Nesting chinstrap penguins accrue large quantities of sleep through seconds-long microsleeps

Microsleeps, the seconds-long interruptions of wakefulness by eye closure and sleep-related brain activity, are dangerous when driving and might be too short to provide the restorative functions of sleep. If microsleeps do fulfill sleep functions, then animals faced with a continuous need for vigilance might resort to this sleep strategy. We investigated electroencephalographically defined sleep in wild chinstrap penguins, at sea and while nesting in Antarctica, constantly exposed to an egg predator and aggression from other penguins. The penguins nodded off >10,000 times per day, engaging in bouts of bihemispheric and unihemispheric slow-wave sleep lasting on average only 4 seconds, but resulting in the accumulation of >11 hours of sleep for each hemisphere. The investment in microsleeps by successfully breeding penguins suggests that the benefits of sleep can accrue incrementally.

Cluster Analysis of DSC MRI, Dynamic Contrast-Enhanced MRI, and DWI Parameters Associated with Prognosis in Patients with Glioblastoma after Removal of the Contrast-Enhancing Component: A Preliminary Study

BACKGROUND AND PURPOSE

No report has been published on the use of DSC MR imaging, DCE MR imaging, and DWI parameters in combination to create a prognostic prediction model in glioblastoma patients. The aim of this study was to develop a machine learning-based model to find preoperative multiparametric MR imaging parameters associated with prognosis in patients with glioblastoma. Normalized CBV, volume transfer constant, and ADC of the nonenhancing T2 high-signal-intensity lesions were evaluated using K-means clustering.

MATERIALS AND METHODS

A total of 142 patients with glioblastoma who underwent preoperative MR imaging and total resection were included in this retrospective study. From the normalized CBV, volume transfer constant, and ADC maps, the parametric data were sorted using the K-means clustering method. Patients were divided into training and test sets (ratio, 1:1), and the optimal number of clusters was determined using receiver operating characteristic analysis. Kaplan-Meier survival analysis and log-rank tests were performed to identify potential parametric predictors. A multivariate Cox proportional hazard model was conducted to adjust for clinical predictors.

RESULTS

The nonenhancing T2 high-signal-intensity lesions were divided into 6 clusters. The cluster (class 4) with the relatively low normalized CBV and volume transfer constant value and the lowest ADC values was most associated with predicting glioblastoma prognosis. The optimal cutoff of the class 4 volume fraction of nonenhancing T2 high-signal-intensity lesions predicting 1-year progression-free survival was 9.70%, below which the cutoff was associated with longer progression-free survival. Two Kaplan-Meier curves based on the cutoff value showed a statistically significant difference (P = .037). When we adjusted for all clinical predictors, the cluster with the relatively low normalized CBV and volume transfer constant values and the lowest ADC value was an independent prognostic marker (hazard ratio, 3.04; P = .048). The multivariate Cox proportional hazard model showed a concordance index of 0.699 for progression-free survival.

CONCLUSIONS

Our model showed that nonenhancing T2 high-signal-intensity lesions with the relatively low normalized CBV, low volume transfer constant values, and the lowest ADC values could serve as useful prognostic imaging markers for predicting survival outcomes in patients with glioblastoma.

Paid Sick Leave and Sickness Benefits for employees’ economic and job security: A Scoping Review

 

In health emergencies, such as in the COVID-19 pandemic, the need to expand or introduce the Paid sick leave(PSL) and Sickness benefits(SB) increases. They are key components of the universal health coverage(UHC) and active labor market policies(ALMPs) that enable workers to take care of their health and guarantee return-to-work after recovery. This study examines effects those policies in achieving economic stability and job security of covered workers through a scoping review. Studies were selected using the search terms ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ in PubMed and Web of Science. Our search conducted on 6th April 2021 yielded 1,030 articles, of which 22 articles were included in the review. All articles were analyzed by the 4 sub-groups(employees, families, employers, and government) and we investigated indicators of socio-economic impacts on their lives. Articles are largely PSL(90.9%)-focused. PSL guarantees not only workers’ job security by securing employment agreement, but also their income security by promising part of wages enough to afford healthcare and living expenses during the medical treatment and recovery. Additionally, PSL attenuates employers’ financial risk, as it reduces presenteeism while increasing the return-to-work rate. Moreover, PSL and SB reduce the total healthcare and social security expenditures of the government. To sum up, PSL and SB guarantee health and labor rights by ensuring income and job security to employees while assuring financial stability to both employers, and the government. However, as the previous studies paid less attention on the equity of these impacts at the system levels, future research should more focus on the dimension.

Key messages

• PSL and SB guarantee health and labour rights by ensuring income and job security for employees, while assuring financial stability for both employers and the government.

• The previous studies that examined the effects of PSL and SB paid less attention on the equity of ensuring income and employment security, therefore future studies should focus more on this dimension.

The paid sick leave and sickness benefits for universal health coverage: a scoping review

Background

The countries with paid sick leave (PSL) and sickness benefits (SB) mostly provide the benefit coverage to specific categories of workers, which results in health inequalities among employees in COVID-19. The PSL and SB are key factors to achieve universal health coverage (UHC) in that they protect access to healthcare and improve population health. This study attempted to investigate whether the policies helped achieve the UHC when they were expanded.

Methods

This review followed the scoping review protocol of PRISMA-ScR. On April 6, 2021, we extracted the literature using the keywords ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ from PubMed and Web of Science and added two studies through hand-search. All articles were written in English. We did not limit the publication date.

Results

Forty-four selected studies were based in four single countries and the European Union. Most of the studies were published after 2010 (84.1%) and were conducted as cross-sectional (72.7%) studies. Not only workers who use PSL and SB but also children whose parents use PSL and SB increased their use of healthcare services and getting flu shots. Also, using PSL and SB decreased their unmet healthcare needs and emergency use. The various health status factors, such as infectious disease incidence, mortality, and presenteeism, also decreased.

Conclusions

The provisions of PSL and SB offer individual and public health benefits by allowing employees and their families to use healthcare services. Group of employees, we can expect similar public health impacts on newly covered groups, thus contributing to achieving the UHC. Since more than 90% of articles are published from the United States, future studies need to evaluate the outcomes of health effects in various European or Asian countries.

Key messages

• The provision of PSL and SB positively affects employees and their families by allowing them to use healthcare services.

• The expansion of PSL and SB contributes to the UHC by guaranteeing indirect medical costs that enable universal access to essential healthcare services.

A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul

 

South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea.

Key messages

• Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed.

• By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.

Inequalities in adverse birth outcomes and survival in early childhood: birth cohort in South Korea

Background

Adverse birth outcomes (ABOs) are considered the most common factor of deaths in early childhood. Inequalities in child mortality occur due to interactions between intrinsic and socio-environmental factors related to socioeconomic disadvantage. There are, however, few studies investigating the impact of ABOs on mortality in terms of parental SEP.

Methods

Using the Under-5 Infant Birth-Death Cohort Data in Korea, a pooled retrospective birth cohort of all children born in 2012-2014 was built (N = 1,356,584). We analyzed neonatal, post-neonatal, and childhood mortality by ABOs and with the interaction of parental SEP using the Cox proportional hazard regression model for survival analyses. We further stratified the analysis both by parental SEP and child age. Multiple logistic regression was performed to confirm the social inequalities in ABO itself.

Results

After adjusting for covariates, children born with ABOs presented higher risk of mortality for all periods. For post-neonatal period, lower maternal education showed significant interaction effect with LBW (HR = 0.57; 95% CI = [0.39-0.85]), PTB (HR = 0.53; 95% CI = [0.33-0.86]), LBW & PTB ([HR = 0.67; 95% CI = [0.54-0.83]) while lower paternal education (HR = 0.67; 95% CI = [0.54-0.82]) and maternal unemployment (HR = 0.80; 95% CI = [0.63-0.99]) showed significance for babies with LBW & PTB. However, stratification analyses suggested that the impact of ABOs on mortality was greater for children born to lower parental SEP in neonatal period. Meanwhile apparent social inequalities in ABOs were suggested from regression analyses.

Conclusions

We confirmed social inequalities in the incidence of ABOs as well as mortalities from ABOs. However, the difference in mortality between babies with and without ABOs was greater for advantaged children. Policies to reduce the mortality of children with ABOs as well as those of healthy children among socioeconomically disadvantaged families are required.

Key messages

• Social inequalities in mortality from ABOs were apparent especially in the neonatal period while the incidence of ABOs itself was greater among children from disadvantaged families.

• Disadvantaged children are more likely to die not only from ABOs but also from other socio-environmental determinants, especially in the post-neonatal period than their counterparts.

Myocardial extracellular space expansion is related to burden of premature ventricular contractions in patients with hypertrophic cardiomyopathy without non-sustained ventricular tachycardia

Funding Acknowledgements

Type of funding sources: None.

Background

Current guidelines suggest the presence of non-sustained ventricular tachycardia (NSVT) as a risk factor of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, high burden of premature ventricular contraction (PVC) may reflect myocardial fibrosis although the absence of NSVT.

Purpose

We investigated the association between PVC burden and myocardial extracellular space expansion in HCM patients without NSVT.

Methods

Of the 212 patients prospectively enrolled to the HCM registry of genetics, 84 patients were evaluated with both cardiac magnetic resonance and 24hr holter. Among them, 71 patients (58 males, mean age: 71 ± 13 years) have not been diagnosed with NSVT.

Results

Patients with NSVT (n = 13) showed more impaired LA functional indices and higher myocardial fibrosis burden compared with patients without NSVT (n = 71). Among patients who have not been diagnosed with NSVT, patients with late gadolinium enhancement (LGE, n = 46) had a higher total beats (109 ± 332 vs. 7 ± 13 beats per a day, p = 0.003) and burden (0.114 ± 0.225 vs. 0.008 ± 0.014 %, p = 0.003) of PVC during 24-hour compared with patients without LGE (n = 25). %LGE was correlated with total beats of PVC (r = 0.358, p = 0.002) and PVC burden (r = 0.377, p = 0.001). ECV also correlated with total beats of PVC (r = 0.387, p = 0.001) and PVC burden (r = 0.401, p = 0.001). The optimal cutoff value for PVC number was 45 (37.0% of sensitivity and 100% of specificity) with 0.733 of the area under the ROC curve (p < 0.001). Pathogenic or likely pathogenic sarcomere mutation was higher in NSVT group than no NSVT group (p < 0.05), and had a higher tendency in higher PVC burden group (0.05 < p < 0.1) than lower PVC burden group.

Conclusions

Total beats and burden of PVC are significantly related to increase in myocardial fibrosis in HCM patients without NSVT.

Abstract Figure. Mechanism of ventricular arrhythmia

Non-full-length Water-Soluble CXCR4QTY and CCR5QTY Chemokine Receptors: Implication for Overlooked Truncated but Functional Membrane Receptors

It was posited that functionalities of GPCRs require full-length sequences that are negated by residue deletions. Here we report that significantly truncated nfCCR5^QTY and nfCXCR4^QTY still bind native ligands. Receptor-ligand interactions were discovered from yeast 2-hybrid screening and confirmed by mating selection. Two nfCCR5^QTY (SZ218a, SZ190b) and two nfCXCR4^QTY (SZ158a, SZ146a) were expressed in E. coli. Synthesized receptors exhibited α-helical structures and bound respective ligands with reduced affinities. SZ190b and SZ158a were reconverted into non-QTY forms and expressed in HEK293T cells. Reconverted receptors localized on cell membranes and functioned as negative regulators for ligand-induced signaling when co-expressed with full-length receptors. CCR5-SZ190b individually can perform signaling at a reduced level with higher ligand concentration. Our findings provide insight into essential structural components for CCR5 and CXCR4 functionality, while raising the possibility that non-full-length receptors may be resulted from alternative splicing and that pseudo-genes in genomes may be present and functional in living organisms.

•

Y2H screening reveals ligand interaction from truncated CXCR4 and CCR5 in QTY form

•

Truncated CCR5^QTY and CXCR4^QTY can be produced in E. coli and bind native ligands

•

Reconverted receptors localize on membranes and regulate cell signaling in HEK293

•

Our finding indicates potential presence and function for truncated receptors

Development of comparable algorithms to measure primary care indicators using administrative health data across three Canadian provinces

INTRODUCTION

Performance measurement has been recognized as key to transforming primary care (PC). Yet, performance reporting in PC lags behind even though high-performing PC is foundational to an effective and efficient health care system.

OBJECTIVES

We used administrative data from three Canadian provinces, British Columbia, Ontario and Nova Scotia, to: 1) identify and develop a core set of PC performance indicators using administrative data and 2) examine their ability to capture PC performance.

METHODS

Administrative data used included Physician Billings, Discharge Abstract Database, the National Ambulatory Care and Reporting System database, Census and Vital Statistics. Indicators were compiled based on a literature review of PC indicators previously developed with administrative data available in Canada (n=158). We engaged in iterative discussions to assess data conformity, completeness, and plausibility of results in all jurisdictions. Challenges to creating comparable algorithms were examined through content analysis and research team discussions, which included clinicians, analysts, and health services researchers familiar with PC.

RESULTS

Our final list included 21 PC performance indicators pertaining to 1) technical care (n=4), 2) continuity of care (n=6), and 3) health services utilization (n=11). Establishing comparable algorithms across provinces was possible though time intensive. A major challenge was inconsistent data elements. Ease of data access, and a deep understanding of the data and practice context, was essential for selecting the most appropriate data elements.

CONCLUSIONS

This project is unique in creating algorithms to measure PC performance across provinces. It was essential to balance internal validity of the indicators within a province and external validity across provinces. The intuitive desire of having the exact same coding across provinces was infeasible due to lack of standardized PC data. Rather, a context-tailored definition was developed for each jurisdiction. This work serves as an example for developing comparable PC performance indicators across different provincial/territorial jurisdictions.