bluuebunny/crossref_metadata_2025 huggingface dataset:
It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria
Authors: Ajisegiri Whenayon Simeon , Peiris David , Abimbola Seye , Odusanya Olumuyiwa O , Tesema Azeb Gebresilassie , Joshi Rohina , Angell Blake
Published: October 2022

Introduction

Community health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery.

Methods

A discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated.

Results

About 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the ‘opportunity to convert from CHW to another cadre of health workers, such as nursing’ was the most important motivator among the volunteers’ CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs.

Conclusion

CHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.
Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review
Authors: Gill Angus , Ackermann Khalia , Hughes Clifford , Lam Vincent , Li Ling
Published: October 2022

Objectives

To investigate whether adding lactate to the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) improves the prediction of mortality in adult hospital patients, compared with qSOFA alone.

Design

Systematic review in accordance with Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines.

Data sources

Embase, Medline, PubMed, SCOPUS, Web of Science, CINAHL and Open Grey databases were searched in November 2020.

Eligibility criteria

Original research studies published after 2016 comparing qSOFA in combination with lactate (LqSOFA) with qSOFA alone in adult patients with sepsis in hospital. The language was restricted to English.

Data extraction and synthesis

Title and abstract screening, full-text screening, data extraction and quality assessment (using Quality Assessment of Diagnostic Accuracy Studies-2) were conducted independently by two reviewers. Extracted data were collected into tables and diagnostic test accuracy was compared between the two tests.

Results

We identified 1621 studies, of which 11 met our inclusion criteria. Overall, there was a low risk of bias across all studies. The area under the receiver operating characteristic (AUROC) curve for qSOFA was improved by the addition of lactate in 9 of the 10 studies reporting it. Sensitivity was increased in three of seven studies that reported it. Specificity was increased in four of seven studies that reported it. Of the six studies set exclusively within the emergency department, five published AUROCs, all of which reported an increase following the addition of lactate. Sensitivity and specificity results varied throughout the included studies. Due to insufficient data and heterogeneity of studies, a meta-analysis was not performed.

Conclusions

LqSOFA is an effective tool for identifying mortality risk both in adult inpatients with sepsis and those in the emergency department. LqSOFA increases AUROC over qSOFA alone, particularly within the emergency department. However, further original research is required to provide a stronger base of evidence in lactate measurement timing, as well as prospective trials to strengthen evidence and reduce bias.

PROSPERO registration number

CRD42020207648.
What is the impact of introducing a non-clinical community health advice and navigation service on the demand for primary care in socially deprived areas? Evidence from an observational panel study with difference-in-differences design
Authors: Wild Eva-Maria , Winter Vera , Ress Vanessa , Golubinski Veronika
Published: October 2022

Objectives

To examine the effect of introducing a non-clinical community health advice and navigation service on the demand for primary care in a socially deprived area.

Design

Observational panel study with difference-in-differences design. We conducted fixed-effects negative binomial regressions to compare changes in the number of visits to general practitioners (GPs) in individuals who visited the health advice and navigation service and a matched control group of individuals who did not visit the service. In addition, we analysed the effects of visiting the service multiple times.

Setting and participants

Our empirical setting is a socially deprived urban area in Germany with a multicultural population of about 110 000 people. Our analyses are based on patient data (N=1044) from a non-clinical community health advice and navigation service and from two statutory health insurers.

Outcome measures

Patient demand for primary care measured as the number of visits to GPs before and after the first visit to the health advice and navigation service.

Results

Visiting the service for the first time significantly decreased the number of GP visits compared with the control group (β=−0.113, p<0.1). Each additional visit to the service, however, significantly decreased the effect of the first visit (β=0.037, p<0.05).

Conclusions

Our findings suggest that non-clinical community health advice and navigation services can serve as a low-threshold first point of contact. As first point contact, such services might possibly reduce the burden of primary care physicians in socially deprived areas. At the same time, such services might function as a gateway to accessing the health system, reducing unmet care needs and stimulate demand. Ongoing counselling in the service can identify medical needs that require a physician visit. Our findings may be useful for policymakers and healthcare leaders seeking to reduce the demand on the primary care workforce and can stimulate further research in this area.
Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention
Authors: Miller Rachael Lucia , Barnes Jonathan David , Mouton Ronelle , Braude Philip , Hinchliffe Robert
Published: October 2022

Objectives

Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of future studies focused on optimising CGA as a complex intervention.

Setting

A systematic review of randomised controlled trials.

Participants

A systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021.

Interventions

Any randomised controlled trials of perioperative CGA versus ‘standard care’ were included.

Outcome measures

Qualitative description of CGA.

Results

12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention.

Conclusions

CGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the intervention and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention as well as measuring adherence within trials.

PROSPERO registration number

CRD42020221797.
Combining precision oncology and immunotherapy by targeting the MALT1 protease
Authors: Mempel Thorsten R , Krappmann Daniel
Published: October 2022

An innovative strategy for cancer therapy is to combine the inhibition of cancer cell-intrinsic oncogenic signaling with cancer cell-extrinsic immunological activation of the tumor microenvironment (TME). In general, such approaches will focus on two or more distinct molecular targets in the malignant cells and in cells of the surrounding TME. In contrast, the protease Mucosa-associated lymphoid tissue protein 1 (MALT1) represents a candidate to enable such a dual approach by engaging only a single target. Originally identified and now in clinical trials as a lymphoma drug target based on its role in the survival and proliferation of malignant lymphomas addicted to chronic B cell receptor signaling, MALT1 proteolytic activity has recently gained additional attention through reports describing its tumor-promoting roles in several types of non-hematological solid cancer, such as breast cancer and glioblastoma. Besides cancer cells, regulatory T (Treg) cells in the TME are particularly dependent on MALT1 to sustain their immune-suppressive functions, and MALT1 inhibition can selectively reprogram tumor-infiltrating Treg cells into Foxp3-expressing proinflammatory antitumor effector cells. Thereby, MALT1 inhibition induces local inflammation in the TME and synergizes with anti-PD-1 checkpoint blockade to induce antitumor immunity and facilitate tumor control or rejection. This new concept of boosting tumor immunotherapy in solid cancer by MALT1 precision targeting in the TME has now entered clinical evaluation. The dual effects of MALT1 inhibitors on cancer cells and immune cells therefore offer a unique opportunity for combining precision oncology and immunotherapy to simultaneously impair cancer cell growth and neutralize immunosuppression in the TME. Further, MALT1 targeting may provide a proof of concept that modulation of Treg cell function in the TME represents a feasible strategy to augment the efficacy of cancer immunotherapy. Here, we review the role of MALT1 protease in physiological and oncogenic signaling, summarize the landscape of tumor indications for which MALT1 is emerging as a therapeutic target, and consider strategies to increase the chances for safe and successful use of MALT1 inhibitors in cancer therapy.
Use of a bDMARD or tsDMARD for the management of inflammatory arthritis under checkpoint inhibitors: an observational study
Authors: De La Fuente Fanny , Belkhir Rakiba , Henry Julien , Nguyen Chi Duc , Pham Thao , Germain Vincent , Gavand Pierre Edouard , Labadie Céline , Briere Claire , Lauret Ambre , Cardon Thierry , Mouterde Gael , Bonnet Isabelle , Rouxel Léa , Truchetet Marie-Elise , Schaeverbeke Thierry , Richez Christophe , Kostine Marie
Published: October 2022

Objective

There is limited experience regarding the use of biological disease-modifying antirheumatic drug (bDMARD) and JAK inhibitor (JAKi) for the management of immune checkpoint inhibitors (ICI)-induced inflammatory arthritis. We aimed to assess their efficacy and safety in this setting.

Methods

Using the Club Rhumatismes and Inflammation French network, we conducted a multicentre, retrospective, observational study of patients with cancer diagnosed with inflammatory arthritis under ICI(s) and treated with bDMARD or JAKi. Clinical data were collected using a standardised case report form.

Results

Twenty patients (60% men, median age 69.5 years) were included, with rheumatoid arthritis (RA)-like (n=16), polymyalgia rheumatica-like (n=2) or psoriatic arthritis-like (n=2) clinical presentation. Two patients had pre-existing RA. 90% were treated with glucocorticoids as first-line therapy and 60% received methotrexate prior to bDMARD or JAKi. Anti-interleukin-6 receptor (IL-6R) therapy was used in 13/20 patients (65%), leading to clinical improvement in 11/13 patients (85%), but one patient experienced intestinal perforation and cancer progression was noticed in 6/13 patients (46%). Tumour necrosis factor inhibitors were used in 5/20 patients (25%), with improvement in 4/5 patients (80%) and cancer progression was observed in 3/5 patients (60%). Two infections (diverticulitis and pneumonitis) were reported. Anakinra, baricitinib and ustekinumab were each used in one patient. Median duration of the bDMARD or JAKi was 17 weeks.

Conclusion

Anti-IL-6R therapy is currently the most common strategy in patients with ICI-induced inflammatory arthritis and insufficient response to glucocorticoids and methotrexate, leading to improvement in >80%. Overall, cancer progression occurred in about half of patients and whether the bDMARD/JAKi impacted the tumour response remains to be determined.
Comparative study of the effects of high- versus low-dose zinc oxide in the diet with or without probiotic supplementation on weaning pigs' growth performance, nutrient utilization, fecal microbes, noxious gas discharges, and fecal score
Authors: Biswas Sarbani , Kim Min Hee , Park Jae Hong , Kim Yangseon , Kim In Ho
Published: October 2022

This study was conducted to determine the effects of high- versus low-dose (3000  vs. 300) zinc oxide (ZnO) in combination with or without a probiotic complex (0.1%) on weaned piglet production efficiency, nutrient absorption, fecal bacterial counts, noxious gas emissions, and fecal score. A 42-day experiment included 180 crossbred weaned piglets [Duroc × (Yorkshire × Landrace); 28 days old; 6.61 ± 1.29 kg] and four dietary treatments. An HZ (high ZnO) diet increased body weight at week 6, average daily gain at week 3, week 6, and overall period, and gain-to-feed ratio (G:F) at week 3 compared with an LZ (low ZnO) diet. G:F tended to increase with the LZP (LZ with probiotic) diet compared with the HZP (HZ with probiotic) diet at week 1. Escherichia coli count decreased by HZ diet compared with the LZ diet. In addition, E. coli count decreased and Lactobacillus count increased with the HZP diet compared with the LZP diet. There was no effect of treatment on nutrient digestibility, noxious gas emission, and fecal score. No interactive effect was seen between ZnO and probiotic. Therefore, high-dose ZnO inclusion improved growth performance and probiotic addition improved fecal microbiota, but no synergistic effect was found from ZnO and probiotic complex interaction.
Research on the Effect Evaluation and the Time-series Evolution of Public Culture's Internet Communication under the Background of New Media: Taking the Information Dissemination of Red Tourism Culture as an Example
Authors: Feng Xin , Wang Xu , Zhang Yue
Published: October 2022

The emergence of new online media has promoted the communication of public cultural information, and systematic evaluation of its communication effectiveness has become an increasingly important research topic. This article aims to enrich and improve the evaluation index system for the effect of public cultural network communication and provide suggestions for improving the effect of public cultural network communication and constructing a good communication ecology. Based on factors such as propagation force, guiding force, and influence, this article crawled 78,140 pieces multi-source heterogeneous of nine Altmetrics index data from Sina Weibo, Baidu, Sogou, Bilibili, and other platforms, constructs the evaluation index system of public culture network communication effect under the background of new media, and quantifies and analyzes the network communication effect of red public culture in Beijing-Tianjin-Hebei. On this basis, the time-series evolution of communication effect is modeled and analyzed, and the law of communication is found systematically. The study finds that the communicating effect of red public culture varies significantly and has a large room for improvement overall; the communicating effect improves steadily with seasonal changes, and the communicating effect in summer and autumn is better than the other two seasons; the Autoregressive Integrated Moving Average (1,1,1) model can better present the dynamic changes of cultural communication system after the first-order difference of the time-series data. This article innovatively embeds the Beijing-Tianjin-Hebei red culture in the public cultural construction system and research system, and a comprehensive communication effect evaluation index system is constructed to measure the effect of public culture network communication under the background of new media and analyze its dynamic evolution.
Sharp Interface Methods for Simulation and Analysis of Free Surface Flows with Singularities: Breakup and Coalescence
Authors: Anthony Christopher R. , Wee Hansol , Garg Vishrut , Thete Sumeet S. , Kamat Pritish M. , Wagoner Brayden W. , Wilkes Edward D. , Notz Patrick K. , Chen Alvin U. , Suryo Ronald , Sambath Krishnaraj , Panditaratne Jayanta C. , Liao Ying-Chih , Basaran Osman A.
Published: October 2022

A common feature of many free surface flows—drop/bubble breakup or coalescence and film/sheet rupture—is the occurrence of hydrodynamic singularities. Accurately computing such flows with continuum mechanical, multidimensional free surface flow algorithms is a challenging task given these problems’ multiscale nature, which necessitates capturing dynamics occurring over disparate length scales across 5–6 orders of magnitude. In drop breakup, the thinning of fluid threads that form and eventually pinch-off must be simulated until the thread's radius is about 10 nm. When two drops approach one another, the thickness of the fluid film separating them must fall below 10 nm before coalescence is said to have occurred. If the initial drop radii are 1 mm, simulations must remain faithful to the physics as thread radius or film thickness falls from 10−3 m to below 10−8 m. Here we review significant findings in interfacial flows with hydrodynamic singularities spearheaded by sharp interface algorithms. These multidimensional algorithms can achieve resolution that to date has only been possible with the use of simple 1D evolution equations.
Molecular Characteristics and Distribution of Virulence Genes among Staphylococcus aureus Complex Isolates Derived from Vascular Access Infections
Authors: Wong Min Yi , Tseng Yuan-Hsi , Huang Tsung-Yu , Chu Chishih , Lin Bor-Shyh , Huang Yao-Kuang
Published: October 2022

Staphylococcus aureus is a major human pathogen that produces various virulence factors which promote the binding of bacteria to tissues and medical devices such as vascular access devices, thereby developing a wide range of invasive infections. Vascular access serves as an entry site for S. aureus and elevates the risk of infection in the hemodialysis population. Nevertheless, the distribution of virulence genes in Staphylococcus spp. associated with vascular access infections (VAIs) has not been studied previously. In this study, we determined the relationship between the molecular characteristics and virulence profiles of S. aureus isolates obtained from VAIs. We collected isolates from patients with VAIs between August 2017 and December 2020 and further analyzed the molecular characteristics, antimicrobial resistance profiles, and virulence gene distribution in the isolates. Overall, 15 sequence types (STs), including a new ST (ST6892) and 19 spa types, were identified among the 56 isolates. Of the 53 S. aureus isolates, ST8, ST239, ST45, and ST59 were the predominant STs, whereas ST2250 was the only ST in 3 S. argenteus isolates. ST45-SCCmecIV-t026 (abbreviated as ST45-IV-t026), ST59-V-t437, and ST8-IV-t008 were the predominant clones that belonged to agr type I. All isolates harbored clfB and eno, whereas all S. aureus isolates harbored clfA. In addition, 10 Panton-Valentine leucocidin-positive isolates belonged to ST8 and ST59, with ST8-IV-t008 and ST59-V-t437 being the predominant clones. In brief, the distribution of virulence genes associated with STs may assist in the spread of molecular types of Staphylococcus spp.
Antibacterial Efficacy and Healing Potential of Honey from Different Zones in Nigeria on Diabetic-Induced Wound Infection in Wistar Rats
Authors: Agbagwa Obakpororo Ejiro , Ekeke Chimezie , Israel Precious Chidinma
Published: October 2022

There is an increase in drug-resistant strains causing infection, thus making available therapeutics less effective. As resistance increases, modern medicine focuses on the antibacterial potential of natural products, which can aid in wound healing. The present study determined Nigeria honey’s antibacterial efficacy in treating diabetes-induced wound infections in Wistar albino rats. 54 Wistar rats randomly divided into 9 groups of 6 each were used for the study: group I (negative control, no treatment), group II (positive control, diabetes without treatment), group III (diabetes treated with 1% silver sulfadiazine), and groups IV–IX (diabetes treated with different honey samples). Physiochemical analysis and microbiological and antibacterial activity of the honey samples were determined. The treatments were carried out for 17 days, and wound contraction, malondialdehyde (MDA) levels, and catalase activity were measured. Results obtained showed that the most effective honey was DCH (21.5 ± 2.12), followed by HBP + M (15 ± 2.12) and TRB, JS, and HBP (13 ± 2.8; 13 ± 1.41; 13.5 ± 0.71) for antibacterial activity on Staphylococcus aureus. Microbiologically, no coliform was detected in all the samples, confirming the honey’s quality. The amount of lipid peroxidation was raised in the diabetic group with no treatment, 1% silver sulfadiazine group, and JS group, while no significant reduction was observed in other groups. Differences in wound contraction were significantly notable on various days of measurement, day 3 (

p
<
0.002

), day 6 (

p
<
0.046

), and day 9 (

p
=
0.00

). The catalase level in the different treatment groups increased significantly (

p
<
0.05

), implying an antioxidant potential of the different honey samples except for Jos honey. The study concludes that honey infused with moringa was faster and more efficient in healing diabetic wounds than other honey samples and silver sulfadiazine.
Risk of Exposure to Trace Elements through the Application of Facial Makeup Powders
Authors: Saah Selina Ama , Boadi Nathaniel Owusu , Sakyi Patrick Opare , Darko Godfred , Mensah Michael Baah
Published: October 2022

The study aimed to ascertain the levels of trace elements present in the face powders marketed in Ghana. Fifteen different brands of facial makeup powders were purchased from a local market in Ghana. The samples were analyzed using an X-ray fluorescence (XRF) analyzer to determine the concentrations of 16 elements (Pb, As, Hg, Zn, Fe, Mn, Cr, Ti, Cu, Ni, Co, Sb, Cd, Ag, Sn, and Au). The contents of the trace elements were ordered in the following descending order according to the maximum concentrations: Fe > Zn > Ti > Mn > Cr > Hg > As > Pb > Cu, Ni, Co, Sb, Cd, Ag, Sn, and Au. Pearson correlation statistics showed strong positive relationships between Pb and Zn (r = 0.71), Pb and Cr (r = 0.57), Hg and Zn (r = 0.63), Hg and Fe (r = 0.73), Hg and Cr (r = 0.61), Zn and Fe (r = 0.69), Zn and Cr (r = 0.88), Fe and Cr (r = 0.67), and Fe and Ti (r = 0.62). Except for Pb and Cr, all the other elements had their margin of safety (MOS) values less than 100. The hazard indices (HIs) for Pb, Mn, Cr, and Ti were less than 1, indicating no risk. However, the HIs for As, Hg, Zn, and Fe were more than 1, indicating a potential risk of usage in adults. As a result, using face powders could put users at risk of exposure to trace elements. Dermal exposure to trace elements from cosmetics resulted in a lifetime cancer risk (LCR) that was higher than what was considered tolerable (LCR >10−6) due to the presence of Pb, As, and Cr. Mercury was identified as a potential skin sensitizer in the cosmetic samples examined by an exposure-based sensitization quantitative risk assessment (SQRA).
Do Filling Defects of the Vestibule Represent a Neuroradiological Marker for Congenital Cytomegalovirus? A Retrospective Case Series
Authors: Kanona Hala , Jawad Susan , Hare Julie , Mehta Nishchay , Manjaly Joseph G. , Lavy Jeremy , Khalil Sherif , Shaida Azhar , Saeed Shakeel
Published: October 2022

Introduction: The aim of this study was to investigate whether radiological marker(s) of the inner ear can be detected in congenital cytomegalovirus (cCMV) patients with severe-profound sensorineural hearing loss. Methods: A retrospective imaging review of confirmed cCMV paediatric patients that had undergone consecutive cochlear implantation was performed at a tertiary hospital. Available pre- and postoperative imaging was examined, and abnormalities of the labyrinth were catalogued by a consultant neuroradiologist in the study group and control group. Results: Twenty-eight paediatric patients with cCMV having undergone cochlear implantation were identified between the ages of 1–15 years (mean 4.7 years) at the time of implantation. Increased density of the vestibule on computed tomography (CT) or filling defects of the vestibule on magnetic resonance imaging (MRI) were identified in 11 and 4 patients, respectively, of the 24 in the case series. No filling defects were identified in any of the 48 CT and MRI control group. Conclusion: This study demonstrates a potential novel radiological finding of the inner ear of patients with cCMV. With more research, greater onus placed on MRI and CT for inner ear assessment may facilitate early detection and treatment for patients at risk of significant hearing loss. Further prospective studies in this area will help to validate radiological markers in order to establish a comprehensive inner ear classification system for neuroradiological features in cCMV.
External Validity of a Randomized Controlled Trial on Duration of Antibiotics for the Treatment of Gram-Negative Bacteremia
Authors: Turjeman Adi , Koppel Fidi , Franceschini Erica , Yahav Dafna , Dolci Giovanni , Bacca Erica , Babich Tanya , Khazem Ebtehal , Baum Eyal , Nassar Rima , Bitterman Roni , Dishon-Benatta Yael , Hassoun-Kheir Nasreen , Santoro Antonella , Eliakim-Raz Noa , Poran Itamar , Pertzov Barak , Stern Anat , Dickstein Yaakov , Maroun Elias , Raines Marina , Meschiari Marianna , Bishara Jihad , Goldberg Elad , Venturelli Claudia , Sarti Mario , Mussini Cristina , Paul Mical , Leibovici Leonard
Published: October 2022

Introduction: Reports regarding the external validity of randomized controlled trials (RCTs) are scarce. We aimed to assess the population external validity of an investigator-initiated RCT on the duration of antibiotics for the treatment of Gram-negative bacteremia by comparing patients included in the RCT to patients that were not included in the trial. Methods: Hospitalized patients with Gram-negative bacteremia were recruited into an RCT and randomized to receive 7 or 14 days of covering antibiotic therapy in Israel and Italy from 2013 to 2017. In a concomitant observational study, RCT participants were compared with patients who fulfilled the inclusion criteria but were not included in the trial due to participation in other trials, discharge before approached by researchers, refusal to participate, or unwillingness of the treating physician to allow participants’ recruitment. Results: Six hundred and four RCT patients were compared with 613 nonincluded patients. Almost 50% of nonincluded patients (288/613) were dependent on others for activities of daily living at baseline compared to 37.7% of RCT participants (228/604). Dementia was nearly 2-fold more frequent in nonincluded patients than those included (5.9% [36/613] versus 3.6% [22/604], p = 0.07). Patients who were not included in the RCT were more likely to acquire their infection in the hospital (53.3% [327/613] versus 29.1% [176/604], p < 0.001). The primary composite outcome of mortality, clinical failure, readmissions, or extended hospitalization at 90 days occurred in 353 of 613 nonincluded patients (57.6%) compared to 299 of 604 RCT participants (49.6%), p = 0.005. However, on multivariate analysis noninclusion in the RCT was not an independent risk factor for clinical failure and mortality. Conclusions: RCTs, even with broad eligibility criteria, do not represent the whole spectrum of patients and leave out a population with more severe illness for whom the evidence is lacking.
Infliximab Induction Strategies in Corticosteroid-Refractory Acute Severe Ulcerative Colitis: A Case Series and Literature Review
Authors: Antunes Pedro Bernardes , Gonçalves Bruno , Arroja Bruno , Gonçalves Raquel , Leal Tiago
Published: October 2022

Acute severe ulcerative colitis (ASUC) is an emergent medical condition and particularly challenging to treat efficaciously. Infliximab is one of the medical salvage treatment options after corticosteroid refractoriness, but the best induction strategy is not yet defined. With this case series, the authors intend to describe three corticosteroid-refractory ASUC cases with different intensified/accelerated infliximab induction approaches and review the literature on this topic.The first case describes an 18-year-old girl with ASUC at disease onset with rapid progression to toxic megacolon, complicated also with anemia, hypoalbuminemia, and coagulopathy. After corticosteroid failure, both accelerated and intensified (10 mg/kg) infliximab regimen was completed within 11 days, with solid clinical response and colon imaging normalization. Second, we present a 26-year-old male with left-sided ulcerative colitis known for 2 years, under mesalazine, who developed a moderate flare and was started on infliximab after partial and inconsistent response to corticosteroids. During the induction period, he presented this time an ASUC episode, which motivated an early and intensified third dose with good clinical response. Finally, we describe the case of a 78-year-old man with ulcerative proctitis for 12 years presenting ASUC with proximal disease extension as well. After unsatisfactory response to corticosteroids, infliximab was initiated on an accelerated induction regimen, completed in 13 days, with the standard dose, achieving clinical remission. Accelerated or intensified infliximab induction plans are becoming current clinical practice in corticosteroid-refractory ASUC. Current guidelines refer to the possibility of this type of strategies, not determining the optimal regimen due to lack of solid evidence. Literature is mainly based on retrospective studies, not randomized, with heterogeneous groups according to disease severity, and the effect on colectomy rates, mainly on the long term, is not clear. Additional well-supported studies are needed on this subject in order to seek a more widely uniform approach.
Die Pneumektomie ist berechtigt zur radikalen Resektion eines NSCLC – auch bei mediastinalem Lymphknotenbefall
Authors: Lesser Thomas
Published: October 2022

Background: N2 stage disease constitutes approximately 20%–30% of all non-small cell lung cancer (NSCLC). Concurrently, surgery remains the first-choice treatment for patients with N2 NSCLC if feasible. However, the role of pneumonectomy in N2 NSCLC has rarely been investigated and remains controversial Methods: We enrolled 26,798 patients with T1–4N2M0 NSCLC (stage IIIA/IIIB) from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. We compared the overall survival (OS) and cancer-specific survival (CSS) between patients who received pneumonectomy and those who did not receive surgery. The Kaplan–Meier method, Cox regression analyses, and propensity score matching (PSM) were applied to demonstrate the effect of pneumonectomy. Results: Patients receiving pneumonectomy had a significantly better OS and CSS than those without pneumonectomy both before [adjusted-HR (95% CI): 0.461 (0.425–0.501) for OS, 0.444 (0.406–0.485) for CSS] and after PSM [adjusted-HR (95% CI): 0.499 (0.445–0.560) for OS, 0.457 (0.405–0.517) for CSS] with all p-values <0.001. Subgroup analysis demonstrated concordant results stratified by demographic or clinicopathological variables. In sensitivity analysis, no significant difference was observed between patients receiving single pneumonectomy and chemoradiotherapy without surgery in OS and CSS both before [unadjusted-HR (95% CI): 1.016 (0.878–1.176) for OS, 0.934 (0.794–1.099) for CSS, p = 0.832] and after PSM [unadjusted-HR (95% CI): 0.988 (0.799–1.222) for OS, 0.938 (0.744–1.182) for CSS] with all p-values >0.4. Conclusions: For patients with T1–4N2M0 NSCLC (stage IIIA/IIIB), pneumonectomy is an independent protective factor of OS and should be considered when applicable.
MicroRNA-133a-3p Inhibits Lung Adenocarcinoma Development and Cisplatin Resistance through Targeting GINS4
Authors: Zhou Yafu , Yan Jianhua , Chen Huiguo , Zhou Wenwu , Yang Jinsong
Published: October 2022

GINS subunit complex 4 (GINS4) is fundamental to DNA replication and G1/S phase transition of the cell cycle in eukaryotes. Further, recent studies implied that GINS4 can mediate the progression of several tumors, but its mechanism in lung adenocarcinoma (LUAD) is not clarified. Therefore, the role of GINS4 in LUAD was explored. miR-133a-3p and GINS4 mRNA expression were tested through qRT-PCR. Protein levels of the two genes were assayed by Western blot. Their targeting relationship was predicted and verified by bioinformatics prediction and dual-luciferase analysis. The functions of miR-133a-3p and GINS4 in LUAD were evaluated by Transwell, wound healing, CCK-8, and flow cytometry assays. MTT assay and caspase-3 activity detection were utilized to measure the regulation of miR-133a-3p/GINS4 in the cisplatin sensitivity of LUAD cells. The results showed that GINS4 was highly expressed in LUAD cells (p < 0.05). miR-133a-3p, the upstream gene of GINS4 in LUAD, negatively mediated GINS4 expression. Moreover, overexpressing GINS4 enhanced the proliferative, migratory, and invasive abilities of LUAD cells and inhibited cell apoptosis and the sensitivity to cisplatin, while overexpressing miR-133a-3p caused the contrary results. However, the promoting effects of GINS4 overexpression on LUAD could be offset by miR-133a-3p overexpression. miR-133a-3p could regulate malignant behaviors and cisplatin sensitivity of LUAD cells through negatively regulating GINS4. In conclusion, our findings demonstrated that GINS4 was overexpressed in LUAD and promoted the malignant behavior of LUAD cells. Moreover, miR-133a-3p could negatively regulate GINS4, thereby suppressing the malignant progression and increasing the cisplatin sensitivity of LUAD.
Study the dynamic performance of PM machines for different rotor topologies
Authors: Shanshal Abdullah K. , Ali Ahmed J. , AL-Rifaie Alya H.
Published: October 2022

For hybrid and electric vehicle drive-train (automotive applications) achieving high torque and efficiency at a wide range of operating conditions can be considered an important matter. Therefore, precise structure optimization of the permanent magnet synchronous machines (PMSMs) is recommended. Consequently, the effect of the main leading design parameters (such as PM arrangement, magnet thickness, pole arc to pole pitch ratio, airgap length as well as the effect of shaft material) for a different number of rotor poles configuration of PMSM can achieve optimum design results in electric motors with economical cost and excellent performance. This paper submits a comparative analysis of different rotor topologies of (PMSM). Moreover, the dynamic performances of the suggested rotor geometry topologies are investigated based on investigation of finite element analysis (FEA). The analysis offers a piece of complete information about the magnetic flux distribution and magnetic flux density over the motor geometry. Gained results from the analysis are used to give a decision for the selection of a suitable PMSM design.
Torque ripple alleviation of a five-phase permanent magnet synchronous motor using predictive torque control method
Authors: Bahar Saif Talal , Omar Riyadh G.
Published: October 2022

The benefits of a five-phase permanent magnet synchronous motor (five-phase-PMSM) are its compact size, high fault tolerance, low voltage, and high output. The drives of this kind of machines can be enhanced using model predictive torque control (MP-DTC) technique. The outcomes of this technique with additional weighting factors are reduces the complexity of calculation, and reduction in current harmonics, which present in harmonic subspace in standard model predictive torque control. Decrease the low-order harmonic constituents of stator currents and alleviation torque ripple can be achieved by optimizing the objective function. Adding current limitations and switching frequency-weighting factor improves the cost function. The suggested technique can provide superior steady-state performance and keep the quick transient performing as a possible characteristic of the MP-DTC scheme. Thus, with the advantageous steady state and dynamic performing obtained concurrently, the most important aspects of the suggested system are the reduced mathematical burden, and with simplified objective functions compared to classic MP-DTC structure. The proposed method reduced the torque ripple from (3.49%) in a traditional method to (0.58%).
Voltage profile and power quality improvement using multicell dynamic voltage restorer
Authors: Tahar Karim Benamar , Allali Ahmed , Boulouiha Houari Merabet , Denai Mouloud
Published: October 2022

Multi-level converter topologies are increasingly being used in various applications due to their high power, high voltage, and low harmonic levels in the output waveforms. These converter topologies produce different output voltage levels and have a highly modular structure. This paper proposes the design of a dynamic voltage restorer (DVR) based on multilevel topology to enhance the voltage profile and improve the power quality in the network. The DVR is an effective, fast-acting device which detects voltage sags and swells in a transmission line and inject a compensating voltage through a boost transformer. A simulation study is carried out under MATLAB/Simulate to demonstrate the performance of the proposed DVR circuit. The simulation results show improved transient response and enhanced power quality in the transmission network.
Immunomodulatory Cell Therapy Using αGalCer-Pulsed Dendritic Cells Ameliorates Heart Failure in a Murine Dilated Cardiomyopathy Model
Authors: Ikeda Masataka , Ide Tomomi , Matsushima Shouji , Ikeda Soichiro , Okabe Kosuke , Ishikita Akihito , Tadokoro Tomonori , Sada Masashi , Abe Ko , Sato Midori , Hanada Akiko , Arai Shinobu , Ohtani Kisho , Nonami Atsushi , Mizuno Shinichi , Morimoto Sachio , Motohashi Shinichiro , Akashi Koichi , Taniguchi Masaru , Tsutsui Hiroyuki
Published: October 2022

Background:

Dilated cardiomyopathy (DCM) is a life-threatening disease, resulting in refractory heart failure. An immune disorder underlies the pathophysiology associated with heart failure progression. Invariant natural killer T (iNKT) cell activation is a prospective therapeutic strategy for ischemic heart disease. However, its efficacy in nonischemic cardiomyopathy, such as DCM, remains to be elucidated, and the feasible modality for iNKT cell activation in humans is yet to be validated.

Methods:

Dendritic cells isolated from human volunteers were pulsed with α-galactosylceramide ex vivo, which were used as α-galactosylceramide-pulsed dendritic cells (αGCDCs). We treated DCM mice harboring mutated troponin T
ΔK210/ΔK210
with αGCDCs and evaluated the efficacy of iNKT cell activation on heart failure in DCM mice. Furthermore, we investigated the molecular basis underlying its therapeutic effects in these mice and analyzed primary cardiac cells under iNKT cell-secreted cytokines.

Results:

The number of iNKT cells in the spleens of DCM mice was reduced compared with that in wild-type mice, whereas αGCDC treatment activated iNKT cells, prolonged survival of DCM mice, and prevented decline in the left ventricular ejection fraction for 4 weeks, accompanied by suppressed interstitial fibrosis. Mechanistically, αGCDC treatment suppressed TGF (transforming growth factor)-β signaling and expression of fibrotic genes and restored vasculature that was impaired in DCM hearts by upregulating angiopoietin 1 (
Angpt1
) expression. Consistently, IFNγ (interferon gamma) suppressed TGF-β-induced Smad2/3 signaling and the expression of fibrotic genes in cardiac fibroblasts and upregulated
Angpt1
expression in cardiomyocytes via Stat1.

Conclusions:

Immunomodulatory cell therapy with αGCDCs is a novel therapeutic strategy for heart failure in DCM.
A Generalised Dropout Mechanism for Distributed Systems
Authors: Bull Larry , Liu Haixia
Published: October 2022

This letter uses a modified form of the NK model introduced to explore aspects of distributed control. In particular, a previous result suggesting the use of dynamically formed subgroups within the overall system can be more effective than global control is further explored. The conditions under which the beneficial distributed control emerges are more clearly identified, and the reason for the benefit over traditional global control is suggested as a generally applicable dropout mechanism to improve learning in such systems.
Culturescape: Environment, Science, and Art at Bundanon
Authors: Helyer Nigel , Potts John
Published: October 2022

This article describes the website Culturescape: An Environmental Portrait of Bundanon. This online portrait, a collaboration combining environmental science and art, includes an interactive environmental map of the Bundanon region in New South Wales, Australia, and documentation of environmental artworks by Nigel Helyer, all initially installed at Bundanon. The interactive map displays soil quality data at Bundanon in sonified and visualized form. The user hears a sonification of environmental data, represented as a musical piece, and sees a visualization of mineral data as a graphic display.
Seeking a Philosophical Basis for Trait Psychology
Authors: McCrae Robert R.
Published: October 2022

I summarize an early effort to provide a conceptual basis for psychology. Natural science studies material objects, and its methods and assumptions may not be appropriate for the study of persons. Persons exist within the natural attitude and are characterized by such properties as temporality, responsibility, normality, and identity. Contemporary theories of mind focus on people’s understanding of how minds make decisions and shape behavior, but say little about the nature of the entity that possesses a mind; ethnopsychologies are concerned with cultural variations in beliefs about accidental rather than essential aspects of human psychology. The lay philosophical view of the person sketched here is intended to be broader and deeper. It is particularly relevant to trait psychology, appears to have been implicit in much trait research, and is generally consistent with empirical findings on personality traits.
Culture, Strengths, and Risk: The Language of Pre-Sentence Reports in Indigenous Sentencing Courts and Mainstream Courts
Authors: Coulter Darcy J. , Forkan Abdur Rahim Mohammad , Kang Yong-Bin , Trounson Justin S. , Anthony Thalia , Marchetti Elena , Shepherd Stephane M.
Published: October 2022

Pre-sentence reports (PSRs) provide important information about an individual’s background and circumstances to assist judicial officers in the sentencing process. The present study analyzed PSRs for 63 Aboriginal and Torres Strait Islander people sentenced by either an Indigenous sentencing court or a mainstream court in the Australian State of Victoria. Using natural language processing techniques, our analyses revealed few differences between PSRs conducted for each court. However, PSRs were found to predominantly feature key words that are risk-based, with mainstream court PSRs more negatively worded than the Indigenous sentencing court’s PSRs. This may have been due to the inclusion of results from a risk and need assessment tool. Pro-social factors did comprise more than one third of extracted keywords, although the number of strength-based culture-related keywords, in particular, was low across PSRs in both courts. It is possible that courts may not be receiving all the information needed to promote individualized justice.
Mental Healthcare Providers Understanding and Experiences of Palliative Care: A Qualitative Analysis
Authors: Park Tanya , Mutoni Lydia , Sridhar Ramya , Hegadoren Kathy , Workun Bernadette
Published: October 2022

Objective: To understand the experiences and perceptions of mental health providers about palliative care. Background: Little attention is paid to the experience of people with chronic persistent mental illness (CPMI) and life-threatening diseases and how their dying experience might differ from those without a CPMI. Methods: Interpretive description informed the project. Sixteen mental health care providers were interviewed using a semi-structured interview template. The interviews were recorded, transcribed, and analyzed using a reflexive, inductive-deductive thematic approach, guided by Braun & Clarke's framework for thematic analysis. Results: Four themes were identified from the data: intersectionality, limited collaboration, misconceptions about palliative care, and relationships. Mental health providers identified gaps in their knowledge of palliative care practices along with their knowledge of death and dying.
A novel servo-stabilized electromagnetic levitation formicro-EDM processing and its feasibility analysis
Authors: Kumar Deepak , Sisodiya Mangal Singh , Bajpai Vivek
Published: October 2022

The purpose of this paper is to evaluate the feasibility of a novel gap-controlled strategy for micro-EDM process using magnetic levitation. The tool is levitated and positioned accurately using a unique actuator arm. The actuator arm attained the required positioning accuracy in the thrust (Z) direction to ensure a uniform and smooth discharge free of arcing and short circuits. Experiments were carried out using a copper tool and EDM oil on Nimonic superalloy (Grade C-263). Material removal rate (79.26 µg/min), tool wear rate (19.75 µg/min), and average surface roughness (Ra = 1.196 µm) all proved the efficacy of the developed technology. Furthermore, the machining stability and average specific energy (1.7350 J/μg) were examined and compared to the experimental results of traditional EDM, as well as literature data. Maglev μ-EDM is substantially more stable than traditional EDM, according to a comparison of the current-voltage (V-I) curve. Microholes, micropores, recast layer, and other surface topographical features are detected in a low amount using FESEM. The bidirectional material movement and elemental diffusion are shown by elemental characterization using EDX analysis.