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PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255345
Author(s):  
Jean Ferrières ◽  
Victoria Banks ◽  
Demetris Pillas ◽  
Francesco Giorgianni ◽  
Laurene Gantzer ◽  
...  

Background and aims Untreated Familial Hypercholesterolemia (FH) leads to premature morbidity and mortality. In France, its epidemiology and management are understudied in ambulatory care. We described the clinical profile, pharmacological management, and clinical outcomes in a French sample of FH patients. Methods This was a retrospective longitudinal study on patients from The Health Improvement Network (THIN®) database in France, between October 2016-June 2019. Patients ≥18 years, with probable/definite FH based on the Dutch Lipid Clinic Network (DLCN) criteria were included. Baseline characteristics, lipid profile, lipid-lowering therapy (LLT), low-density lipoprotein-cholesterol (LDL-C) goal achievement; and disease management at 6-month of follow-up were analyzed. Results 116 patients with probable (n = 70)/definite (n = 46) FH were included (mean age:57.8±14.0 years; 56.0% women; 9.5% with personal history of cardiovascular events); 90 patients had data available at follow-up. At baseline, 77.6% of patients had LDL-C>190 mg/dL, 27.6% were not receiving LLTs, 37.9% received statins alone, 20.7% statins with other LLTs, and 7.7% other LLTs. High-intensity statins were prescribed to 11.2% of patients, 30.2% received moderate-intensity statins, and 8.6% low-intensity statins. Only 6.0% of patients achieved LDL-C goal. At 6-month of follow-up, statins discontinuation and switching were 22.7% and 2.3%, respectively. None of the patients received proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors at baseline nor follow-up. Conclusions Despite the existence of effective LLTs, FH patients are suboptimally-treated, do not achieve LDL-C goal, and exhibit worsened pharmacological management over time. Future studies with longer follow-up periods and assessment of factors affecting LDL-C management, including lifestyle and diet, are needed.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255543
Author(s):  
Zhijun Wu

Since the outbreak of the global COVID-19 pandemic, social distancing has been known to everyone and recommended almost everywhere everyday. Social distancing has been and will be one of the most effective measures and sometimes, the only available one for fighting epidemics and saving lives. However, it has not been so clear how social distancing should be practiced or managed, especially when it comes to regulating everyone’s otherwise normal social activities. The debate on how to implement social distancing often leads to a heated political argument, while research on the subject is lacking. This paper is to provide a theoretical basis for the understanding of the scientific nature of social distancing by considering it as a social dilemma game played by every individual against his/her population. From this perspective, every individual needs to make a decision on how to engage in social distancing, or risk being trapped into a dilemma either exposing to deadly diseases or getting no access to necessary social activities. As the players of the game, the individual’s decisions depend on the population’s actions and vice versa, and an optimal strategy can be found when the game reaches an equilibrium. The paper shows how an optimal strategy can be determined for a population with either closely related or completely separated social activities and with either single or multiple social groups, and how the collective behaviors of social distancing can be simulated by following every individual’s actions as the distancing game progresses. The simulation results for populations of varying sizes and complexities are presented, which not only justify the choices of the strategies based on the theoretical analysis, but also demonstrate the convergence of the individual actions to an optimal distancing strategy in silico and possibly in natura as well, if every individual makes rational distancing decisions.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255607
Author(s):  
Maya Kanno ◽  
Mana Doi ◽  
Kazumi Kubota ◽  
Yuka Kanoya

Postoperative delirium (POD) and subsyndromal delirium (SSD) among older patients is a common, serious condition associated with a high incidence of negative outcomes. However, there are few accurate methods for the early detection of POD and SSD in surgical wards. This study aimed to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward. This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Delirium symptoms were assessed using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint and bed sensor were collected from medical records. Multiple logistic regression analyses were conducted to identify the risk factors for both POD and SSD. A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD (n = 4) and SSD (n = 15). The use of bed sensors (odds ratio 10.2, p = .001) was identified as a risk factor for both POD and SSD. Our findings suggest that the use of bed sensors might be related to the development of both POD and SSD among older patients in surgical wards.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255496
Author(s):  
Ross Ensley ◽  
Richard D. Hansen ◽  
Carlos Morales-Aguilar ◽  
Josie Thompson

This paper classifies the karst landscapes of the Petén Plateau and defines the Mirador-Calakmul Karst Basin by illustrating the distribution of its karst hydrologic features. Archaeological and spatial research of the Mirador-Calakmul area of Guatemala and Mexico has shown it to be a karst basin with geopolitical implications. Current research characterizes the karst landscapes of the Petén Plateau, maps the distribution of karst hydrologic features, and delineates the basin in geomorphological terms. To further this aim, multiple forms of remote sensing data including orthophotographs, a satellite Digital Elevation Model, satellite multispectral images, and Light Detection and Ranging (LiDAR) data have been integrated to interpret the karst features in the study area. Outcrop study and thin section analysis of the upper Buena Vista Formation document that the dominant lithologies are a shallow water algal boundstone interbedded with terrestrial caliche. Karst landforms have been mapped over the Petén Plateau and we identify five karst landscapes, the largest of which is a fluviokarst landscape dominated by karst valleys. We further map karst hydrologic features including seasonal swamps, dolines, intermittent lakes, intermittent streams, solution-enhanced fractures, and springs all of which are characteristic of drainage basins. Boundaries of the karst basin are mapped from multiple lines of evidence including distribution of the karst valleys, a line of springs along the western boundary of the fluviokarst landscape, and a surface drainage analysis. We capture and classify hydrologic data points and develop a regional groundwater map that indicates subsurface flow from east to west within the basin. A drainage map illustrates the extensive system of karst valleys, boundaries, and inferred groundwater flow paths of the Mirador-Calakmul Karst Basin. It was within this geomorphological setting that the ancient Maya developed an extensive civilization during the Middle and Late Preclassic periods (1000 BCE-150 CE).


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255110
Author(s):  
Kazi Ahsan Habib ◽  
Amit Kumer Neogi ◽  
Muntasir Rahman ◽  
Jina Oh ◽  
Youn-Ho Lee ◽  
...  

The present study aims to apply a DNA barcoding tool through amplifying two mitochondrial candidate genes i.e., COI and 16S rRNA for accurate identification of fish, aquatic molluscs and crustaceans of Sundarbans mangrove wetland, to build a reference library of fish and shellfishes of this unique ecosystems. A total of 185 mitochondrial COI barcode sequences and 59 partial sequences of the 16S rRNA gene were obtained from 120 genera, 65 families and 21 orders of fish, crustaceans and molluscs. The collected samples were first identified by examining morphometric characteristics and then assessed by DNA barcoding. The COI and 16S rRNA sequences of fishes and crustaceans were clearly discriminated among genera in their phylogenies. The average Kimura two-parameter (K2P) distances of COI barcode sequences within species, genera, and families of fishes are 1.57±0.06%, 15.16±0.23%, and 17.79±0.02%, respectively, and for 16S rRNA sequences, these values are 1.74±.8%, 0.97±.8%, and 4.29±1.3%, respectively. The minimum and maximum K2P distance based divergences in COI sequences of fishes are 0.19% and 36.27%, respectively. In crustaceans, the K2P distances within genera, families, and orders are 1.4±0.03%, 17.73±0.15%, and 22.81±0.02%, respectively and the minimum and maximum divergences are 0.2% and 33.93%, respectively. Additionally, the present study resolves the misidentification of the mud crab species of the Sundarbans as Scylla olivacea which was previously stated as Scylla serrata. In case of molluscs, values of interspecific divergence ranges from 17.43% to 66.3% in the barcoded species. The present study describes the development of a molecular and morphometric cross-referenced inventory of fish and shellfish of the Sundarbans. This inventory will be useful in future biodiversity studies and in forming future conservation plan.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255193
Author(s):  
Yoshiko Kawaguchi ◽  
Ahmad M. Sayed ◽  
Alliya Shafi ◽  
Sengchanh Kounnavong ◽  
Tiengkham Pongvongsa ◽  
...  

Background Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities. Methods A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model. Results Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs’ assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD. Conclusions Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252156
Author(s):  
Roberta Facioli ◽  
Fernando Henrique Lojudice ◽  
Ana Carolina Anauate ◽  
Edgar Maquigussa ◽  
José Luiz Nishiura ◽  
...  

Background Kidney organoids have been broadly obtained from commercially available induced pluripotent stem cells (iPSCs); however, it has been a great challenge to efficiently produce renal organoid models from patients with autosomal dominant polycystic kidney disease (ADPKD) that recapitulate both embryogenesis and the mechanisms of cystogenesis. Methods Blood erythroid progenitors (EPs) from two ADPKD patients and one healthy donor (HC) was used as a comparative control to normalize the many technical steps for reprogramming EPs and for the organoids generation. EPs were reprogrammed by an episomal vector into iPSCs, which were differentiated into renal tubular organoids and then stimulated by forskolin to induce cysts formation. Results iPSCs derived from EPs exhibited all characteristics of pluripotency and were able to differentiate into all three germ layers. 3D tubular organoids were generated from single cells after 28 days in Matrigel. HC and ADPKD organoids did not spontaneously form cysts, but upon forskolin stimulation, cysts-like structures were observed in the ADPKD organoids but not in the HC-derived organoids. Conclusion The findings of this study showed that kidney organoids were successfully generated from the blood EP cells of ADPKD patients and a healthy control donor. This approach should contribute as a powerful tool for embryonic kidney development model, which is able to recapitulate the very early pathophysiological mechanisms involved in cytogenesis.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255128
Author(s):  
Maki Nagaoka ◽  
Zenta Hashimoto ◽  
Hiroyoshi Takeuchi ◽  
Mitsuhiro Sado

Objective To assess the effectiveness of mindfulness-based interventions on people with dementia and mild cognitive impairment. Methods We searched several electronic databases, namely Cochrane Library, EMBASE, and MEDLINE with no limitations for language or document type (last search: 1 February 2020). Randomized controlled trials of mindfulness-based interventions for people with dementia and mild cognitive impairment compared to active-control interventions, waiting lists, or treatment as usual were included. Predefined outcomes were anxiety symptoms, depressive symptoms, cognitive function, quality of life, mindfulness, ADL and attrition. We used the random effects model (DerSimonian-Laird method) for meta-analysis, reporting effect sizes as Standardized Mean Difference. Heterogeneity was assessed with the I2 statistics. Results Eight randomized controlled trials, involving 276 patients, met the eligibility criteria and were included in the meta-analysis. We found no significant effects for mindfulness-based interventions in either the short-term or the medium- to long-term on any outcomes, when compared with control conditions. The number of included studies and sample sizes were too small. Additionally, the quality of evidence was low for each randomized controlled trial included in the analysis. This is primarily due to lack of intent-to-treat analysis, high risk of bias, and imprecise study results. The limited statistical power and weak body of evidence prevented us from reaching firm conclusions. Conclusions We found no significant effects of mindfulness-based interventions on any of the outcomes when compared with control conditions. The evidence concerning the efficacy of mindfulness-based interventions in this population is scarce in terms of both quality and quantity. More well-designed, rigorous, and large-scale randomized controlled trials are needed.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0253873
Author(s):  
Hanxuan Yang ◽  
Wei Xiong ◽  
Xueliang Zhang ◽  
Kai Wang ◽  
Maozai Tian

Online social networks like Twitter and Facebook are among the most popular sites on the Internet. Most online social networks involve some specific features, including reciprocity, transitivity and degree heterogeneity. Such networks are so called scale-free networks and have drawn lots of attention in research. The aim of this paper is to develop a novel methodology for directed network embedding within the latent space model (LSM) framework. It is known, the link probability between two individuals may increase as the features of each become similar, which is referred to as homophily attributes. To this end, penalized pair-specific attributes, acting as a distance measure, are introduced to provide with more powerful interpretation and improve link prediction accuracy, named penalized homophily latent space models (PHLSM). The proposed models also involve in-degree heterogeneity of directed scale-free networks by embedding with the popularity scales. We also introduce LASSO-based PHLSM to produce an accurate and sparse model for high-dimensional covariates. We make Bayesian inference using MCMC algorithms. The finite sample performance of the proposed models is evaluated by three benchmark simulation datasets and two real data examples. Our methods are competitive and interpretable, they outperform existing approaches for fitting directed networks.


PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254628
Author(s):  
Yasunari Haseda ◽  
Lisa Munakata ◽  
Chiyo Kimura ◽  
Yumi Kinugasa-Katayama ◽  
Yasuko Mori ◽  
...  

Most current clinical vaccines work primarily by inducing the production of neutralizing antibodies against pathogens. Vaccine adjuvants that efficiently induce T cell responses to protein antigens need to be developed. In this study, we developed a new combination adjuvant consisting of 1,2-dioleoyl-3-trimethylammonium propane (DOTAP), D35, and an aluminum salt. Among the various combinations tested, the DOTAP/D35/aluminum salt adjuvant induced strong T cell and antibody responses against the model protein antigen with a single immunization. Adjuvant component and model antigen interaction studies in vitro also revealed that the strong mutual interactions among protein antigens and other components were one of the important factors for this efficient immune induction by the novel combination adjuvant. In addition, in vivo imaging of the antigen distribution suggested that the DOTAP component in the combination adjuvant formulation elicited transient antigen accumulation at the draining lymph nodes, possibly by antigen uptake DC migration. These results indicate the potential of the new combination adjuvant as a promising vaccine adjuvant candidate to treat infectious diseases and cancers.


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