting high‐level texture features: the gray‐level co‐occurrence matrix (GLCM), gray‐level run length matrix (GLRLM), and gray‐level size zone matrix (GLSZM). Using these algorithms, 12 GLCM, 11 GLRLM, and 16 GLSZM features were extracted from three scores of breast carcinoma (Scores 1–3). Classification accuracy was assessed using the support vector machine (SVM) and k‐nearest neighbor (KNN) classification models. Three features of GLCM, 11 of GLRLM, and 12 of GLSZM were consistent across the three nuclear pleomorphism scores of breast cancer. Comparing Scores 1 and 3, the GLSZM feature large zone high gray‐level emphasis showed the largest difference among breast cancer nuclear scores among all features of the three algorithms. The SVM and KNN classifiers showed favorable results for all three algorithms. A multiclass classification was performed to compare and distinguish between the scores of breast cancer. Texture features of nuclear chromatin can provide useful information for nuclear scoring. However, further validation of the correlations of histopathologic features, and standardization of the texture analysis process, are required to achieve better classification results. © 2021 The Authors. Cytometry Part A published by Wiley Periodicals LLC on behalf of International Society for Advancement of Cytometry.

Handover Patterns in the PACU: A Review of the Literature

PURPOSE

Currently, there is no standardized handover pattern for patients undergoing general anesthesia when being transferred to the postanesthesia care unit (PACU).

DESIGN

A review of the literature.

METHODS

In this study, a review of the literature was conducted to analyze the PACU handover status, factors for poor handover, and commonly used handover patterns.

FINDINGS

Important handover information was often omitted during the handover of PACU patients, and there were many factors influencing postoperative patient handover quality. This study analyzed and compared several commonly used handover patterns for patients. Among these, the Situation-Background-Assessment-Recommendation tool is relatively mature. However, there is currently no unified standardized patient handover pattern, and the validity and applicability of tools still need to be verified.

CONCLUSIONS

PACU is an important place for the recovery of surgical patients. Anesthesia providers need to provide PACU nurses with complete and comprehensive postoperative handover information. A standardized handover model for clinical nurses is needed to improve patient safety management and work efficiency.

What do you mean "functional" in ecology? Patterns versus processes

Use of the term "functional" trait has increased exponentially in ecology. Although accounting for numerous ecological questions, this concept raises several issues. We propose that the term "functional" could be misleading because (1) no rigorous criteria exist to identify "functional" traits and (2) it suggests that only some traits ("functional" ones) can inform our understanding of species functioning, whatever the scale or discipline. Hence, the concept of "functional" trait in ecology is starting to be challenged and it remains unclear why some traits should be considered functional, whereas other traits should not. We argue that the most used "functional" traits are meaningful because they reflect important differences between populations or species, based on synchronic comparisons, that is, irrespective of time (hereafter "pattern" traits). Hence, they are useful for identifying trade-offs and strategies across large numbers of observations, usually at rather coarse scales, and are most often used in analyses of "big data." However, given that many ecological processes occur across short time scales and narrow gradients of climate and resource availability, the efficacy of these traits to inform us about these ecological processes appears questionable. We show that trait measurements that take time explicitly into account (hereafter "process" traits) differ from pattern traits because they quantify the flows of material and energy within a given environment across a defined period of time. Although pattern traits and process traits are both functional, it is important to understand the differences between the approaches. Moreover, better accounting of ontogeny, life form, plasticity, and genetic variability is required to enhance the convergence between pattern and process approaches. This revised framework allows more explicit connections between trait ecology and other biological sciences. It should enhance the study of processes at all scales in order to investigate efficiently the adaptive responses of biological organisms to climate change.

Area-Selective Atomic Layer Deposition of Metal Oxides on DNA Nanostructures and Its Applications

We demonstrate area-selective atomic layer deposition (ALD) of oxides on DNA nanostructures. Area-selective ALD of Al₂O₃, TiO₂, and HfO₂ was successfully achieved on both 2D and 3D DNA nanostructures deposited on a polystyrene (PS) substrate. The resulting DNA-inorganic hybrid structure was used as a hard mask to achieve deep etching of a Si wafer for antireflection applications. ALD is a widely used process in coating and thin film deposition; our work points to a way to pattern oxide materials using DNA templates and to enhance the chemical/physical stability of DNA nanostructures for applications in surface engineering.

Prevalence and pattern of skin diseases in patients with diabetes mellitus at a tertiary hospital in Northern Nigeria

Background

Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients.

Aims

This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.

Materials and Methods

One hundred consecutive diabetic patients attending the clinic were included in the study.

Results

Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients.

Conclusion

Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.

Application of Stereolithography Based 3D Printing Technology in Investment Casting

Advanced methods for manufacturing high quality parts should be used to ensure the production of competitive products for the world market. Investment casting (IC) is a process where a wax pattern is used as a sacrificial pattern to manufacture high precision casting of solid metal parts. Rapid casting is in turn, a technique that eases the IC process by combining additive manufacturing (AM) technologies with IC. The use of AM technologies to create patterns for new industrial products is a unique opportunity to develop cost-effective methods for producing investment casting parts in a timely manner. Particularly, stereolithography (SLA) based AM is of interest due to its high dimensional accuracy and the smooth surface quality of the printed parts. From the first appearance of commercially available SLA printers in the market, it took a few decades until desktop SLA printers became available to consumers at a reasonable price. Therefore, the aim of this review paper is to analyze the state-of-the-art and applicability of SLA based 3D printing technology in IC manufacturing, as SLA based AM technologies have been gaining enormous popularity in recent times. Other AM techniques in IC are also reviewed for comparison. Moreover, the SLA process parameters, material properties, and current issues are discussed.

Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa, the Democratic Republic of Congo

AIM

To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa, Democratic Republic of Congo.

METHODS

Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa, the University Hospital of Kinshasa (UHK) and Saint Joseph Hospital (SJH), from January 2012 to December 2014. Demographics and diagnoses were retrieved and analyzed. Outcome measures were frequency and prevalence of retinal diseases, blindness and low vision.

RESULTS

A total of 40 965 patients aged 40y or older were examined during this period in both clinics. Of these, 1208 had retinal disease, giving a 3-year and an annual prevalence of 3% and 1%, respectively. Mean age was 61.7±10.7y, and 55.8% of the patients were males. Arterial hypertension (68.1%) and diabetes (43.3%) were the most common systemic comorbidities. Hypertensive retinopathy (41.8%), diabetic retinopathy (37.9%), age-related macular degeneration (AMD; 14.6%), and chorioretinitis and retinal vein occlusion (7.3% each) were the most common retinal diseases, with 3-year prevalence rates of 1.3%, 1.0%, 0.43%, and 0.21% respectively. Bilateral low vision and blindness were present in 26.8% and 8.4% of the patients at presentation. Major causes of low vision and blindness were diabetic retinopathy (14.8%), AMD (4.9%), retinal detachment (2.8%), and retinal vein occlusion (2.5%). The prevalence was significantly higher among males than females, and at the UHK than SJH.

CONCLUSION

Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa. They cause a significant proportion of low vision and blindness.

Pattern of Cardiac Diseases and Co-Existing Morbidities Among Newly Registered Cardiac Patients in an Adult Cardiac Referral Clinic of Hawassa University Comprehensive Specialized Hospital, Southern-Ethiopia

Background

Currently, cardiovascular diseases (CVDs) are rising in the world and require great concern because the consequences are not only morbidity and mortality, but also a high economic burden. However, the pattern of CVDs in Ethiopia is not well known. Therefore, this study aimed to describe CVD and co-existing morbidities among newly registered cardiac patients in Hawassa University Comprehensive Specialized Hospital.

Methods

A retrospective cross-sectional study was conducted from January 1 to December 31, 2016 among newly registered cardiac patients in an adult cardiac referral clinic. Records and cardiac referral clinic logbooks were used to collect relevant information using structured checklists.

Results

Of the total 310 records of cardiac patients, 236 were explored and included in the study, while the records of 74 patients were absent in the cards room when tracing and/or incomplete to assess cardiac pattern. Rheumatic heart disease (RHD) was the leading cardiac problem and diagnosed in 70 (29.7%) cases followed by non-ischemic cardiomyopathy (55, 23.3%), ischemic heart disease (41, 17.4%), hypertensive heart disease (29, 12.3%), and cor pulmonale (14, 5.9%). The mean age of RHD patients was 28.7 (±13.1) years. Eighty-two (35%) females and 23 (19.8%) males had RHD, while 69 (29.2%) females and 23 (19.8%) males had non-ischemic cardiomyopathy. The overall rate of mitral stenosis, mitral regurgitation, and aortic regurgitation among patients with RHD were 39 (55.7%), 48 (68.6%), and 26 (37.1%), respectively. Moreover, the overall coexisted morbidity was 81 (34.3%), with a high rate of hypertension alone at 44 (18.6%) followed by hypertension with diabetes at 11 (4.7%).

Conclusion

This study indicated that more than one-third of cardiac patients had at least one of the co-existing morbidities like hypertension, diabetes mellitus, asthma and other diseases. Therefore, careful diagnosis and management of cardiac patients plays an important role to minimize comorbidity-linked complications. Moreover, population-based studies are recommended for better representing and generalization.

Brain MRI Pattern Recognition in Neurodegeneration With Brain Iron Accumulation

Most neurodegeneration with brain iron accumulation (NBIA) disorders can be distinguished by identifying characteristic changes on magnetic resonance imaging (MRI) in combination with clinical findings. However, a significant number of patients with an NBIA disorder confirmed by genetic testing have MRI features that are atypical for their specific disease. The appearance of specific MRI patterns depends on the stage of the disease and the patient's age at evaluation. MRI interpretation can be challenging because of heterogeneously acquired MRI datasets, individual interpreter bias, and lack of quantitative data. Therefore, optimal acquisition and interpretation of MRI data are needed to better define MRI phenotypes in NBIA disorders. The stepwise approach outlined here may help to identify NBIA disorders and delineate the natural course of MRI-identified changes.

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

Background

Inpatient mortality is among regularly collected data in Key performance indicators in the Ethiopian healthcare system, and it is generally reported to the Federal Ministry of Health and is used as one of inpatient services quality indicators. This study was undertaken to identify the magnitude, causes and pattern of mortalities among patients who are admitted and treated in surgical wards in Saint Paul Hospital Millennium Medical College for a period of three years.

Methods

A retrospective review was done on all patients admitted and died in the Department of Surgery in St. Paul's Hospital Millennium Medical College from January 1, 2016–Dec 30, 2018.

Result

There were 10,259 admissions over three years and out of which there were 350 deaths between 2016–2018 making a crude mortality rate of 3.41 %. The commonest mode of admission was for emergency conditions, 195(62.7%). Out of emergency admissions, 139 mortalities were from general emergency surgery and 75 patients died from elective general surgery admissions. Eighty-four (26.9%) patients had comorbidity and the commonest comorbidity was anemia 21(25%). The commonest possible cause of death was multi-organ failure secondary to septic shock, 159(51%). Mortality rate patterns along the three years (2016, 2017, 2018) showed 3.34% (112/3360), 2.87% (102/3552) and 2.92% (98/3347) respectively.

Conclusion

The mortality rate of this study is much higher than global rates, but still there is a significant difference from other developing countries and also other researches in this country. Pattern of mortality did not show any difference across years of the study period.

Medication use among pregnant women at a secondary health institution: utilisation patterns and predictors of quantity

BACKGROUND

Despite the lack of adequate studies on the safety of drugs in pregnancy, surprisingly, available evidence shows that pregnant women still take large number of drugs.

OBJECTIVES

The study aim was to determine drug utilization pattern and predictors of number of medications used by pregnant women.

METHODS

This was a cross-sectional survey of 369 pregnant women attending a secondary health facility. Data were collected using interviewer-administered questionnaire. Descriptive and inferential statistics using the Chi-Square test were carried out with level of significance set at p<0.05.

RESULTS

Three hundred and sixty-nine women were interviewed. Their mean age was 27.7 years (SD± 4.78) and the mean number of pregnancies was 2.46 (SD± 1.34). On average, 2.62 medications were taken, with the lowest being 1 and the highest being 12 different medications during the course of pregnancy. Those who were on more than 2 medications were more likely to be older than 30 years, had lower education and with history of associated medical conditions. All participants were on one form of supplements or the other, nearly half had used antimalarials, 12.8%, 5.8% 2.4% were on antibiotics, anti-hypertensive and anti-retroviral medications respectively. All the medications prescribed were from category A, B, C, N, and none from category D and X.

CONCLUSION

Varieties of medications were used during the course of pregnancy among this population, however, most of these drugs were still within safety profile.

Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification

Cervical adenocarcinoma is a heterogenous group of tumours with various aetiologies, molecular drivers, morphologies, response to treatment and prognosis. It has become evident that human papillomavirus (HPV) infection does not drive all adenocarcinomas, and appropriate classification is critical for patient management, especially in the era of the HPV vaccine and HPV-only screening. Identified as one of the most important developments in gynaecological pathology during the past 50 years, the separation of cervical adenocarcinomas into HPV-associated (HPVA) and HPV-independent has resulted in a transformation of the classification system for cervical adenocarcinomas. HPVA has been traditionally subclassified by morphology, such as usual type (UEA), mucinous and villoglandular, etc. However, it has become evident that cell type-based histomorphological classification is not clinically meaningful, and the newly proposed International Endocervical Adenocarcinoma Criteria and Classification (IECC) is a necessary and relevant break from this prior system. Non-HPV-associated adenocarcinomas can be divided by their distinct morphology and molecular genomics with very different responses to standard therapies and potential for future targeted therapies. These include gastric-type, clear-cell, mesonephric and endometrioid adenocarcinomas. So-called 'serous' carcinomas of the cervix probably represent morphological variants of UEA or drop metastases from uterine or adnexal serous carcinomas, and the existence of true cervical serous carcinomas is in question. This review will discuss the advances since WHO 2014, and how HPV status, pattern of invasion as described by Silva and colleagues, histological features and molecular markers can be used to refine diagnosis and prognostication for patients with cervical adenocarcinoma.

Patterns and Predictors of Metastatic Spread to the Neck in Pediatric Thyroid Carcinoma

OBJECTIVE

Evaluate patterns and predictors of spread to the neck in pediatric metastatic differentiated thyroid carcinoma (DTC).

METHODS

Patients <18 years old undergoing thyroidectomy by a single surgeon from January 2015 to December 2019 were included. Neck sublevels were removed separately according to AJCC boundaries. Clinical outcomes included nerve injury, hypocalcemia, hematoma, and residual tumor.

RESULTS

Forty-eight children underwent thyroid surgery. Thirty (63%) were for malignancy, 27 (90%) of which were DTC. Nineteen (70%) patients with DTC underwent 24 neck dissections; 19 central plus lateral and 5 central alone. The female to male ratio increased from 1:1 to 3:1 with age. Two children with lateral neck involvement had sub-centimeter primaries. Patients requiring neck dissection were more likely to have 1) diffuse sclerosing or tall cell variant, 2) T3 or T4 disease, 3) genetic mutation, 4) lymphatic invasion, 5) extracapsular extension, 6) positive resection margin. Levels IIA (79%), III (89%), IV (84%), VI (100%) were most commonly involved. Levels IB (16%), IIB (16%), VB (16%) were also involved, often without involvement of adjacent levels. Permanent injuries included one unilateral recurrent laryngeal nerve, one mild marginal mandibular nerve and one mild accessory nerve. Hypocalcemia was highest following neck dissection for malignant disease. One patient was re-operated for a mediastinal node. Most patients with N1 disease received radioactive iodine. Most patients have no evidence or indeterminate disease on long-term follow-up.

CONCLUSION

Children with lateral nodal spread from DTC should be considered for neck dissection including Levels IB, IIA, IIB, III, IV, VB, bilateral VI.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E1002-E1009, 2021.

The patterns and management of fracture patients under COVID-19 outbreak in China

Background

Currently, the perioperative care of fracture patients is compromised due to the outbreak of COVID-19 in China and the world. This study aims to assess the clinical features of fracture patients at our hospital during the COVID-19 outbreak and formulate the medical steps to ensure the effective treatment of fracture patients with minimal risk of infection to healthcare workers.

Methods

One hundred twelve patients with different fractures that were admitted to the orthopedics department of our hospital from January 24 to March 9 in 2020 were reviewed. Data including age, gender, injury location, admission time, operation time, discharge time were compared with fracture patients from the same period in 2019

Results

Compared to the same period in 2019, there is a 42% decrease in the number of fracture patients in 2020. Specifically, the incidences of forearm, thigh, hand, and foot fractures have increased during the COVID-19 outbreak, while other parts are less affected. The time from injury to hospitalization, the surgery wait time and time of discharge after surgery for patients with hip fractures were 2.9±7.1, 2.0±1.7 and 7.7±4.0 days respectively in 2019, which changed to 2.0±5.0, 4.5±4.0 and 10.6±4.2 days in 2020. Following the orthopedic treatment regimen followed at our hospital, all patients had non-life-threatening limb fractures. Six patients were operated in a negative pressure room, and emergency screening was completed for six patients. No patients were positive for COVID-19, and all were discharged safely without infection or other serious complications.

Conclusions

Hip fractures are highly prevalent during this epidemic. However, mandatory screening delays surgery by more than 48 hours. The orthopedic department should prioritize screening of emergency patients to minimize the risk of infection among other patients and medical personnel.

Inhibitory control of active expiration by the Bötzinger complex in rats

KEY POINTS

Contraction of abdominal muscles at the end of expiration during metabolic challenges (such as hypercapnia and hypoxia) improves pulmonary ventilation. The emergence of this active expiratory pattern requires the recruitment of the expiratory oscillator located on the ventral surface of the medulla oblongata. Here we show that an inhibitory circuitry located in the Bötzinger complex is an important source of inhibitory drive to the expiratory oscillator. This circuitry, mediated by GABAergic and glycinergic synapses, provides expiratory inhibition that restrains the expiratory oscillator under resting condition and regulates the formation of abdominal expiratory activity during active expiration. By combining experimental and modelling approaches, we propose the organization and connections within the respiratory network that control the changes in the breathing pattern associated with elevated metabolic demand.

ABSTRACT

The expiratory neurons of the Bötzinger complex (BötC) provide inhibitory inputs to the respiratory network, which, during eupnoea, are critically important for respiratory phase transition and duration control. Here, we investigated how the BötC neurons interact with the expiratory oscillator located in the parafacial respiratory group (pFRG) and control the abdominal activity during active expiration. Using the decerebrated, arterially perfused in situ preparations of juvenile rats, we recorded the activity of expiratory neurons and performed pharmacological manipulations of the BötC and pFRG during hypercapnia or after the exposure to short-term sustained hypoxia - conditions that generate active expiration. The experimental data were integrated in a mathematical model to gain new insights into the inhibitory connectome within the respiratory central pattern generator. Our results indicate that the BötC neurons may establish mutual connections with the pFRG, providing expiratory inhibition during the first stage of expiration and receiving excitatory inputs during late expiration. Moreover, we found that application of GABAergic and glycinergic antagonists in the BötC caused opposing effects on abdominal expiratory activity, suggesting complex inhibitory circuitry within the BötC. Using mathematical modelling, we propose that the BötC network organization and its interactions with the pFRG restrain abdominal activity under resting conditions and contribute to abdominal expiratory pattern formation during active expiration observed during hypercapnia or after the exposure to short-term sustained hypoxia.

Soil transmitted helminth infections in Ghana: a ten year review

For more than a decade, intervention programs have been instituted in Ghana to combat soil transmitted helminth (STHs) infections. Knowledge of the trend of the infection in the country is needed for evaluation and modification of existing control programs to achieve national targets. The objective of this review is to examine the pattern of soil transmitted infections in Ghana between 2009-2018. We searched and reviewed published literature on soil transmitted helminths in Ghana in PubMed, Medline, Google Scholar and Institutional Repositories of Kwame Nkrumah University of Science and Technology, University of Ghana, University of Cape Coast, and University for Development Studies-Tamale. We observed paucity of research work on STHs in Ghana over the period of this review. Twenty-nine studies consisting of 24 published works in peer reviewed journals and five graduate theses were included in the study. Hookworm was the most prevalent of STHs recorded followed by roundworm, threadworm, and whipworm. Pinworm was very rarely reported. These infections were reported from different regions and ecological zones of the country and among children, pregnant women, farmers, food vendors, children in orphanage home and psychiatric institution. Although there is some downward trend over the period, soil transmitted helminths are still prevalent in Ghana. This is an indication of some hope of eventual control and elimination of these diseases in the country if control measures are optimised. Further research particularly population studies into soil transmitted helminths in Ghana is needed.

Prevalence and pattern of birth defects in the two tertiary hospitals in Enugu, South East Nigeria: A hospital-based observational study

BACKGROUND

Birth defects have medical, surgical and aesthetic consequences. The impact of birth defects is particularly severe in low-income countries where health-care resources are limited.

AIMS AND OBJECTIVES

The aim of this study was to determine the prevalence and types of birth defects in live newborns delivered at the two tertiary hospitals in Enugu, South East Nigeria.

MATERIALS AND METHODS

This was a hospital-based observational study carried out on neonates delivered in the maternity units of the University of Nigeria Teaching Hospital Ituku/Ozalla and Enugu State University Teaching Hospital Parklane, Enugu during the periods of January 2015 and December 2018. All the live-born babies born in the two hospitals during this period were recruited into the study. The neonates were examined by a paediatrician for the presence of birth defects. The birth defects were classified according to the system involved and also into major and minor.

RESULTS

During the study period, 9492 babies were born, of which 166 had birth defects, which gave a prevalence of 1.75%. The predominant system affected by birth defects was the musculoskeletal system (45.2%) followed by the central nervous system (34.9%), urogenital system (10.8%) and gastrointestinal tract (9%). 13 (7.8%) patients had their birth defects diagnosed prenatally during the maternal ultrasound scan. Fifteen (9%) and 13 (7.8%) mothers of the neonates who had birth defects were diabetics and hypertensives, respectively. Most of the neonates were delivered vaginally.

CONCLUSION

Birth defects are not uncommon. This study showed a prevalence of 1.75% in the two tertiary hospitals in Enugu, South East Nigeria. The most commonly affected system was the musculoskeletal system.

Seasonal Dynamics of Pelagic Mycoplanktonic Communities: Interplay of Taxon Abundance, Temporal Occurrence, and Biotic Interactions

Marine fungi are an important component of pelagic planktonic communities. However, it is not yet clear how individual fungal taxa are integrated in marine processes of the microbial loop and food webs. Most likely, biotic interactions play a major role in shaping the fungal community structure. Thus, the aim of our work was to identify possible biotic interactions of mycoplankton with phytoplankton and zooplankton groups and among fungi, and to investigate whether there is coherence between interactions and the dynamics, abundance and temporal occurrence of individual fungal OTUs. Marine surface water was sampled weekly over the course of 1 year, in the vicinity of the island of Helgoland in the German Bight (North Sea). The mycoplankton community was analyzed using 18S rRNA gene tag-sequencing and the identified dynamics were correlated to environmental data including phytoplankton, zooplankton, and abiotic factors. Finally, co-occurrence patterns of fungal taxa were detected with network analyses based on weighted topological overlaps (wTO). Of all abundant and persistent OTUs, 77% showed no biotic relations suggesting a saprotrophic lifestyle. Of all other fungal OTUs, nearly the half (44%) had at least one significant negative relationship, especially with zooplankton and other fungi, or to a lesser extent with phytoplankton. These findings suggest that mycoplankton OTUs are embedded into marine food web chains via highly complex and manifold relationships such as parasitism, predation, grazing, or allelopathy. Furthermore, about one third of all rare OTUs were part of a dense fungal co-occurrence network probably stabilizing the fungal community against environmental changes and acting as functional guilds or being involved in fungal cross-feeding. Placed in an ecological context, strong antagonistic relationships of the mycoplankton community with other components of the plankton suggest that: (i) there is a top-down control by fungi on zooplankton and phytoplankton; (ii) fungi serve as a food source for zooplankton and thereby transfer nutrients and organic material; (iii) the dynamics of fungi harmful to other plankton groups are controlled by antagonistic fungal taxa.

Parallel Processing of Sound Dynamics across Mouse Auditory Cortex via Spatially Patterned Thalamic Inputs and Distinct Areal Intracortical Circuits

Natural sounds have rich spectrotemporal dynamics. Spectral information is spatially represented in the auditory cortex (ACX) via large-scale maps. However, the representation of temporal information, e.g., sound offset, is unclear. We perform multiscale imaging of neuronal and thalamic activity evoked by sound onset and offset in awake mouse ACX. ACX areas differed in onset responses (On-Rs) and offset responses (Off-Rs). Most excitatory L2/3 neurons show either On-Rs or Off-Rs, and ACX areas are characterized by differing fractions of On and Off-R neurons. Somatostatin and parvalbumin interneurons show distinct temporal dynamics, potentially amplifying Off-Rs. Functional network analysis shows that ACX areas contain distinct parallel onset and offset networks. Thalamic (MGB) terminals show either On-Rs or Off-Rs, indicating a thalamic origin of On and Off-R pathways. Thus, ACX areas spatially represent temporal features, and this representation is created by spatial convergence and co-activation of distinct MGB inputs and is refined by specific intracortical connectivity.

[Pattern of ecological planting for Chinese materia medica based on regional distribution]

As an environment-friendly agriculture, ecological agriculture of Chinese materia medica(CMM) is being implemented in all parts of the country. Due to the stronger dependence on natural environmental conditions, ecological agriculture of CMM shows obvious regional differences in production practice. More mature CMM ecological planting patterns representative of each region were collected. It was found that common types of patterns in various regions of the country mainly included intercropping,intercropping,rotation planting mode, undergrowth planting mode, wild tending planting mode and landscape ecological planting mode. Based on the Construction Plan of National Dao-di Herbs Production Base(2018-2025) and Chinese Medicine Division, this paper systematically sorts out the pattern of ecological planting of CMM in the 8-avenue medicinal materials production areas according to the varieties and regions. The specific pattern of ecological planting of CMM included the ginseng undergrowth planting pattern in northeastern China, the bionics wild ecological planting of the Forsythia suspensa in northern China, the Fritillaria thunbergii-rice rotation in eastern China, the imitation wild planting pattern under the Polygonatum cyrtonema in central China, the planting pattern of the Fructus amomi under forest in southern China, the Ligusticum chuanxiong-rice rotation pattern in the Southwest, wild tending of Glycyrrhiza uralensis in the Northwest, and rhubarb imitation wild planting pattern in Qinghai-Tibet area. Finally, it is expected to provide reference for the screening and popularization of ecological planting patterns of other CMMs in various distribution areas.

Lumbar and thoracic kinematics during step-up: Comparison of three-dimensional angles between patients with chronic low back pain and asymptomatic individuals

While alterations in spinal kinematics have been repeatedly observed in patients with chronic low back pain (CLBP), their exact nature is still unknown. Specifically, there is a need for comprehensive assessments of multisegment spinal angles during daily-life activities. The purpose of this exploratory study was to characterize three-dimensional angles at the lower lumbar, upper lumbar, lower thoracic, and upper thoracic joints in CLBP patients and asymptomatic controls during stepping up with three different step heights. Spinal angles of 10 patients with nonspecific CLBP (six males; 38.7 ± 7.2 years old, 22.3 ± 1.6 kg/m² ) and 11 asymptomatic individuals (six males; 36.7 ± 5.4 years old, 22.9 ± 3.8 kg/m² ) were measured in a laboratory using a camera-based motion capture system. Seven out of the 12 angle curves had characteristic patterns, leading to the identification of 20 characteristic peaks. Comparing peak amplitudes between groups revealed statistically significantly smaller sagittal- and frontal-plane angles in the patient group at the upper lumbar joint with the two higher steps and at the lower lumbar joint with the higher step. Significantly reduced angles were also observed in sagittal plane at the upper thoracic joint with the two smaller steps. Moreover, a higher number of significant differences between groups was detected with the two higher steps than with the smallest step. In conclusion, this study showed the value of a comprehensive description of spinal angles during step-up tasks and provided insights into the alterations with CLBP. These preliminary results support prior research suggesting that CLBP rehabilitation should facilitate larger amplitudes of motion during functional activities.

Brain Functional and Structural Signatures in Parkinson's Disease

The aim of this study is to explore functional and structural properties of abnormal brain networks associated with Parkinson’s disease (PD). ¹⁸F-Fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) and T1-weighted magnetic resonance imaging from 20 patients with moderate-stage PD and 20 age-matched healthy controls were acquired to identify disease-related patterns in functional and structural networks. Dual-modal images from another prospective subject of 15 PD patients were used as the validation group. Scaled Subprofile Modeling based on principal component analysis method was applied to determine disease-related patterns in both modalities, and brain connectome analysis based on graph theory was applied to verify these patterns. The results showed that the expressions of the metabolic and structural patterns in PD patients were significantly higher than healthy controls (PD1-HC, p = 0.0039, p = 0.0058; PD2-HC, p < 0.001, p = 0.044). The metabolic pattern was characterized by relative increased metabolic activity in pallidothalamic, pons, putamen, and cerebellum, associated with metabolic decreased in parietal–occipital areas. The structural pattern was characterized by relative decreased gray matter (GM) volume in pons, transverse temporal gyrus, left cuneus, right superior occipital gyrus, and right superior parietal lobule, associated with preservation in GM volume in pallidum and putamen. In addition, both patterns were verified in the connectome analysis. The findings suggest that significant overlaps between metabolic and structural patterns provide new evidence for elucidating the neuropathological mechanisms of PD.

Patterns of Extrathoracic Metastases in Different Histological Types of Lung Cancer

Lung cancer is the leading cause of cancer-related deaths mainly attributable to metastasis, especially extrathoracic metastasis. This large-cohort research is aimed to explore metastatic profiles in different histological types of lung cancer, as well as to assess clinicopathological and survival significance of diverse metastatic lesions. Lung cancer cases were extracted and enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. χ²-tests were conducted to make comparisons of metastatic distribution among different histological types and odds ratios were calculated to analyze co-occurrence relationships between different metastatic lesions. Kaplan–Meier methods were performed to analyze survival outcomes according to different metastatic sites and Cox regression models were conducted to identify independent prognostic factors. In total, we included 159,241 lung cancer cases with detailed metastatic status and complete follow-up information. In order to understand their metastatic patterns, we elucidated the following points in this research: (1) Comparing the frequencies of different metastatic lesions in different histological types. The frequency of bone metastasis was highest in adenocarcinoma, squamous cell carcinoma, LCLC and NSCLC/NOS, while liver was the most common metastatic site in SCLC. (2) Elaborating the tendency of combined metastases. Bi-site metastases occurred more common than tri-site and tetra-site metastases. And several metastatic sites, such as bone and liver, intended to co-metastasize preferentially. (3) Clarifying the prognostic significance of single-site and bi-site metastases. All single-site metastases were independent prognostic factors and co-metastases ended up with even worse survival outcomes. Thus, our findings would be beneficial for research design and clinical practice.

Multimorbidity among Two Million Adults in China

To explore the multimorbidity prevalence and patterns among middle-aged and older adults from China. Data on thirteen chronic diseases were collected from 2,097,150 participants aged over 45 years between January 1st 2011 and December 31st 2015 from Beijing Medical Claim Data for Employees. Association rule mining and hierarchical cluster analysis were applied to assess multimorbidity patterns. Multimorbidity prevalence was 51.6% and 81.3% in the middle-aged and older groups, respectively. The most prevalent disease pair was that of osteoarthritis and rheumatoid arthritis (OARA) with hypertension (HT) (middle-aged: 22.5%; older: 41.8%). Ischaemic heart disease (IHD), HT, and OARA constituted the most common triad combination (middle-aged: 11.0%; older: 31.2%). Among the middle-aged group, the strongest associations were found in a combination of cerebrovascular disease (CBD), OARA, and HT with IHD in males (lift = 3.49), and CBD, OARA, and COPD with IHD in females (lift = 3.24). Among older patients, glaucoma and cataracts in females (lift = 2.95), and IHD, OARA, and glaucoma combined with cataracts in males (lift = 2.45) were observed. Visual impairment clusters, a mixed cluster of OARA, IHD, COPD, and cardiometabolic clusters were detected. Multimorbidity is prevalent among middle-aged and older Chinese individuals. The observations of multimorbidity patterns have implications for improving preventive care and developing appropriate guidelines for morbidity treatment.

Health information technology use among older adults in the United States, 2009-2018

Objectives: The purpose of this study was to assess (1) the trends of and (2) the factors associated with health information technology (HIT) use among older adults in the U.S.Methods: A decade (2009-2018) of data from the U.S. National Health Interview Survey (NHIS) was used. The trends of HIT use among older adults (aged 65 over) were reported and compared to younger adults (aged 18-64) using weighted percentages adjusted by NHIS complex sampling design. HIT use, which was assessed with five questions asking whether respondents used the internet to (1) look up health information, (2) use chat groups to learn about health topics, (3) fill a prescription, (4) schedule medical appointments, and (5) communicate with health care providers by email. Andersen's Behavioral Model of Health Services Use was used to select and categorize the covariates. Multivariable logistic regression models were conducted to identify the predictors of HIT use.Results: The prevalence of HIT use significantly increased from 9.3 million (24.8% of the 37.3 million older adults) in 2009 to 22.3 million (43.9% of the 50.9 million older adults) in 2018 (p < .01). Among U.S. older adults, young-older, white females, higher education, higher income, insurance coverage, and good health status were more likely to report HIT use.Conclusions: This study found an increasing trend of HIT use among older adults in the U.S. from 2009 to 2018. Healthcare providers should be conscious of older adults' increased HIT use patterns and guide them to proper health management.

A database for inventory of proteoform profiles: "2DE-pattern"

The human proteome is composed of a diverse and heterogeneous range of gene products/proteoforms/protein species. Because of the growing amount of information about proteoforms generated by different methods, we need a convenient approach to make an inventory of the data. Here, we present a database of proteoforms that is based on information obtained by separation of proteoforms using 2DE followed by shotgun ESI-LC-MS/MS. The database's principles and structure are described. The database is called "2DE-pattern" as it contains multiple isoform-centric patterns of proteoforms separated according to 2DE principles. The database can be freely used at http://2de-pattern.pnpi.nrcki.ru.

Shape and Orientation Controlled Hydrothermal Synthesis of Silicide and Metal Dichalcogenide on a Silicon Substrate

Shape-controlled MoS₂ has been grown directly on a silicon substrate, for the first time, with the use of a facile hydrothermal synthesis approach. The growth morphology is dependent on the substrate orientation. Square, hexagonal, and triangular patterns of MoS₂ are grown on Si(100), Si(110), and Si(111), respectively. Detailed studies reveal that Mo silicide is formed at the initial stage, and the formation of silicide patterns is dictated by the different surface energies of Si(100), Si(110) and Si(111). Subsequently, shaped MoS₂ patterns are formed following the silicide ones at the thermodynamic equilibrium. The approach for the formation of these patterns can be generalized to other 2D materials and can also be formed on a large scale by a lithography method. The work has shown a new technique to form silicide via solution processing and grow patterned 2D materials directly on silicon substrates, which may have the potential for advancing next-generation electronic devices.

An intervention study to assess potential effect and user experience of an mHealth intervention to reduce sedentary behaviour among older office workers

BACKGROUND

Office workers spend a high percentage of their time sitting, often in long periods of time. Research suggests that it is healthier to break these long bouts into shorter periods by being physically active.

OBJECTIVE

We evaluated the effect of a context-aware activity coach, called the PEARL app, an mHealth intervention that provides activity suggestions, based on a physical activity prediction model, consisting of past and current physical activity and digital agendas.

METHOD

Fifteen office workers, aged 50+, participated in an intervention study in which they used the intervention for 1 week, preceded by a 1-week baseline period. Measurements were taken before and after the intervention period.

RESULTS

107 days of data from 14 participants were analysed. Total sedentary time was not reduced as a result of using the intervention (baseline vs intervention: 47.8±3.6 vs 46.8±3.0, n.s.). When using the intervention, participants reduced their total time spent in long sitting bouts (≥45 min) from 19.3 to 14.4 min per hour of wear time (p<0.05). Participants indicated that the main value of the intervention lies in creating awareness about their personal sedentary behaviour pattern.

CONCLUSION

An mHealth service has the potential to improve the sedentary behaviour of older office workers, especially for breaking up long sedentary periods. Focusing on total sedentary time as an outcome of an intervention, aimed at reducing sedentary behaviour, is too simplistic. One should take into account both the duration and the number of bouts when determining the effect.

Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel

This study aimed to identify the prevalence and patterns of multimorbidity among Korean adults. A descriptive study design was used. Of 11,232 adults aged 18 and older extracted from the 2014 Korean Health Panel Survey, 7118 had one or more chronic conditions. The chronic conditions code uses the Korean Standard Classification of Diseases. Association rule analysis and network analysis were conducted to identify patterns of multimorbidity among 4922 participants with multimorbidity. The prevalence of multimorbidity in the overall population was 34.8%, with a higher prevalence among women (40.8%) than men (28.6%). Hypertension had the highest prevalence in both men and women. In men, diabetes mellitus and hypertension yielded the highest probability of comorbidity (10.04%). In women, polyarthrosis and hypertension yielded the highest probability of comorbidity (12.51%). The results of the network analysis in four groups divided according to gender and age showed different characteristics for each group. Public health practitioners should adopt an integrated approach to manage multimorbidity rather than an individual disease-specific approach, along with different strategies according to age and gender groups.

Micro-Pattern of Graphene Oxide Films Using Metal Bonding

Recently, graphene has been explored in several research areas according to its outstanding combination of mechanical and electrical features. The ability to fabricate micro-patterns of graphene facilitates its integration in emerging technologies such as flexible electronics. This work reports a novel micro-pattern approach of graphene oxide (GO) film on a polymer substrate using metal bonding. It is shown that adding ethanol to the GO aqueous dispersion enhances substantially the uniformity of GO thin film deposition, which is a great asset for mass production. On the other hand, the presence of ethanol in the GO solution hinders the fabrication of patterned GO films using the standard lift-off process. To overcome this, the fabrication process provided in this work takes advantage of the chemical adhesion between the GO or reduced GO (rGO) and metal films. It is proved that the adhesion between the metal layer and GO or rGO is stronger than the adhesion between the latter and the polymer substrate (i.e., cyclic olefin copolymer used in this work). This causes the removal of the GO layer underneath the metal film during the lift-off process, leaving behind the desired GO or rGO micro-patterns. The feasibility and suitability of the proposed pattern technique is confirmed by fabricating the patterned electrodes inside a microfluidic device to manipulate living cells using dielectrophoresis. This work adds great value to micro-pattern GO and rGO thin films and has immense potential to achieve high yield production in emerging applications.

Dermoscopic Characterization of Dermatophytosis: A Preliminary Observation

Introduction:

Dermatophytosis has become resistant and relapsing infection in India. Diagnosis of dermatophytosis is easy, however, poses diagnostic challenge in partial treatment, steroid abuse. Dermoscopy is noninvasive tool for diagnosis of many infestations and infections. Dermoscopy in dermatophytosis is not well documented. We evaluated dermatoscopic patterns to correlate with histopathological changes.

Materials and Methods:

Study was conducted in tertiary hospital after obtaining ethical clearance and informed consent. DermLite 3 dermoscope was used to examine the lesions. Polarized and nonpolarized modes were used and ultrasound gel was utilized. Potassium hydroxide mount and skin biopsy was done to confirm the diagnosis.

Results:

About 30 patients with 16 males and 14 females were present. Median duration was 3.5 months and median age was 30 years. The most common site was waist and crural area affecting 20 (66.66%). Dermoscopy revealed brown to black dots, globules, and white scales in all patients (100.0%). Lesions of shorter duration (26.66%) demonstrated red dots, dotted vessels, reddish-brown dots, and globules, and brown to black dots and globules were noted in lesions of longer duration (73.33%). Hair changes were noted in five (16.66%) patients.

Conclusion:

Dermoscopy showed particular patterns in dermatophytosis. Patterns were consistent irrespective of age, sex, and site of involvement. Presence of reddish-brown and black globules with white scales was found to be the most characteristic dermoscopic feature.

Hypertensive Disorders in Pregnancy: Pattern and Obstetric Outcome in Bida, Nigeria

Context:

Cases of hypertensive disorders in pregnancy (HDP) are an increase in developing economies. Identifying the pattern of HDP in a particular community and documenting their management outcome may allow for proper planning by all stakeholders.

Aims:

The objective was to determine the pattern and management outcome of hypertensive disorders among pregnant women.

Settings and Design:

This was a prospective cohort study involving 183 consecutive cases of HDP at Federal Medical Centre, Bida, Niger State, Nigeria, between September 2015 and August 2016.

Subjects and Methods:

Pregnant women with hypertension were recruited and managed according to the departmental protocol. They were followed up till 6 weeks after delivery; fetal and maternal outcomes were documented.

Statistical Analysis Used:

Data were analyzed using the SPSS software version 23. The level of statistical significance was set at P < 0.05.

Results:

A total of 1956 deliveries occurred during the study with 183 cases of HDP, giving an incidence of 9.4%. Pregnancy-induced hypertension alongside preeclampsia constitutes the majority of HDP during the study and had accounted for over 64%. Women who did not receive antenatal care in our center were at significantly greater risk of eclampsia (P = 0.000), abruption placentae (P = 0.003), maternal death (P = 0.002), very low-birth-weight (LBW) babies (P = 0.002), extremely LBW babies (P = 0.03), and perinatal death (P = 0.000).

Conclusion:

The need for prenatal screening that enables the early identification and prompt management of all expectant mothers with HDP is advised.

Pattern of uveitis in a tertiary eye care center of central India: Results of a prospective patient database over a period of two years

Purpose

To identify the pattern of uveitis at a tertiary eye center in the central India and to compare with other reported studies.

Methods

This prospective observational study was undertaken with all new uveitis cases attending the uvea clinic between January 2016 and September 2017. A standard clinical protocol and detailed investigations were done to find out the specific cause of uveitis.

Results

A total of 210 patients with uveitis were evaluated. Anterior uveitis (47.1%) followed by intermediate uveitis (31.90%) were the most common type of uveitis in this study. Specific etiology of uveitis could be established in a majority of cases of uveitis (51.91%), except in intermediate uveitis group where the cause was mostly idiopathic (77.61%).

Conclusion

Tuberculosis (46.29%) and viral etiology (38.88%) were the most common forms of infective uveitis (25.71%), whereas spondyloarthropathy (27.27%) and traumatic cause (14.54%) were the most common in the noninfective group of uveitis (26.19%).

Correlations between Microbiota Bioactivity and Bioavailability of Functional Compounds: A Mini-Review

Numerous studies have demonstrated the role of the microbiota in supporting the physiological functions, owing to its metabolomic component. The presence of biocomponents generally leads to the correction of the microbial pattern correlated with the reduction of oxidative pressure. This study aims to present the main processes that correlate the bioavailability and bioactivity of some functional components through the action of the human microbiota. The use of probiotics and prebiotics is an innovative manner involving alternatives that increase the bioavailability of certain natural or metabolic components has been proposed. Probiotic strains (Saccharomyces cerevisiae or Lactobacillus (L.) plantarum) may represent an intermediary for increasing the antioxidant bioactivity, and they may be administered in the form of a biomass enriched with functional compounds, such as phenolic acids. The limiting effect of gastrointestinal transit is, in several cases, the key to the biopharmaceutical value of new products (or supplements). The identification of newer ways of formulating supplements also involves the compatibility of different types of products, the testing of bioaccessibility, and the elimination of biotransformations.

A Proposed Revision of the International Classification of Diseases, 11th Revision, Chapter 26

In 2019, the World Health Assembly approved the International Classification of Diseases, 11th Revision (ICD-11), which included a traditional medicine chapter. This means that traditional medicine (TM) is incorporated into the mainstream medicine of the world. For TM to contribute to human health, the role of ICD-11, chapter 26 (ICD-11-26), is important. Since the ICD-11-26 is “a union set of harmonized traditional medicine conditions of the Chinese, Japanese, and Korean classifications,” it is advisable to supplement the essential patterns while maintaining the already adopted patterns. The ICD-11-26 was originated from the World Health Organization International Standard Terminologies on Traditional Medicine in the Western Pacific Region (WHO-IST), and the WHO-IST is the world’s most authoritative TM standard terminology system with an emphasis on traditional and conventional expression. In addition, it includes patterns that are widely used in TM clinical practice and have representative prescriptions at the same time. Therefore, future revisions of ICD-11-26 should make WHO-IST the main reference. Based on this spirit, this proposed revision is a modification of ICD-11-26’s structure, order, and expression (English translation) with more essential patterns.

Facile Fabrication of Semiconducting Single-Walled Carbon Nanotubes Patterns on Flexible Substrate Based on a Photoimmobilization Technique

Single-walled carbon nanotubes (SWCNTs) have attracted significant attention due to their outstanding properties. For their wide applications in electronics and optoelectronics, pure semiconducting SWCNTs (s-SWCNTs) and their precise placement are preconditions. Recent advances have focused on developing effective strategies to separate s-SWCNTs from raw SWCNTs, a mixture of metallic and semiconducting nanotubes, and deposit s-SWCNTs on target substrates. Herein, a polyfluorene-based alternative copolymer (PFBP) containing the benzophenone group was employed. PFBP achieved higher yield for s-SWCNTs than the well-studied poly(9,9-dioctylfluorene) through solution process. Subsequently, the dispersed s-SWCNTs were immobilized on a flexible polyethylene terephthalate in a facile manner by the photoreactive benzophenone group upon exposure to UV irradiation, and chemically robust patterns were fabricated from micro to macro scales through photomasks. Our method accomplished by utilizing photoimmobilization is a simple cleaning procedure and an important step forward in pitch scaling for further applications of conjugated polymer wrapped s-SWCNTs.

Current Anticoagulant Usage Patterns and Determinants in Korean Patients with Nonvalvular Atrial Fibrillation

PURPOSE

Stroke prevention in patients with atrial fibrillation (AF) is influenced by many factors. Using a contemporary registry, we evaluated variables associated with the use of warfarin or direct oral anticoagulants (OACs).

MATERIALS AND METHODS

In the prospective multicenter CODE-AF registry, 10529 patients with AF were evaluated. Multivariate analyses were performed to identify variables associated with the use of anticoagulants.

RESULTS

The mean age of the patients was 66.9±14.4 years, and 64.9% were men. The mean CHA₂DS₂-VASc and HAS-BLED scores were 2.6±1.7 and 1.8±1.1, respectively. In patients with high stroke risk (CHA₂DS₂-VASc ≥2), OACs were used in 83.2%, including direct OAC in 68.8%. The most important factors for non-OAC treatment were end-stage renal disease [odds ratio (OR) 0.27; 95% confidence interval (CI): 0.19-0.40], myocardial infarct (OR 0.53; 95% CI: 0.40-0.72), and major bleeding (OR 0.57; 95% CI: 0.39-0.84). Female sex (OR 1.40; 95% CI: 1.21-1.61), cancer (OR 1.78; 95% CI: 1.38-2.29), and smoking (OR 1.60; 95% CI: 1.15-2.24) were factors favoring direct OAC use over warfarin. Among patients receiving OACs, the rate of combined antiplatelet agents was 7.8%. However, 73.6% of patients did not have any indication for a combination of antiplatelet agents.

CONCLUSION

Renal disease and history of valvular heart disease were associated with warfarin use, while cancer and smoking status were associated with direct OAC use in high stroke risk patients. The combination of antiplatelet agents with OAC was prescribed in 73.6% of patients without definite indications recommended by guidelines.