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AnteayerPLOS ONE Medicine&Health

Inhalation injury is associated with long-term employment outcomes in the burn population: Findings from a cross-sectional examination of the Burn Model System National Database

by Olivia R. Stockly, Audrey E. Wolfe, Gretchen J. Carrougher, Barclay T. Stewart, Nicole S. Gibran, Steven E. Wolf, Kara McMullen, Alyssa M. Bamer, Karen Kowalske, William G. Cioffi, Ross Zafonte, Jeffrey C. Schneider, Colleen M. Ryan


Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury.


Data collected by the Burn Model System National Database from 1993 to 2019 were analyzed. Demographic and clinical characteristics for adult burn survivors with and without inhalation injury were examined. Outcomes included employment status, Short Form-12/Veterans Rand-12 Physical Composite Score (SF-12/VR-12 PCS), Short Form-12/Veterans Rand-12 Mental Composite Score (SF-12/VR-12 MCS), and Satisfaction With Life Scale (SWLS) at 24 months post-injury. Regression models were used to assess the impacts of sociodemographic and clinical covariates on long-term outcome measures. All models controlled for demographic and clinical characteristics.


Data from 1,871 individuals were analyzed (208 with inhalation injury; 1,663 without inhalation injury). The inhalation injury population had a median age of 40.1 years, 68.8% were male, and 69% were White, non-Hispanic. Individuals that sustained an inhalation injury had larger burn size, more operations, and longer lengths of hospital stay (p Conclusions

Burn survivors with inhalation injury were significantly less likely to be employed at 24 months post-injury compared to survivors without inhalation injury. However, other health-related quality of life outcomes were similar between groups. This study suggests distinct long-term outcomes in adult burn survivors with inhalation injury which may inform future resource allocation and treatment paradigms.

Autophagy mitigates ethanol-induced mitochondrial dysfunction and oxidative stress in esophageal keratinocytes

by Prasanna M. Chandramouleeswaran, Manti Guha, Masataka Shimonosono, Kelly A. Whelan, Hisatsugu Maekawa, Uma M. Sachdeva, Gordon Ruthel, Sarmistha Mukherjee, Noah Engel, Michael V. Gonzalez, James Garifallou, Shinya Ohashi, Andres J. Klein-Szanto, Clementina A. Mesaros, Ian A. Blair, Renata Pellegrino da Silva, Hakon Hakonarson, Eishi Noguchi, Joseph A. Baur, Hiroshi Nakagawa

During alcohol consumption, the esophageal mucosa is directly exposed to high concentrations of ethanol (EtOH). We therefore investigated the response of normal human esophageal epithelial cell lines EPC1, EPC2 and EPC3 to acute EtOH exposure. While these cells were able to tolerate 2% EtOH for 8 h in both three-dimensional organoids and monolayer culture conditions, RNA sequencing suggested that EtOH induced mitochondrial dysfunction. With EtOH treatment, EPC1 and EPC2 cells also demonstrated decreased mitochondrial ATPB protein expression by immunofluorescence and swollen mitochondria lacking intact cristae by transmission electron microscopy. Mitochondrial membrane potential (ΔΨm) was decreased in a subset of EPC1 and EPC2 cells stained with ΔΨm–sensitive dye MitoTracker Deep Red. In EPC2, EtOH decreased ATP level while impairing mitochondrial respiration and electron transportation chain functions, as determined by ATP fluorometric assay, respirometry, and liquid chromatography-mass spectrometry. Additionally, EPC2 cells demonstrated enhanced oxidative stress by flow cytometry for mitochondrial superoxide (MitoSOX), which was antagonized by the mitochondria-specific antioxidant MitoCP. Concurrently, EPC1 and EPC2 cells underwent autophagy following EtOH exposure, as evidenced by flow cytometry for Cyto-ID, which detects autophagic vesicles, and immunoblots demonstrating induction of the lipidated and cleaved form of LC3B and downregulation of SQSTM1/p62. In EPC1 and EPC2, pharmacological inhibition of autophagy flux by chloroquine increased mitochondrial oxidative stress while decreasing cell viability. In EPC2, autophagy induction was coupled with phosphorylation of AMP activated protein kinase (AMPK), a cellular energy sensor responding to low ATP levels, and dephosphorylation of downstream substrates of mechanistic Target of Rapamycin Complex (mTORC)-1 signaling. Pharmacological AMPK activation by AICAR decreased EtOH-induced reduction of ΔΨm and ATP in EPC2. Taken together, acute EtOH exposure leads to mitochondrial dysfunction and oxidative stress in esophageal keratinocytes, where the AMPK-mTORC1 axis may serve as a regulatory mechanism to activate autophagy to provide cytoprotection against EtOH-induced cell injury.

A semi-automated method for unbiased alveolar morphometry: Validation in a bronchopulmonary dysplasia model

by Thomas Salaets, Bieke Tack, André Gie, Benjamin Pavie, Nikhil Sindhwani, Julio Jimenez, Yannick Regin, Karel Allegaert, Jan Deprest, Jaan Toelen

Reproducible and unbiased methods to quantify alveolar structure are important for research on many lung diseases. However, manually estimating alveolar structure through stereology is time consuming and inter-observer variability is high. The objective of this work was to develop and validate a fast, reproducible and accurate (semi-)automatic alternative. A FIJI-macro was designed that automatically segments lung images to binary masks, and counts the number of test points falling on tissue and the number of intersections of the air-tissue interface with a set of test lines. Manual selection remains necessary for the recognition of non-parenchymal tissue and alveolar exudates. Volume density of alveolar septa (VVsep) and mean linear intercept of the airspaces (Lm) as measured by the macro were compared to theoretical values for 11 artificial test images and to manually counted values for 17 lungs slides using linear regression and Bland-Altman plots. Inter-observer agreement between 3 observers, measuring 8 lungs both manually and automatically, was assessed using intraclass correlation coefficients (ICC). VVsep and Lm measured by the macro closely approached theoretical values for artificial test images (R2 of 0.9750 and 0.9573 and bias of 0.34% and 8.7%). The macro data in lungs were slightly higher for VVsep and slightly lower for Lm in comparison to manually counted values (R2 of 0.8262 and 0.8288 and bias of -6.0% and 12.1%). Visually, semi-automatic segmentation was accurate. Most importantly, manually counted VVsep and Lm had only moderate to good inter-observer agreement (ICC 0.859 and 0.643), but agreements were excellent for semi-automatically counted values (ICC 0.956 and 0.900). This semi-automatic method provides accurate and highly reproducible alveolar morphometry results. Future efforts should focus on refining methods for automatic detection of non-parenchymal tissue or exudates, and for assessment of lung structure on 3D reconstructions of lungs scanned with microCT.

Fasting plasma glucose level and the risk of open angle glaucoma: Nationwide population-based cohort study in Korea

by Jin A. Choi, Yong-Moon Park, Kyungdo Han, Jiyoung Lee, Jae-Seung Yun, Seung-Hyun Ko


The level of fasting plasma glucose (FPG) is positively associated with intraocular pressure. Diabetes causes early structural changes of retina, especially on ganglion cell layer. In this regard, the FPG level itself may also show an independent association with open angle glaucoma (OAG) development in general population. Herein, we investigate the association of the FPG level with the incidence of OAG.


Using nationally representative data from the Korean National Health Insurance System, 374,376 subjects ≥40 years of age without OAG who underwent health examinations from 2009 to 2013 were enrolled and followed to the end of 2014. Incident cases of OAG using the International Classification of Diseases 10 codes and medication information were analyzed based on the levels of FPG.


Subjects with the highest FPG level (≥160 mg/dL), compared with the lowest level (P for trend P for trend 2, and those without hypertension (HR 2.022; 95% CI: 1.494–2.736; P for trend P for trend P for trend Conclusions

This nationwide population-based cohort study showed that the fasting glucose was associated with an increased risk of OAG. These findings suggest that subjects with high FPG levels require special attention when screening for glaucoma.

Association between chronic obstructive pulmonary disease (COPD) and occupational exposures: A hospital based quantitative cross-sectional study among the Bangladeshi population

by Ahmed Faisal Sumit, Anindya Das, Ishtiaq Hossain Miraj, Debasish Bhowmick

The association between chronic obstructive pulmonary disease (COPD) and occupational exposures are less studied in Bangladeshi context, despite the fact that occupational exposures are serious public health concerns in Bangladesh. Therefore, this study aimed to evaluate this association considering demographic, health and smoking characteristics of Bangladeshi population. This was a hospital-based quantitative study including 373 participants who were assessed for COPD through spirometry testing. Assessment of occupational exposures was based on both self-reporting by respondents and ALOHA based job exposure matrix (JEM). Here, among the self-reported exposed group (n = 189), 104 participants (55%) were found with COPD compared to 23 participants (12.5%) in unexposed group (n = 184) that differed significantly (p = 0.00). Similarly, among the JEM measured low (n = 103) and high exposed group (n = 236), 23.3% and 41.5% of the participants were found with COPD respectively; compared to unexposed group (14.7%; n = 34), that differed significantly also (p = 0.00). Likewise, participants with longer self-reported occupational exposures (>8 years) showed significantly (p = 0.00) higher proportions of COPD (79.5%) compared to 40.4% in shorter exposure group (1–8 years). Similarly, significant (p = 0.00) higher cases of COPD were observed among the longer cumulative exposure years (>9 years) group than the shorter cumulative exposure years (1–9 years) group in JEM. While combining smoking and occupational exposure, the chance of developing COPD among the current, former and non-smokers of exposed group were 7.4, 7.2 and 12.7 times higher respectively than unexposed group. Furthermore, logistic analysis revealed that after adjustments for confounding risk factors, the chance of developing COPD among the self-reported exposure group was 6.3 times higher (ORs: 6.3, p = 0.00) than unexposed group; and JEM exposure group has odds of 2.8 and 1.1 respectively (p

Continuous pressure measurement and serial micro–computed tomography analysis during injection laryngoplasty: A preliminary canine cadaveric study

by Min-Su Kim, Seongmin An, Songwan Jin, Taehoen Kim, Tack-Kyun Kwon

Injection laryngoplasty (IL) has been used to treat various types of glottal insufficiency. The precise volume and location of the injected materials impact the outcomes. However, exactly how increasing volumes of material are distributed is unknown. In fact, the amount of IL material required to medialize a vocal cord tends to be determined empirically. Thus, the goal of this study was to investigate the pattern of IL material distribution by checking serial micro–computed tomography (MCT) and pressure changes during ILs. This experimental study used 10 excised canine larynges. Experimental devices included the IL syringe, pressure sensor, infusion pump, fixed frame, and monitoring system. We injected calcium hydroxyapatite in the thyroarytenoid muscle; whenever 0.1 mL of material was injected, we obtained an MCT scan while simultaneously measuring the pressure. After the experiments, we performed histologic analyses. MCT analyses showed that materials initially expanded centrifugally and then expanded in all directions within the muscle. The pressure initially increased rapidly but then remained relatively constant until the point at which the materials expanded in multiple directions. Histologic analyses showed that the IL material tended to expand within the epimysium of the thyroarytenoid muscle. However, in some cases, the MCT revealed that there were leakages to the surrounding space with a corresponding pressure drop. If the IL material passes through the epimysium, leakage can occur in the surrounding space, which can account for the reduction in resistance during ILs.

Individual test-retest reliability of evoked and induced alpha activity in human EEG data

by Manuel Vázquez-Marrufo, Rocío Caballero-Díaz, Rubén Martín-Clemente, Alejandro Galvao-Carmona, Javier J. González-Rosa

Diverse psychological mechanisms have been associated with modulations of different EEG frequencies. To the extent of our knowledge, there are few studies of the test-retest reliability of these modulations in the human brain. To assess evoked and induced alpha reliabilities related to cognitive processing, EEG data from twenty subjects were recorded in 58 derivations in two different sessions separated by 49.5 ± 48.9 (mean ± standard deviation) days. A visual oddball was selected as the cognitive task, and three main parameters were analyzed for evoked and induced alpha modulations (latency, amplitude and topography). Latency and amplitude for evoked and induced modulations showed stable behavior between the two sessions. The correlation between sessions for alpha evoked and induced topographies in the grand average (group level) was r = 0.923, p

Mindfulness and cardiovascular health: Qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study

by William R. Nardi, Abigail Harrison, Frances B. Saadeh, Julie Webb, Anna E. Wentz, Eric B. Loucks


Mindfulness-based programs hold promise for improving cardiovascular health (e.g. physical activity, diet, blood pressure). However, despite theoretical frameworks proposed, no studies have reported qualitative findings on how study participants themselves believe mindfulness-based programs improved their cardiovascular health. With an emphasis on in-depth, open-ended investigation, qualitative methods are well suited to explore the mechanisms underlying health outcomes. The objective of this qualitative study was to explore the mechanisms through which the mindfulness-based program, Mindfulness-Based Blood Pressure Reduction (MB-BP), may influence cardiovascular health.


This qualitative study was conducted as part of a Stage 1 single arm trial with one-year follow-up. The MB-BP curriculum was adapted from Mindfulness-Based Stress Reduction to direct participants’ mindfulness skills towards modifiable determinants of blood pressure. Four focus group discussions were conducted (N = 19 participants), and seven additional participants were selected for in-depth interviews. Data analysis was conducted using the standard approach of thematic analysis. Following double-coding of audio-recorded transcripts, four members of the study team engaged in an iterative process of data analysis and interpretation.


Participants identified self-awareness, attention control, and emotion regulation as key mechanisms that led to improvements in cardiovascular health. Within these broader themes, many participants detailed a process beginning with increased self-awareness to sustain attention and regulate emotions. Many also explained that the specific relationship between self-awareness and emotion regulation enabled them to respond more skillfully to stressors. In a secondary sub-theme, participants suggested that higher self-awareness helped them engage in positive health behaviors (e.g. healthier dietary choices).


Qualitative analyses suggest that MB-BP mindfulness practices allowed participants to engage more effectively in self-regulation skills and behaviors lowering cardiovascular disease risk, which supports recent theory. Results are consistent with quantitative mechanistic findings showing emotion regulation, perceived stress, interoceptive awareness, and attention control are influenced by MB-BP.

Characteristics of the inner retinal layer in the fellow eyes of patients with unilateral exudative age-related macular degeneration

by Seong Eun Lee, Hyung Bin Lim, Yong Il Shin, Cheon Kuk Ryu, Woo Hyuk Lee, Jung-Yeul Kim


To investigate the thicknesses of the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) of the fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD).


A total of 107 patients with unilateral exudative AMD [34 of typical choroidal neovascularization (tCNV), Group A; 73 of polypoidal choroidal vasculopathy (PCV), Group B] and 73 normal control eyes (Group C) were included. Drusen and subretinal drusenoid deposits were assessed in all participants using fundus photography, autofluorescence, and optical coherence tomography (OCT). The GC-IPL and RNFL thicknesses were measured using Cirrus HD-OCT and compared among groups. Linear regression analyses were used to evaluate the factors associated with GC-IPL thicknesses.


The average GC-IPL thicknesses of Groups A, B, and C were 77.09 ± 3.87, 80.10 ± 6.61, and 80.88 ± 6.50 μm, respectively (p = 0.022). Sectoral GC-IPLs and central macular thicknesses (CMTs) were significantly different among groups (all, p 0.05). Multivariate linear regression analyses revealed that age (p Conclusions

Unilateral tCNV patients exhibited statistically significant reduction of the GC-IPL thickness in the fellow eyes, compared to values of the fellow eyes of unilateral PCV patients or control patients. RNFL values trended to be lower but did not reach statistical significance.

City size and the spreading of COVID-19 in Brazil

by Haroldo V. Ribeiro, Andre S. Sunahara, Jack Sutton, Matjaž Perc, Quentin S. Hanley

The current outbreak of the coronavirus disease 2019 (COVID-19) is an unprecedented example of how fast an infectious disease can spread around the globe (especially in urban areas) and the enormous impact it causes on public health and socio-economic activities. Despite the recent surge of investigations about different aspects of the COVID-19 pandemic, we still know little about the effects of city size on the propagation of this disease in urban areas. Here we investigate how the number of cases and deaths by COVID-19 scale with the population of Brazilian cities. Our results indicate small towns are proportionally more affected by COVID-19 during the initial spread of the disease, such that the cumulative numbers of cases and deaths per capita initially decrease with population size. However, during the long-term course of the pandemic, this urban advantage vanishes and large cities start to exhibit higher incidence of cases and deaths, such that every 1% rise in population is associated with a 0.14% increase in the number of fatalities per capita after about four months since the first two daily deaths. We argue that these patterns may be related to the existence of proportionally more health infrastructure in the largest cities and a lower proportion of older adults in large urban areas. We also find the initial growth rate of cases and deaths to be higher in large cities; however, these growth rates tend to decrease in large cities and to increase in small ones over time.

Familial Alzheimer’s disease mutations at position 22 of the amyloid β-peptide sequence differentially affect synaptic loss, tau phosphorylation and neuronal cell death in an <i>ex vivo</i> system

by Christian Tackenberg, Luka Kulic, Roger M. Nitsch

Familial forms of Alzheimer’s disease (AD) are caused by mutations in the presenilin genes or in the gene encoding for the amyloid precursor protein (APP). Proteolytic cleavage of APP generates the β-amyloid peptide (Aβ), which aggregates into amyloid plaques, one of the major hallmarks of AD. APP mutations within the Aβ sequence, so-called intra-Aβ mutations, cluster around position E693 of APP, which corresponds to position E22 in the Aβ sequence. One of these mutations is the Osaka mutation, E693Δ, which has unique aggregation properties with patients showing unusually low brain amyloid levels on amyloid PET scans. Despite intense research on the pathomechanisms of different intra-Aβ mutants, our knowledge is limited due to controversial findings in various studies. Here, we investigated in an ex vivo experimental system the neuro- and synaptotoxic properties of two intra-Aβ mutants with different intrinsic aggregation propensities, the Osaka mutation E22Δ and the Arctic mutation E22G, and compared them to wild-type (wt) Aβ. Experiments in hippocampal slice cultures from transgenic mice were complemented by treating wild-type slices with recombinantly produced Aβ40 or Aβ42 containing the respective intra-Aβ mutations. Our analyses revealed that wt Aβ and E22G Aβ, both recombinant and transgenic, caused a loss of dendritic spines along with an increase in tau phosphorylation and tau-dependent neurodegeneration. In all experiments, the 42-residue variants of wt and E22G Aβ showed stronger effects than the respective Aβ40 isoforms. In contrast, E22Δ Aβ neither reduced dendritic spine density nor resulted in increased tau phosphorylation or neuronal cell death in our ex vivo system. Our findings suggest that the previously reported major differences in the aggregation kinetics between E22G and E22Δ Aβ are likely reflected in different disease pathomechanisms.

Quantifying archaeo-organic degradation – A multiproxy approach to understand the accelerated deterioration of the ancient organic cultural heritage at the Swedish Mesolithic site Ageröd

by Adam Boethius, Hege Hollund, Johan Linderholm, Santeri Vanhanen, Mathilda Kjällquist, Ola Magnell, Jan Apel

Despite a growing body of evidence concerning accelerated organic degradation at archaeological sites, there have been few follow-up investigations to examine the status of the remaining archaeological materials in the ground. To address the question of archaeo-organic preservation, we revisited the Swedish, Mesolithic key-site Ageröd and could show that the bone material had been subjected to an accelerated deterioration during the last 75 years, which had destroyed the bones in the areas where they had previously been best preserved. To understand why this has happened and to quantify and qualify the extent of the organic degradation, we here analyse the soil chemistry, bone histology, collagen preservation and palaeobotany at the site. Our results show that the soil at Ageröd is losing, or has already lost, its preservative and buffering qualities, and that pH-values in the still wet areas of the site have dropped to levels where no bone preservation is possible. Our results suggest that this acidification process is enhanced by the release of sulphuric acid as pyrite in the bones oxidizes. While we are still able to find well-preserved palaeobotanical remains, they are also starting to corrode through re-introduced oxygen into the archaeological layers. While some areas of the site have been more protected through redeposited soil on top of the archaeological layers, all areas of Ageröd are rapidly deteriorating. Lastly, while it is still possible to perform molecular analyses on the best-preserved bones from the most protected areas, this opportunity will likely be lost within a few decades. In conclusion, we find that if we, as a society, wish to keep this valuable climatic, environmental and cultural archive, both at Ageröd and elsewhere, the time to act is now and if we wait we will soon be in a situation where this record will be irretrievably lost forever.

Detection of acute toxicity of aflatoxin B1 to human hepatocytes <i>in vitro</i> and <i>in vivo</i> using chimeric mice with humanized livers

by Yuji Ishida, Chihiro Yamasaki, Hiroko Iwanari, Hisahiko Yamashita, Yuko Ogawa, Ami Yanagi, Suzue Furukawa, Yuha Kojima, Kazuaki Chayama, Junichi Kamiie, Chise Tateno

Aflatoxin B1 (AFB1), a mycotoxin, is acutely hepatotoxic to many animals including humans. However, there are marked interspecies differences in sensitivity to AFB1-induced toxicity depending on bioactivation by cytochrome P450s (CYPs). In the present study, we examined the applicability of chimeric mice with humanized livers and derived fresh human hepatocytes for in vivo and vitro studies on AFB1 cytotoxicity to human hepatocytes. Chimeric mice with highly humanized livers and SCID mice received daily injections of vehicle (corn oil), AFB1 (3 mg/kg), and carbon tetrachloride (50 mg/kg) for 2 days. Histological analysis revealed that AFB1 promoted hepatocyte vacuolation and inflammatory cell infiltration in the area containing human hepatocytes. A novel human alanine aminotransferase 1 specific enzyme-linked immunosorbent assay demonstrated the acute toxicity of AFB1 to human hepatocytes in the chimeric mouse livers. The sensitivity of cultured fresh human hepatocytes isolated from the humanized liver mice for AFB1 cytotoxicity was comparable to that of primary human hepatocytes. Long-term exposure to AFB1 (6 or 14 days) produced a more severe cytotoxicity. The half-maximal lethal concentration was 10 times lower in the 2-week treatment than after 2 days of exposure. Lastly, the significant reduction of AFB1 cytotoxicity by a pan-CYP inhibitor or transfection with CYP3A4 specific siRNA clearly suggested that bioactivation of AFB1 catalyzed by CYPs was essential for AFB1 cytotoxicity to the human hepatocytes in our mouse model. Collectively, our results implicate the humanized liver mice and derived fresh human hepatocytes are useful models for studies of AFB1 cytotoxicity to human hepatocytes.

Effects of long-term <i>in vivo</i> micro-CT imaging on hallmarks of osteopenia and frailty in aging mice

by Ariane C. Scheuren, Gisela A. Kuhn, Ralph Müller

In vivo micro-CT has already been used to monitor microstructural changes of bone in mice of different ages and in models of age-related diseases such as osteoporosis. However, as aging is accompanied by frailty and subsequent increased sensitivity to external stimuli such as handling and anesthesia, the extent to which longitudinal imaging can be applied in aging studies remains unclear. Consequently, the potential of monitoring individual mice during the entire aging process–from healthy to frail status–has not yet been exploited. In this study, we assessed the effects of long-term in vivo micro-CT imaging—consisting of 11 imaging sessions over 20 weeks—on hallmarks of aging both on a local (i.e., static and dynamic bone morphometry) and systemic (i.e., frailty index (FI) and body weight) level at various stages of the aging process. Furthermore, using a premature aging model (PolgA(D257A/D257A)), we assessed whether these effects differ between genotypes. The 6th caudal vertebrae of 4 groups of mice (PolgA(D257A/D257A) and PolgA(+/+)) were monitored by in vivo micro-CT every 2 weeks. One group was subjected to 11 scans between weeks 20 and 40 of age, whereas the other groups were subjected to 5 scans between weeks 26–34, 32–40 and 40–46, respectively. The long-term monitoring approach showed small but significant changes in the static bone morphometric parameters compared to the other groups. However, no interaction effect between groups and genotype was found, suggesting that PolgA mutation does not render bone more or less susceptible to long-term micro-CT imaging. The differences between groups observed in the static morphometric parameters were less pronounced in the dynamic morphometric parameters. Moreover, the body weight and FI were not affected by more frequent imaging sessions. Finally, we observed that longitudinal designs including baseline measurements at young adult age are more powerful at detecting effects of in vivo micro-CT imaging on hallmarks of aging than cross-sectional comparisons between multiple groups of aged mice subjected to fewer imaging sessions.

e-health usage and health workers’ motivation and job satisfaction in Ghana

by Roger A. Atinga, Patience Aseweh Abor, Saratu Jenepha Suleman, Emmanuel Anongeba Anaba, Bii Kipo


The application of digital technology to improve health service delivery is increasing rapidly in Low- and Middle- Income Countries (LMICs). Digital tools such as electronic health (e-health) have been shown to improve healthcare quality, efficiency and patient satisfaction. However, evidence on health workers’ experiences using e-health services is limited in LMICs. This study examined the relationship between e-health usage and health workers’ motivation and job satisfaction.


This was a cross-sectional survey design involving health workers across public and private hospitals in the Accra Metropolitan Assembly (AMA). A structured questionnaire was designed and self-administered to 305 respondents. Partial Least Square-Structural Equation Modelling (PLS-SEM) was employed to analyse the data.


Findings showed a significant positive association of job satisfaction with e-health (p p Conclusion

The findings suggest that e-health systems can catalyse health workers job satisfaction. Thus, measures to strengthen e-health structures to improve on their efficiency and effectiveness is crucial.

Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey

by Md. Akhtarul Islam, Sutapa Dey Barna, Hasin Raihan, Md. Nafiul Alam Khan, Md. Tanvir Hossain

The purpose of this study was to investigate the prevalence of depression and anxiety among Bangladeshi university students during the COVID-19 pandemic. It also aimed at identifying the determinants of depression and anxiety. A total of 476 university students living in Bangladesh participated in this cross-sectional web-based survey. A standardized e-questionnaire was generated using the Google Form, and the link was shared through social media—Facebook. The information was analyzed in three consecutive levels, such as univariate, bivariate, and multivariate analysis. Students were experiencing heightened depression and anxiety. Around 15% of the students reportedly had moderately severe depression, whereas 18.1% were severely suffering from anxiety. The binary logistic regression suggests that older students have greater depression (OR = 2.886, 95% CI = 0.961–8.669). It is also evident that students who provided private tuition in the pre-pandemic period had depression (OR = 1.199, 95% CI = 0.736–1.952). It is expected that both the government and universities could work together to fix the academic delays and financial problems to reduce depression and anxiety among university students.

A simple predictive model for estimating relative e-cigarette toxic carbonyl levels

by Shawna Vreeke, Xijing Zhu, Robert M. Strongin

E-cigarette devices are wide ranging, leading to significant differences in levels of toxic carbonyls in their respective aerosols. Power can be a useful method in predicting relative toxin concentrations within the same device, but does not correlate well to inter-device levels. Herein, we have developed a simple mathematical model utilizing parameters of an e-cigarette’s coil and wick in order to predict relative levels of e-liquid solvent degradation. Model 1, which is coil length/(wick surface area*wraps), performed in the moderate-to-substantial range as a predictive tool (R2 = 0.69). Twelve devices, spanning a range of coil and wick styles, were analyzed. Model 1 was evaluated against twelve alternative models and displayed the best predictability. Relationships that included power settings displayed weak predictability, validating that power levels cannot be reliably compared between devices due to differing wicking and coil components and heat transfer efficiencies.

Utility of circulating cell-free <i>Mycobacterium tuberculosis</i> DNA for the improved diagnosis of abdominal tuberculosis

by Pratibha Sharma, Divya Anthwal, Pooja Kumari, Rakesh Kumar Gupta, Surabhi Lavania, Neera Sharma, Lokesh Kumar Sharma, Deepak Rath, Pavan Kumar Soraganvi, Ashish Sharma, A. K. Gadpayle, R. S. Taneja, Jaya Sivaswami Tyagi, Sagarika Haldar

Abdominal tuberculosis (ATB) continues to pose a major diagnostic challenge for clinicians due to its nonspecific clinical presentation, variable anatomical location and lack of sensitive diagnostic tools. In spite of the development of several assays till date; no single test has proved to be adequate for ATB diagnosis. In this study, we for the first time report the detection of circulating cell-free Mycobacterium tuberculosis (M. tuberculosis) DNA (cfMTB-DNA) in ascitic fluid (AF) samples and its utility in ATB diagnosis. Sixty-five AF samples were included in the study and processed for liquid culture, cytological, biochemical and molecular assays. A composite reference standard (CRS) was formulated to categorize the patients into ‘Definite ATB’ (M. tuberculosis culture positive, n = 2), ‘Probable ATB’ (n = 16), ‘Possible ATB’ (n = 13) and ‘Non-TB’ category (n = 34). Two molecular assays were performed, namely, the novel cfMTB-DNA qPCR assay targeting M. tuberculosis devR gene and Xpert MTB/RIF assay (Xpert), and their diagnostic accuracy was assessed using CRS as reference standard. Clinical features such as fever, loss of weight, abdominal distension and positive Mantoux were found to be strongly associated with ATB disease (pM. tuberculosis etiology and has promise to pave the way for improving ATB diagnosis.

Diagnosis and management of an inappropriate sinus tachycardia in adolescence based upon a Holter ECG: A retrospective analysis of 479 patients

by Reiner Buchhorn, Christoph Baumann, Semanur Gündogdu, Ulla Rakowski, Christian Willaschek

Inappropriate sinus tachycardia (IST) is a common disease of the autonomic nervous system in children and adults. Diagnosis and treatment of IST in adolescents is not well defined. In this retrospective study, we tested our hypothesis regarding autonomic dysfunction in childhood by analyzing 24-h heart rate variability (HRV) in 479 children, with a mean age of 13.7 ± 2.1 years, who were referred to the outpatient clinic in the Pediatrics Department within the last 15 years. Seventy-four adolescents with a mean 24-h heart rate ≥ 95 bpm (our cut-off for an IST based upon 66 healthy controls) were deemed to have IST. We found the risk of IST to be high in adolescents with attention deficit disorder (OR = 3.5,p

Immune and sex-biased gene expression in the threatened Mojave desert tortoise, <i>Gopherus agassizii</i>

by Cindy Xu, Greer A. Dolby, K. Kristina Drake, Todd C. Esque, Kenro Kusumi

The immune system of ectotherms, particularly non-avian reptiles, remains poorly characterized regarding the genes involved in immune function, and their function in wild populations. We used RNA-Seq to explore the systemic response of Mojave desert tortoise (Gopherus agassizii) gene expression to three levels of Mycoplasma infection to better understand the host response to this bacterial pathogen. We found over an order of magnitude more genes differentially expressed between male and female tortoises (1,037 genes) than differentially expressed among immune groups (40 genes). There were 8 genes differentially expressed among both variables that can be considered sex-biased immune genes in this tortoise. Among experimental immune groups we find enriched GO biological processes for cysteine catabolism, regulation of type 1 interferon production, and regulation of cytokine production involved in immune response. Sex-biased transcription involves iron ion transport, iron ion homeostasis, and regulation of interferon-beta production to be enriched. More detailed work is needed to assess the seasonal response of the candidate genes found here. How seasonal fluctuation of testosterone and corticosterone modulate the immunosuppression of males and their susceptibility to Mycoplasma infection also warrants further investigation, as well as the importance of iron in the immune function and sex-biased differences of this species. Finally, future transcriptional studies should avoid drawing blood from tortoises via subcarapacial venipuncture as the variable aspiration of lymphatic fluid will confound the differential expression of genes.