Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases

BackgroundDespite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers.MethodsThis cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated.ResultsThe psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients'' factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence.ConclusionThe good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients'' factors and time constraints.     

Solid State Joining of a Cold Rolled Zr-Based Bulk Metallic Glass to a Wrought Aluminum Alloy by Power Ultrasonics

Ultrasonic metal welding (UMW) enables joining in the solid state at relative low temperatures with short cycle times. This technique is of particular interest for joining metallic glasses to each other or to other materials, because crystallization of the amorphous structure can be prevented due to the low thermal loading and the rapidity of the process. In this work, UMW is applied to join one 1 mm thick sheet of a commercial wrought aluminum alloy (AA5754) and one 0.4 mm thick strip of a commercial Zr-based bulk metallic glass (AMZ4). The introduced heat of the welding process is detected with thermocouples and thermal imaging. To investigate the strength of the joint and the influence on the microstructure, mechanical tensile tests are carried out in combination with scanning electron microscopy and differential scanning calorimetry. The results show that ultrasonic metal welding is a suitable technique to join amorphous bulk metallic glasses to crystalline aluminum alloys. The metallic glass component retains its amorphous structure in the joint, and the joint strength is higher than the strength of the Al sheet. These findings will help to develop future applications of BMG-based multi-material components, including medical tools.     

A placebo-controlled study of tropisetron added to risperidone for the treatment of negative symptoms in chronic and stable schizophrenia

Rational

A growing body of evidence illustrates that 5-HT3 receptor antagonist drugs may be of benefit in the treatment of negative symptoms in schizophrenia.

Objective

The objective of this study was to assess the efficacy and tolerability of tropisetron add-on to risperidone on negative symptoms in patients with chronic stable schizophrenia.

Methods

In a double-blind, placebo-controlled 8-week trial, 40 patients with chronic schizophrenia who were stabilized on risperidone were randomized into tropisetron or placebo add-on groups. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) every 2 weeks. Furthermore, extrapyramidal and depressive symptoms as well as side effects were assessed. The primary outcome measure was the difference in change from baseline of negative subscale scores between the two groups at week 8.

Results

Tropisetron resulted in greater improvement of the total PANSS scores [F(1.860,70.699)?=?37.366, p?<?0.001] as well as negative scores [F(2.439,92.675)?=?16.623, p?<?0.001] and general psychopathology [F(1.767,67.158)?=?4.602, p?=?0.017], but not positive subscale scores [F(1.348, 51.218)?=?0.048, p?=?0.893] compared to placebo. In a multiple regression analysis controlling for positive, extrapyramidal, and depressive symptoms, treatment group (standardized β?=??0.640) significantly predicted changes in primary negative symptoms. The side effect profile did not differ significantly between the two groups.

Conclusion

Tropisetron add-on to risperidone improves the primary negative symptoms of patients with chronic stable schizophrenia.     

Primary malignant epithelioid hemangioendothelioma of the pleura: A review and report of a novel case

Epithelioid hemangioendothelioma is considered an uncommon tumor originating from vascular tissues. Although this disease is an extremely rare malignant cancer, its pleural subtype is even less common. We discuss a 68‐year‐old man with isolated pleural epithelioid hemangioendothelioma, along with a literature review of all similar cases.     

Systematic evaluation of machine learning algorithms for neuroanatomically‐based age prediction in youth

Application of machine learning (ML) algorithms to structural magnetic resonance imaging (sMRI) data has yielded behaviorally meaningful estimates of the biological age of the brain (brain‐age). The choice of the ML approach in estimating brain‐age in youth is important because age‐related brain changes in this age‐group are dynamic. However, the comparative performance of the available ML algorithms has not been systematically appraised. To address this gap, the present study evaluated the accuracy (mean absolute error [MAE]) and computational efficiency of 21 machine learning algorithms using sMRI data from 2105 typically developing individuals aged 5–22 years from five cohorts. The trained models were then tested in two independent holdout datasets, one comprising 4078 individuals aged 9–10 years and another comprising 594 individuals aged 5–21 years. The algorithms encompassed parametric and nonparametric, Bayesian, linear and nonlinear, tree‐based, and kernel‐based models. Sensitivity analyses were performed for parcellation scheme, number of neuroimaging input features, number of cross‐validation folds, number of extreme outliers, and sample size. Tree‐based models and algorithms with a nonlinear kernel performed comparably well, with the latter being especially computationally efficient. Extreme Gradient Boosting (MAE of 1.49 years), Random Forest Regression (MAE of 1.58 years), and Support Vector Regression (SVR) with Radial Basis Function (RBF) Kernel (MAE of 1.64 years) emerged as the three most accurate models. Linear algorithms, with the exception of Elastic Net Regression, performed poorly. Findings of the present study could be used as a guide for optimizing methodology when quantifying brain‐age in youth.     

Predicting long-term dynamics of soil salinity and sodicity on a global scale

Knowledge of spatiotemporal distribution and likelihood of (re)occurrence of salt-affected soils is crucial to our understanding of land degradation and for planning effective remediation strategies in face of future climatic uncertainties. However, conventional methods used for tracking the variability of soil salinity/sodicity are extensively localized, making predictions on a global scale difficult. Here, we employ machine-learning techniques and a comprehensive set of climatic, topographic, soil, and remote sensing data to develop models capable of making predictions of soil salinity (expressed as electrical conductivity of saturated soil extract) and sodicity (measured as soil exchangeable sodium percentage) at different longitudes, latitudes, soil depths, and time periods. Using these predictive models, we provide a global-scale quantitative and gridded dataset characterizing different spatiotemporal facets of soil salinity and sodicity variability over the past four decades at a ∼1-km resolution. Analysis of this dataset reveals that a soil area of 11.73 Mkm² located in nonfrigid zones has been salt-affected with a frequency of reoccurrence in at least three-fourths of the years between 1980 and 2018, with 0.16 Mkm² of this area being croplands. Although the net changes in soil salinity/sodicity and the total area of salt-affected soils have been geographically highly variable, the continents with the highest salt-affected areas are Asia (particularly China, Kazakhstan, and Iran), Africa, and Australia. The proposed method can also be applied for quantifying the spatiotemporal variability of other dynamic soil properties, such as soil nutrients, organic carbon content, and pH.

Soil salinization is one of the main land-degrading threats influencing soil fertility, stability, and biodiversity. Saline soils are ones with excess accumulation of soluble salts in the root zone (1). On the other hand, accumulation of high levels of sodium salt relative to other exchangeable cations is the main attribute of sodic soils (2). Wind, rainfall, and parent rock weathering are the main origins of these salts in “primary” soil salinization, whereas in “secondary” soil salinization excessive salt accumulation is human-induced (3). Saline and sodic soils, or in general salt-affected soils, mostly lie across arid and semiarid climates where the dominance of evaporation over precipitation concentrates the salts in the root zone (1, 4), leading to undesirable alterations in the physical, chemical, and biological functions of the soil (5, 6). Sodicity adversely influences the soil infiltration capacity (7), increases the susceptibility of water and wind-blown erosion (8), and exposes more soil organic matter to decomposing processes (9). Soil salinity, on the other side, distresses the soil respiration, nitrogen cycle, and decomposing functionality of soil microorganisms (9, 10). Salinity stress affects the vegetation growth directly by reducing the plant water uptake (osmotic stress) and/or by deteriorating the transpiring leaves (specific ion effects) (11), in turn reducing organic input to the soil and ultimately leading to desertification of lands (12, 13). Under extreme conditions, dispersion of saline dust (8, 14), poverty, migration, and high costs of soil reclamation are long-term socioeconomic consequences of soil salinization (15).Soil salinity and sodicity levels are spatially, vertically, and temporally dynamic (15, 16), particularly at the top 0- to 30-cm soil layer which is substantially affected by governing climatic conditions. Naturally occurring events, such as flash floods, El Niño and La Niña, alternative wet and dry years, and long periods of drought can considerably affect soil salinization and accumulation/leaching of the salts in/from the root zone at daily to multiyear temporal resolutions. Similarly, anthropogenic activities like irrigation and dryland management can affect soil salinization at different temporal resolutions. Given the high dynamism in soil salinization processes, updated spatial and temporal information on the extent of salt-affected soils is indispensable for devising appropriate sustainable action programs for managing land and soil resources (6, 17–19). This information can be also valuable for enhancing our understanding of terrestrial carbon dynamics (7, 20), food security and agricultural modeling (21, 22), climate change impacts (23, 24), water resources and irrigation management (25, 26), and efficiency of organic/inorganic reclamation practices (27, 28). Several statistics on the global distribution of salt-affected soils (17–19, 29–33) have been generated based on data from soil surveys and statistical extrapolation (1, 19), yet these estimations are mainly purely spatial (17, 34), not necessarily up-to-date (15, 17), and in some cases incomparable (3, 35). Therefore, there is still a need for a methodologically consistent dataset documenting long-term variations of the soil salinity and sodicity at high spatial resolutions (36)To address this need, we focused on two target variables: ground-derived measurements of soil EC_e (the ability of a water-saturated soil paste extract to conduct electrical current, representative of salinity severity) and ESP (exchangeable sodium percentage, representative of sodicity severity). We used 42,984 and 197,988 data, respectively, scattered over time from 1980 to 2018. We trained two-part predictive models for making four-dimensional (4D) predictions of soil salinity and sodicity as target variables (longitude, latitude, soil depth, and time; see Methods). Through mapping data-driven relations between soil EC_e/ESP observations and a collection of associated predictors generated from topographic, climatic, vegetative, soil, and landscape properties of the sampling locations (SI Appendix, Table S1), these two-part models enabled us to make long-term gridded predictions of soil salinity and sodicity at new locations with available predictors’ values. Note that “prediction” refers to the estimation by the trained models of soil salinity/sodicity on a global scale from 1980 to 2018 even in locations where there is no measurement available rather than to future projection of soil salinity/sodicity on the basis of current trends. The first part of the models classified the soil into saline/sodic and nonsaline/nonsodic classes (binary classification) and the second part predicted per-class severity of the salinity/sodicity issue (regression). Meaningful statistics derived from the EC_e and ESP predictions were then used to generate univariate thematic maps of the variability of different aspects of soil salinity/sodicity between 1980 and 2018 at ∼1-km spatial resolution (30 arc-seconds; e.g., Fig. 1). These were delimited to −55° and 55° latitudes, comprising tropics, subtropics, and temperate zones (see Data Availability). We focused on the topsoil layer (or surface soil), referring to the top 30 cm of the soil profile measured from the surface.Open in a separate windowFig. 1.Variability of different aspects of soil salinity and sodicity in the western United States. (A and D) SD of annually predicted soil salinity (EC_e) and sodicity (ESP), respectively, between 1980 and 2018. (B and E) Average of annually predicted EC_e and ESP, respectively (1980 to 2018). (C and F) Change in the likelihood (θ) of soils with an EC_e ≥4 dS⋅m⁻¹ or ESP ≥6% in the period 2000 to 2018 relative to 1981 to 1999 (the likelihood is dimensionelss, calculated by dividing the number of years with EC_e ≥4 dSm⁻¹ or ESP ≥6% by the total number of years in the studied period). Positive θ indicates that the likelihood has increased and negative shows that it has decreased.     

Gender Differences in Epidemiology,Pathophysiology, and Treatment of Hypertension

Purpose of Review

This review aims to examine gender differences in both the epidemiology and pathophysiology of hypertension and to explore gender peculiarities on the effects of antihypertensive agents in decreasing BP and CV events.

Recent Findings

Men and women differ in prevalence, awareness, and control rate of hypertension in an age-dependent manner. Studies suggest that sex hormones changes play a pivotal role in the pathophysiology of hypertension in postmenopausal women. Estrogens influence the vascular system inducing vasodilatation, inhibiting vascular remodeling processes, and modulating the renin-angiotensin aldosterone system and the sympathetic system. This leads to a protective effect on arterial stiffness during reproductive age that is dramatically reversed after menopause.

Summary

Data on the efficacy of antihypertensive therapy between genders are conflicting, and the underrepresentation of aged women in large clinical trials could influence the results. Therefore, further clinical research is needed to uncover potential gender differences in hypertension to promote the development of a gender-oriented approach to antihypertensive treatment.

     

Evaluation of a biosimilar recombinant alpha epoetin in the management of anemia in hemodialysis patients

Background: The efficacy of human recombinant erythropoietins (rHuEPOs) in the treatment of anemia with different etiologies is proven. Development of biosimilar rHuEPO products with lower cost and wider availability is important for the care of anemic patients. Objective: The aim of the present study was to determine the bioequivalence and safety of a biosimilar rHuEPO (Pastopoitin^®) and compare it with the innovator product Eprex^®, as a standard rHuEPO. Methods: One hundred and seven anemic patients on stable hemodialysis were recruited to this randomized double-blind comparative trial and assigned to either subcutaneous Pastopoitin (n = 50) or Eprex (n = 57). Each study group received rHuEPO at a dose of 80–120 IU/kg/week in 2–3 divided doses for a period of 3 months. Hematologic parameters including Hemoglobin, hematocrit, RBC, EBC, platelet, MCV, MCH and MCHC were checked every 2 weeks. Blood iron, ferritin, TIBC, creatinine, BUN and electrolytes (Na, K, Ca and P) were evaluated monthly over the 3 months. Results: A significant increase in hemoglobin, hematocrit and RBC was observed by the end of study in both Pastopoitin and Eprex groups (p < 0.001). However, these factors were not significantly different between the groups, neither at baseline nor at the end of study (p > 0.05). Likewise, the groups were comparable regarding MCV, MCH, MCHC, iron, ferritin, TIBC, creatinine, BUN and electrolytes at baseline as well as at the end of trial. Adverse events were not serious and occurred with the same frequency in the study groups. Conclusion: Pastopoitin showed comparable efficacy and safety profile with Eprex in anemic patients on hemodialysis. Hence, Pastopoitin may be considered as a rHuEPO with a lower cost and wider availability compared with the innovator product Eprex.     

An Investigation of the Effects of Curcumin on Anxiety and Depression in Obese Individuals: A Randomized Controlled Trial

Objective: To investigate the effectiveness of curcumin, a natural polyphenolic compound with antioxidant and anti-inflammatory activities, on the frequency of symptoms of anxiety and depression in obese individuals. Methods: In this double blind, cross-over trial, 30 obese subjects were randomized to receive either curcumin (1 g/day) or placebo for a period of 30 days. Following a wash-out interval of 2 weeks, each subject was crossed over to the alternative regimen for a further 30 days. Severity of anxiety and depression was assessed at baseline and at weeks 4, 6 and 10 of the trial using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scales, respectively. Results: Mean BAI score was found to be significantly reduced following curcumin therapy (P=0.03). However, curcumin supplementation did not exert any significant impact on BDI scores (P=0.7). Conclusion: Curcumin has a potential anti-anxiety effect in individuals with obesity.