bluuebunny/crossref_metadata_2025 huggingface dataset:
Cloud computing and 5G challenges and open issues
Authors: Ullah Arif , Aznaoui Hanane , Şahin Canan Batur , Rafie Mahnaz , Dinler Ozlem Batur , Imane Laassar
Published: September 2022

The obtainable fourth-generation technology (4G) networks have been extensively used in the cloud application and are constantly evolving to match the needs of the future cloud applications. The ﬁfth generation (5G) networks are probable to immense expand today's cloud that can boost communication operations, cloud security, and network challenges and drive the cloud future to the edge and internet of things (IoT) applications. The existing cloud solutions are facing a number of challenges such as large number of connection of nodes, security, and new standards. This paper reviews the current research state-of-the-art of 5G cloud, key-enabling technologies, and current research trends and challenges in 5G along with cloud application.
An effective control structure of on-board battery charger for electric vehicles
Authors: Khadem Mohammad , Karami Mohammad
Published: September 2022

The plug-in electric vehicles (PEVs) including plug-in hybrid electric and all-electric vehicles will play a key role in the transportation future throughout the World. Consequently, a variety of works must be done to decrease the cost, improve the structure and increase the convenience of PEVs. This study proposed a single-phase, non-isolated and on-board battery charger with no use of any transformer which reduced the volume and weight of the system for PEVs. The main purpose is to provide an accurate control structure in order to achieve an acceptable charging in the wide range of voltage. The proposed structure is simulated by matrix laboratory (MATLAB) software. The results showed a high-power density, high efficiency and appropriate power factor from the structure of the non-isolated and single-phase charger.
Digital terrestrial television in Nigeria: A technical review of path loss modeling and optimization techniques
Authors: Ilori Abolaji Okikiade , Amusa Kamoli Akinwale , Erinosho Tolulope Christianah
Published: September 2022

The switch from analog to digital terrestrial broadcasting (DTTV) has resulted in a substantial shift in the contemporary television broadcasting environment, introducing a new means of transmitting content, as well as a new and upgraded process that will improve consumer satisfaction by ensuring greater reception. Despite the deadline, only a small percentage of terrestrial television stations in Nigeria have been digitalized. This work takes a critical review of various aspects of DTTV implementation, ranging from evolution to path loss estimation, prospects and challenges associated with the switch-over on the very high frequency (VHF) communication links as well as various optimization techniques that are adopted for DTTV in Nigeria and sub-Sahara Africa. Findings show that the prospects are bright and numerous benefits are accruable if the government of Nigeria can solve the problems facing its full migration. Furthermore, investigations into the path-loss of DTTV in the ultra-high frequency (UHF) communication links have enjoyed scanty attention, therefore, careful examination and suitable path-loss model development in this frequency regime for TV services across various ecological and vegetation zones should be considered as it will aid the full deployment of DTTV in Nigeria.
The development of molecular genetics concept test for senior high school students using Rasch analysis
Authors: Sari Indah Juwita , Pongsophon Pongprapan , Vongsangnak Wanwipa , Pimthong Pattamaporn , Pitiporntapin Sasithep
Published: September 2022

Developing a high-quality test item requires substantial time and effort. A well-developed item bank is conducted using rigorous development and validation procedures. This study aimed to describe the development process of molecular genetics concept test (MGCT) for senior high school students using Rasch analysis under Berkeley evaluation and assessment research (BEAR) assessment system framework. The test consists of 50 multiple-choice items to assess conceptual understanding of molecular genetics concepts. The MGCT was developed based on curriculum analysis from the Indonesian ministry of education and culture and content-validated by three content experts comprising an expert in biology, an expert in bioinformatics, and an experienced Indonesian biology teacher in a senior high school. The MGCT was then piloted to 114 students who had taught the molecular genetics unit from a senior high school to conduct the empirical validation. The results from Rasch analysis showed that the MGCT is acceptable because all items have outfit and infit mean-square values in the acceptable range of 0.7 to 1.3 and the reliability is 0.43. So, the MGCT can be used to assess the understanding of the molecular genetics concept. However, several items were too difficult to discriminate the student ability. So, future studies need to develop more this MGCT to get a more appropriate instrument.
Guided inquiry laboratory to improve research skills of prospective biology teachers
Authors: Maknun Djohar , Prasetyo Zuhdan Kun , Djukri Djukri
Published: September 2022

This study described guided-inquiry laboratory impact on increase in research skills of prospective biology teachers. Skill research indicators are designing, implementing, and reporting. This study was a non-equivalent control group design using experimental and control groups. Data were collected from 60 participants through observation of research skill indicators, namely designing, performing, and reporting then analyzed quantitatively-descriptively. The sample was selected using purposive sampling. The results confirmed that the guided-inquiry laboratory application has a more effective impact on improving research skills than ordinary learning. Each indicator of research skills (designing, performing, and reporting in the experimental class) meets the "Medium" category, while the "Low" category in the control class. This study concluded that the guided inquiry laboratory has a positive impact in improving the research skills of prospective biology teachers. This research provides a reference for teachers to explore the research abilities of their students.
E-learning issues and solutions for students with disabilities during COVID-19 pandemic: Al-Zaytoonah University of Jordan case study
Authors: Ahmad Amal Qassed , Jawad Mohammad Abdul , Jaber Khalid Mohammad
Published: September 2022

In this research, approaches to making e-learning accessible to students with impairments were studied based on the authors’ experience at Jordan’s Al-Zaytoonah University. The educational, organizational, and instructional concerns are underlined when analyzing the university’s experience in giving access to online content. Furthermore, these difficulties must be addressed in order to create the necessary organizational change to effectively solve accessibility concerns. This study looked into the e-learning issues that 56 university students with disabilities had reported. Students reported issues with: accessibility to websites and learning course management systems; accessibility to digital audio and video; time management in completing online tasks; trouble handling data during lectures; and a lack of appropriate adaptive strategies in online questionnaires. Students also noted technical issues with using e-learning, instructors’ communication with e-learning, and their treatment of all students equally, overlooking the necessity of considering the needs of students with impairments. In this study, we present the problems raised by students with disabilities and how the e-learning affects students’ outcomes in the e-learning experience. We also make recommendations based on the students’ realistic special-needs experience at Al-Zaytoonah University in Jordan during the COVID-19 pandemic to inspire decision-makers in educational institutions and those interested in this field.
Being successful in school: A case study of the Orang Asli (Aboriginal People) of Malaysia
Authors: Ahmad Badli Esham , Abdullah Mohd Amli , Shariff Tengku Intan Suzila Tengku , Nor Mohd Yusri Mohamad , Ismail Mohd Rozaidi , Mohd Akhir Nor Farah Liyana
Published: September 2022

The Orang Asli have been marginalized in many aspects including education. Despite the various support and assistance provided by the government, their development in the educational process is still lagging. However, there are cases of Orang Asli children who have managed to complete their education. The objective of the study is to identify the success factors that help the Orang Asli to be successful in their education. The research is exploratory research using qualitative method, with semi structured interviews as the primary data collection. The respondents are Orang Asli children who have completed their tertiary education. The study found that motivation and the right environment are the two important factors that contributed to the success of the respondents in the study. Environment factor is inclusive of parental, familial and societal contribution to the development of the Orang Asli education. Hence, providing the right motivation and creating the correct environment for the Orang Asli children would help them to complete their education. However, the findings are limited to the selected Orang Asli tribes and cannot be generalized to the whole Orang Asli in the country. Nonetheless, the findings provided relevant insights into the Orang Asli education and can serve as a platform for future studies.
Pteris trifoliolata (Pteridaceae), a new brake fern species from karst area in Guangxi, China
Authors: WEI HONG-JIN , LIANG YONG-YAN
Published: September 2022

Pteris trifoliolata H.J. Wei, a new species of Pteridaceae from karst area in Guangxi, China, is described and illustrated. The new species resembles P. nanlingensis R.H. Miao by its short creeping rhizome, dimorphic fronds and oblong-lanceolate pinnae, but can be distinguished from the latter by the number and size of pinnae, and the degree of frond dimorphism.
New Discoveries and New Combinations of the Fossil-genus Ginkgoites Seward (Ginkgoales) from the Lower and Middle Jurassic of East Siberia (Russia)
Authors: FROLOV ANDREY O. , MASHCHUK IRINA M.
Published: September 2022

Based on study of leaves from the outcrops of the Mura Formation (East Siberia) the diagnosis of the species Ginkgo abaniensis is emended. Because fossils of Ginkgoales reproductive organs are absent in the Early and Middle Jurassic sediments of East Siberia, the assignment of Ginkgo-like leaves to the genus Ginkgo is not proved. Therefore, such leaves are assigned to the fossil-genus Ginkgoites and the new combinations: Ginkgoites abaniensis comb. nov., G. capillata comb. nov. and G. glinkiensis comb. nov. are proposed. The epidermal structure clearly differentiates Ginkgoites abaniensis comb. nov. from other representatives of Ginkgoites known from Jurassic and Lower Cretaceous sediments of Europe, Central Asia and Siberia.
Madden–Julian Oscillation Impacts on Australian Temperatures and Extremes
Authors: Marshall Andrew G. , Wheeler Matthew C. , Cowan Tim
Published: September 2022

We assess seasonally varying impacts of the Madden–Julian oscillation (MJO) on Australian maximum and minimum temperature anomalies and extremes, and their modulation by El Niño–Southern Oscillation (ENSO), for the period June 1974–May 2022. Our composite-based approach uses observed temperatures from the Australian Gridded Climate Data, and 850-hPa wind data from the NCEP–NCAR reanalysis, to show how relationships to temperature and circulation evolve over the eight-phase life cycle of the MJO, which we derive from the real-time multivariate MJO index. The MJO has significant impacts on Australian temperatures and winds in all parts of the country at various times throughout the year, and to varying degrees. Two of the most pronounced impacts are 1) daytime warming across southeastern Australia in MJO phase 3 during spring associated with a strong anomalous anticyclone and 2) nighttime cooling over Queensland in MJO phase 7 during winter associated with anomalous advection of cool dry continental air. La Niña acts to significantly lessen both of these impacts, while El Niño enhances both the phase 3 warming over southern Australia in spring and the phase 7 overnight cooling over southern Queensland in winter. We show how the MJO can combine with El Niño and La Niña to have strong compounding influences, thus highlighting the importance of understanding interactions between multiple modes of climate variability and how they relate to Australian temperatures and extremes.
Impact of Assimilating Radar Data with 3D Thermodynamic Fields in an Ensemble Kalman Filter: Proof of Concept and Feasibility
Authors: Ke Chieh-Ying , Chung Kao-Shen , Liou Yu-Chieng , Tsai Chih-Chien
Published: September 2022

This study examined the impact of assimilating 3D temperature and water vapor information in addition to radar observations in a multiscale weather system. A frontal system with extremely heavy rainfall over northern Taiwan was selected. Using the WRF–LETKF Radar Assimilation System, we performed three sets of observing system simulation experiments to assimilate radar observations with or without thermodynamic variables obtained using different methods. First, assimilating the radar data for 2 h showed better structure and short-term forecast than 1 h. Second, we assimilated radar data and thermodynamic variables from a perfect model simulation. The results of the analysis revealed that when a precipitation position error occurred in the background field, assimilating thermodynamic information with the radar data could correct the dynamic structure and shorten the spinup assimilation period, resulting in substantial improvements to the quantitative precipitation forecast. Third, we applied a thermodynamics retrieval algorithm for a feasibility study. With a warm and wet bias of the retrieved fields, assimilating the temperature data had significant impact on the midlevel of stratiform areas and the forecast of the heavy rainfall was consequently improved. Assimilating the water vapor information helped reconstruct the range and intensity of the cold pool, but the improvement of rainfall forecast was limited. The optimal results of analysis and short-term forecast were achieved when both retrieved temperature and water vapor fields were assimilated. In conclusion, assimilating thermodynamic variables in the precipitation system is feasible for shortening the spinup period of data assimilation and improving the analysis and short-term forecast.
Implementation of machine learning in the clinic: challenges and lessons in prospective deployment from the System for High Intensity EvaLuation During Radiation Therapy (SHIELD-RT) randomized controlled study
Authors: Hong Julian C. , Eclov Neville C. W. , Stephens Sarah J. , Mowery Yvonne M. , Palta Manisha
Published: September 2022

Background

Artificial intelligence (AI) and machine learning (ML) have resulted in significant enthusiasm for their promise in healthcare. Despite this, prospective randomized controlled trials and successful clinical implementation remain limited. One clinical application of ML is mitigation of the increased risk for acute care during outpatient cancer therapy. We previously reported the results of the System for High Intensity EvaLuation During Radiation Therapy (SHIELD-RT) study (NCT04277650), which was a prospective, randomized quality improvement study demonstrating that ML based on electronic health record (EHR) data can direct supplemental clinical evaluations and reduce the rate of acute care during cancer radiotherapy with and without chemotherapy. The objective of this study is to report the workflow and operational challenges encountered during ML implementation on the SHIELD-RT study.

Results

Data extraction and manual review steps in the workflow represented significant time commitments for implementation of clinical ML on a prospective, randomized study. Barriers include limited data availability through the standard clinical workflow and commercial products, the need to aggregate data from multiple sources, and logistical challenges from altering the standard clinical workflow to deliver adaptive care.

Conclusions

The SHIELD-RT study was an early randomized controlled study which enabled assessment of barriers to clinical ML implementation, specifically those which leverage the EHR. These challenges build on a growing body of literature and may provide lessons for future healthcare ML adoption.

Trial registration: NCT04277650. Registered 20 February 2020. Retrospectively registered quality improvement study.
Visualizing the knowledge structure and evolution of bioinformatics
Authors: Wang Jiaqi , Li Zeyu , Zhang Jiawan
Published: September 2022

Background

Bioinformatics has gained much attention as a fast growing interdisciplinary field. Several attempts have been conducted to explore the field of bioinformatics by bibliometric analysis, however, such works did not elucidate the role of visualization in analysis, nor focus on the relationship between sub-topics of bioinformatics.

Results

First, the hotspot of bioinformatics has moderately shifted from traditional molecular biology to omics research, and the computational method has also shifted from mathematical model to data mining and machine learning. Second, DNA-related topics are bridge topics in bioinformatics research. These topics gradually connect various sub-topics that are relatively independent at first. Third, only a small part of topics we have obtained involves a number of computational methods, and the other topics focus more on biological aspects. Fourth, the proportion of computing-related topics hit a trough in the 1980s. During this period, the use of traditional calculation methods such as mathematical model declined in a large proportion while the new calculation methods such as machine learning have not been applied in a large scale. This proportion began to increase gradually after the 1990s. Fifth, although the proportion of computing-related topics is only slightly higher than the original, the connection between other topics and computing-related topics has become closer, which means the support of computational methods is becoming increasingly important for the research of bioinformatics.

Conclusions

The results of our analysis imply that research on bioinformatics is becoming more diversified and the ranking of computational methods in bioinformatics research is also gradually improving.
Oxidative stress genes in patients with esophageal squamous cell carcinoma: construction of a novel prognostic signature and characterization of tumor microenvironment infiltration
Authors: Liu Wei , Yang Hao-Shuai , Zheng Shao-Yi , Luo Hong-He , Feng Yan-Fen , Lei Yi-Yan
Published: September 2022

Background

Oxidative stress plays an important role in the progression of various types of tumors. However, its role in esophageal squamous cell carcinoma (ESCC) has seldom been explored. This study aimed to discover prognostic markers associated with oxidative stress in ESCC to improve the prediction of prognosis and help in the selection of effective immunotherapy for patients.

Results

A consensus cluster was constructed using 14 prognostic differentially expressed oxidative stress-related genes (DEOSGs) that were remarkably related to the prognosis of patients with ESCC. The infiltration levels of neutrophils, plasma cells, and activated mast cells, along with immune score, stromal score, and estimated score, were higher in cluster 1 than in cluster 2. A prognostic signature based on 10 prognostic DEOSGs was devised that could evaluate the prognosis of patients with ESCC. Calculated risk score proved to be an independent clinical prognostic factor in the training, testing, and entire sets. P53 signaling pathway was highly enriched in the high-risk group. The calculated risk score was positively related to the infiltration levels of resting mast cells, memory B cells, and activated natural killer (NK) cells and negatively associated with the infiltration levels of M1 and M2 macrophages. The relationship between clinical characteristics and risk score has not been certified. The half-maximal inhibitory concentration (IC50) values for sorafenib and gefitinib were lower for patients in the low-risk group.

Conclusion

Our prognostic signature based on 10 prognostic DEOSGs could predict the disease outcomes of patients with ESCC and had strong clinical value. Our study improves the understanding of oxidative stress in tumor immune microenvironment (TIME) and provides insights for developing improved and efficient immunotherapy strategies.
The changing spectrum of microbial aetiology of respiratory tract infections in hospitalized patients before and during the COVID-19 pandemic
Authors: Serigstad Sondre , Markussen Dagfinn L. , Ritz Christian , Ebbesen Marit H. , Knoop Siri T. , Kommedal Øyvind , Heggelund Lars , Ulvestad Elling , Bjørneklett Rune O. , Grewal Harleen M. S. ,   the CAPNOR study group, Clark Tristan W. , Faurholt-Jepsen Daniel , Ravn Pernille , van Werkhoven Cornelis H.
Published: September 2022

Background

The COVID-19 pandemic was met with strict containment measures. We hypothesized that societal infection control measures would impact the number of hospital admissions for respiratory tract infections, as well as, the spectrum of pathogens detected in patients with suspected community acquired pneumonia (CAP).

Methods

This study is based on aggregated surveillance data from electronic health records of patients admitted to the hospitals in Bergen Hospital Trust from January 2017 through June 2021, as well as, two prospective studies of patients with suspected CAP conducted prior to and during the COVID-19 pandemic (pre-COVID cohort versus COVID cohort, respectively). In the prospective cohorts, microbiological detections were ascertained by comprehensive PCR-testing in lower respiratory tract specimens. Mann–Whitney’s U test was used to analyse continuous variables. Fisher’s exact test was used for analysing categorical data. The number of admissions before and during the outbreak of SARS-CoV-2 was compared using two-sample t-tests on logarithmic transformed values.

Results

Admissions for respiratory tract infections declined after the outbreak of SARS-CoV-2 (p < 0.001). The pre-COVID and the COVID cohorts comprised 96 and 80 patients, respectively. The proportion of viruses detected in the COVID cohort was significantly lower compared with the pre-COVID cohort [21% vs 36%, difference of 14%, 95% CI 4% to 26%; p = 0.012], and the proportion of bacterial- and viral co-detections was less than half in the COVID cohort compared with the pre-COVID cohort (19% vs 45%, difference of 26%, 95% CI 13% to 41%; p < 0.001). The proportion of bacteria detected was similar (p = 0.162), however, a difference in the bacterial spectrum was observed in the two cohorts. Haemophilus influenzae was the most frequent bacterial detection in both cohorts, followed by Streptococcus pneumoniae in the pre-COVID and Staphylococcus aureus in the COVID cohort.

Conclusion

During the first year of the COVID-19 pandemic, the number of admissions with pneumonia and the microbiological detections in patients with suspected CAP, differed from the preceding year. This suggests that infection control measures related to COVID-19 restrictions have an overall and specific impact on respiratory tract infections, beyond reducing the spread of SARS-CoV-2.
How socioeconomic status, social capital and functional independence are associated with subjective wellbeing among older Indian adults? A structural equation modeling analysis
Authors: Muhammad T. , Kumar Pradeep , Srivastava Shobhit
Published: September 2022

Background

Subjective well-being (SWB) is of particular interest among gerontologists and health researchers with important implications for interventions especially in poor-resource settings. This study aimed to explore the possible pathways from socioeconomic status (SES), functional independence and social capital towards SWB among older adults in India.

Methods

Cross-sectional data from the “Building a Knowledge Base on Population Aging in India” (BKPAI) survey with a total sample of 9231 older adults aged 60 years and above were used. The outcome variable was low SWB (LSWB). The study used univariate and bivariate analysis for reporting the initial results. Further, the study employed the structural equation modeling (SEM) technique using maximum likelihood estimation (MLE) procedure to estimate the covariance matrix.

Results

Overall, about 27% of older adults reported LSWB. Reporting LSWB was more prevalent among older adults who had no income (30.8%) and those who had income but not sufficient to fulfil their basic needs (39.4%, p < 0.001). The prevalence of reporting LSWB was significantly higher among older adults who had no asset ownership (36.5%, p < 0.001) than those who had asset ownership. The path from the SEM shows that LSWB and SES are negatively related to each other. Moreover, LSWB had significant negative relationship with independence (β = -0.032, p < 0.001) and social capital (β = -0.020; p < 0.001). In addition, results found a positive relationship between SES and independence (β = 0.019; p < 0.001), SES and social capital (β = 0.016; p < 0.001), and independence and social capital (β = 0.033; p < 0.001).

Conclusions

The findings highlight that higher SES, good physical functioning as well as favorable social capital are interdependent factors of late-life wellbeing and a multidimensional approach in policymaking can ensure a successful and active ageing among older Indian adults.
Intercalary frozen autografts for reconstruction of bone defects following meta-/diaphyseal tumor resection at the extremities
Authors: Yang Jingyan , Li Wenze , Feng Rongjie , Li Dong
Published: September 2022

Background

For patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully selected patients, resected bone can be recycled after sterilization using methods like autoclaving, irradiation, pasteurization or freezing with liquid nitrogen. We evaluated the clinical outcome and complications of malignant limb tumors treated with intercalary resection and frozen autograft reconstruction.

Methods

We reviewed 33 patients whose malignant bone tumors were treated by wide resection and reconstruction with recycling liquid nitrogen-treated autografts between 2006 and 2017. Limb function, bone union at the osteotomy site and complications were evaluated. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.

Results

The cohort comprised 16 males and 17 females, with a mean age of 35.4 years (14–76 years). The most common tumor was osteosarcoma (7 cases). Tumors were located in the humerus (5), ulna (1), femur (10) and tibia (17). The mean follow-up was 49.9 months (range 12–127 months). Of the 33 patients, 16 remained disease-free, and 3 were alive with disease. The mean size of the defect after tumor resection was 11.6 cm (range 6–25 cm). Bone union was achieved in 32 patients, with a mean union time of 8.8 months (range 4–18 months). Complications included 1 graft nonunion, 2 infections (1 superficial, 1 deep infection), 1 leg length discrepancy, 2 graft fractures and 3 local recurrences. The mean MSTS score was 87.2% (range 70–100%).

Conclusion

Liquid nitrogen-treated tumor-bearing autograft is an effective option for biological reconstruction after meta-/diaphyseal tumor resection of long bones. This method has excellent clinical outcomes and is especially recommended for patients with no severe osteolytic bone tumors.
Predicting IVF outcome in poor ovarian responders
Authors: Lebovitz Oshrit , Haas Jigal , Mor Nitzan , Zilberberg Eran , Aizer Adva , Kirshenbaum Michal , Orvieto Raoul , Nahum Ravit
Published: September 2022

Background

Poor responders to ovarian stimulation are one of the most challenging populations to treat. As a failed cycle can cause a considerable emotional and economical loss, adequate fertility counseling addressing patients’ expectations are highly important when facing patients with poor ovarian response. The study aimed to evaluate reproductive outcomes and to identify factors associated with live birth (LB) after fresh autologous IVF/intracytoplasmic sperm injection (ICSI) cycles of patients fulfilling the Bologna criteria for poor ovarian response (POR).

Methods

A retrospective study included 751 IVF/ICSI treatment cycles which yielded up to three retrieved oocytes, at a tertiary referral hospital between January 2016 and February 2020. A logistic regression analysis was used to adjust for confounders.

Results

Clinical pregnancy and LB rate per cycle were significantly higher among women younger versus older than 40 years (9.8% and 6.8% vs 4.5% and 2.1%, p < 0.01, respectively). Patients who achieved LB were significantly younger, had higher number of oocytes retrieved, fertilization rate and top-quality embryos (p < 0.05). Multivariable regression analysis identified patient’s age (OR 0.90; 95% CI 0.845–0.97; p = 0.005) and mean number retrieved oocytes (OR 1.95; 95% CI 1.20–3.16; p = 0.007) as factors significantly associated with the probability of a LB.

Conclusions

The woman’s age and the number of retrieved oocytes are both independent predicting factors of live birth in poor ovarian responders. Considering the risks, the high financial investment and poor reproductive outcomes involved in IVF treatments, raises questions regarding the adequacy of providing treatments in these patients' population. POR younger than 40 years may represent a possible exception due to acceptable probability for a LB.
A social ecological approach to promote learning health disparities in the clinical years: impact of a home-visiting educational program for medical students
Authors: Sagi Doron , Rudolf Mary Catharine Joy , Spitzer Sivan
Published: September 2022

Background

There is consensus that medical schools have a duty to educate students about social determinants of health (SDOH) and equip them with skills required to ameliorate health disparities. Although the National Academy of Medicine (NAM) urged the development of experiential long term programs, teaching is usually conducted in the pre-clinical years or as voluntary courses. ETGAR a required health disparities course, based on the social ecological model, was initiated to answer the NAM call. This study aimed to ascertain the course impact on students learning of SDOH and health disparities.

Methods

Students during their first clinical year cared for four patients in their transition from hospital back home, one patient in each internal medicine, surgery, pediatrics and obstetrics/gynecology rotation. The students home-visited their patients after meeting them in hospital and preparing a plain language discharge letter. Training session prior to the course, a tutorial in each rotation, and structured feedback gave the educational envelope. Mixed methodology was employed to evaluate the course impact. Quantitative data collected by students during the home-visit: patients’ characteristics and quality and safety of the transition back home using the Medication Discrepancy Tool and Care Transition Measure questionnaire. Stakeholders’ views were collected via interviews and focus groups with students representing all affiliated hospitals, and interviews with heads of departments most involved in the course.

Results

Three hundred six students in three academic years, between October 2016–July 2019, completed home visits for 485 disadvantaged patients with improvement in patients’ knowledge of their treatment (3.2 (0.96) vs 3.8 (0.57), Z = -7.12,p < .0001) and identification of medication discrepancies in 42% of visits. Four themes emerged from the qualitative analysis: contribution to learning, experience-based learning, professional identity formation, and course implementation.

Conclusions

ETGAR was perceived to complement hospital-based learning, making students witness the interaction between patients’ circumstances and health and exposing them to four patients’ environment levels. It provided a didactic framework for promoting awareness to SDOH and tools and behaviors required to ameliorate their impact on health and health disparities.

The course combined communication and community learning into traditionally bio-medical clinical years and serves as a model for how social-ecology approaches can be integrated into the curriculum.
Men’s perception of information and psychological distress in the diagnostic phase of prostate cancer: a comparative mixed methods study
Authors: Søndergaard Maja Elisabeth Juul , Lode Kirsten , Husebø Sissel Eikeland , Dalen Ingvild , Kjosavik Svein Reidar
Published: September 2022

Background

Previous studies indicate that men experience frustration and uncertainty when confronted with an elevated prostate specific antigen (PSA) test and during further diagnostics for prostate cancer. The novel Stockholm3 test is an algorithm-based test that combines plasma protein biomarkers, genetic markers and clinical variables in predicting the risk of PCa. The test was introduced in a western part of Norway as a new tool for detecting prostate cancer. This study aimed to explore and compare men’s perception of information and possible experience of distress between a PSA group and a Stockholm3 group during the diagnostic phase of prostate cancer.

Methods

This study is a part of the trailing research evaluating the impact of the change from PSA to Stockholm3. It is a multicenter study using a comparative mixed method design. Data were collected in a PSA group (n = 130) and a Stockholm3 group (n = 120) between 2017 and 2019. Quantitative data were collected using questionnaires and qualitative data were collected using semi-structured interviews (n = 20). The quantitative and qualitative data were analysed and compared separately and then merged in a side-by-side discussion. The study adheres to the GRAMMS guidelines for reporting mixed-methods research.

Results

Compared with the PSA group, men in the Stockholm3 group reported that the information from the general practitioners was better. Similarly, men in the Stockholm3 group were more likely to indicate that they had received sufficient information regarding how examinations would be conducted. No differences were found between the groups regarding waiting time and distress. Three themes emerged from the qualitative analysis of the two groups: “Information affects the experience of comprehension”, “Stepping into the world of the healthcare system”, and “Periodically feelings of distress”.

Conclusion

The Stockholm3 test may facilitate the provision of information to patients. However, some patients in both groups experienced distress and would benefit from more information and additional support from healthcare professionals. Routines that ensure sufficient information from the interdisciplinary healthcare team should be of priority during the diagnostic phase of prostate cancer in order to provide patients with predictability and to avoid unnecessary distress.
Exploring patient experiences with a telehealth approach for the PRO-ACTIVE trial intervention in head and neck cancer patients
Authors: Khan M. M. , Manduchi B. , Rodriguez V. , Fitch M. I. , Barbon C. E. A. , McMillan H. , Hutcheson K. A. , Martino R.
Published: September 2022

Introduction

Following the COVID-19 directive to cease non-essential services, a rapid shift was made in the delivery of Speech Language Pathology (SLP) dysphagia management in the 3-arm, randomized PRO-ACTIVE trial. To inform future programs, this study explored patients’ experiences with telehealth when the planned in-person SLP intervention was moved to a telehealth modality.

Methods

A theory-guided qualitative descriptive approach was used. Willing participants who had received at least one telehealth swallowing therapy session participated in a one-time semi-structured interview. Interview transcripts were subjected to a standard qualitative content/theme analysis. Researchers reviewed all transcripts and used a multi-step analysis process to build a coding framework through consensus discussion. Summaries and key messages were generated for each code.

Results

Eleven participants recounted their telehealth experiences and reported feeling satisfied, comfortable and confident with the session(s). They identified that previous experience with teleconferencing, access to optimal technical equipment, clinician skill, and caregiver assistance facilitated their telehealth participation. Participants highlighted that telehealth was beneficial as it reduced commuting time, COVID-19 exposure and fatigue from travel; and also allowed caregiver participation particularly during COVID. In comparing their in-person SLP sessions to telehealth sessions, limitations were also identified, including: lack of previous experience with and/or poor access to technology, and less opportunity for personalization. Participants indicated that use of phone alone was less preferred than an audio/video platform.

Discussion

Patients reported that overall, telehealth sessions did not compromise their learning experience when compared to in-person sessions. Patients benefited from use of telehealth in several ways despite some limitations of the use of technology. Patient feedback about telehealth provides an important perspective that may be critical to inform best practices for care delivery.
Distribution and diversity of ROS-generating enzymes across the animal kingdom, with a focus on sponges (Porifera)
Authors: Hewitt Olivia H. , Degnan Sandie M.
Published: September 2022

Background

Reactive derivatives of oxygen (reactive oxygen species; ROS) are essential in signalling networks of all aerobic life. Redox signalling, based on cascades of oxidation–reduction reactions, is an evolutionarily ancient mechanism that uses ROS to regulate an array of vital cellular processes. Hydrogen peroxide (H2O2) and superoxide anion (O2•−) are employed as signalling molecules that alter the oxidation state of atoms, inhibiting or activating gene activity. Here, we conduct metazoan-wide comparative genomic assessments of the two enzyme families, superoxide dismutase (SOD) and NADPH oxidases (NOX), that generate H2O2 and/or O2•− in animals.

Results

Using the genomes of 19 metazoan species representing 10 phyla, we expand significantly on previous surveys of these two ancient enzyme families. We find that the diversity and distribution of both the SOD and NOX enzyme families comprise some conserved members but also vary considerably across phyletic animal lineages. For example, there is substantial NOX gene loss in the ctenophore Mnemiopsis leidyi and divergent SOD isoforms in the bilaterians D. melanogaster and C. elegans. We focus particularly on the sponges (phylum Porifera), a sister group to all other metazoans, from which these enzymes have not previously been described. Within Porifera, we find a unique calcium-regulated NOX, the widespread radiation of an atypical member of CuZnSOD named Rsod, and a novel endoplasmic reticulum MnSOD that is prevalent across aquatic metazoans.

Conclusions

Considering the precise, spatiotemporal specificity of redox signalling, our findings highlight the value of expanding redox research across a greater diversity of organisms to better understand the functional roles of these ancient enzymes within a universally important signalling mechanism.
Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016–2020
Authors: Lopez-de-Andres Ana , Jimenez-Garcia Rodrigo , Hernández-Barrera Valentin , de-Miguel-Díez Javier , de-Miguel-Yanes Jose M. , Martinez-Hernandez David , Carabantes-Alarcon David , Zamorano-Leon Jose J. , Noriega Concepción
Published: September 2022

Background

We performed a study to assess sex-differences in incidence (2016–2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status.

Methods

Ours was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM.

Results

From 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74–2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54–3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018).

The presence of T2DM was not associated with IHM in men or women.

Conclusions

T2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women.
Participatory approaches for raising awareness among subsistence farmers in Tanzania about the spread of insecticide resistance in malaria vectors and the possible link to improper agricultural pesticide use
Authors: Matowo Nancy Stephen , Tanner Marcel , Temba Benigni Alfred , Finda Marceline , Mlacha Yeromin Paul , Utzinger Jürg , Okumu Fredros Oketch
Published: September 2022

Background

Insecticide resistance is a key barrier to long-term malaria control, and it may be exacerbated by poor agricultural pesticide use. Current practices, however, do not link public health and agricultural pesticide use. This study investigated the perspectives of farmers and other stakeholders regarding the integration of agricultural and public health measures to address resistance. Additionally, the feasibility of participatory workshops to increase the farmers’ understanding and participation in pesticide stewardship was assessed.

Methods

Four themes were investigated: pesticide awareness, practices, and opinions of; insecticide resistance in malaria vectors; the effectiveness of current malaria prevention tools; and the links between agricultural and public health pesticide usage. Participatory workshops and field training were held with entomologists, farmers, and agricultural specialists, focusing on agro-ecosystem practices related to pest control; and local farmers were involved in live-testing for insecticides resistance of local Anopheles mosquitoes.

Results

Most farmers (94%) considered pesticides effective, and nearly half of them (n = 198, 46.4%) could identify and name crop pests and diseases, mostly using local names. Three quarters were unaware of mosquito larvae in their fields, and only 7% considered their fields as potential sources of mosquitoes. Two thirds were uninformed of any effects that agricultural pesticides may have on mosquitoes, and three quarters had never heard of resistance in malaria mosquitoes. Experts from various sectors acknowledged that agricultural pesticides might impact malaria control through increasing resistance. They did, however, emphasize the importance of crop protection and advocated for the use of pesticides sparingly and non-chemical approaches. Farmers learnt how to discriminate between malaria vectors and non-vectors, identify agricultural pests and diseases, choose and use pesticides effectively, and conduct resistance tests during the participatory workshops.

Conclusion

This study emphasizes the significance of enhancing subsistence farmers’ awareness of mosquito ecology as well as merging public health and agricultural pest management measures. Participatory techniques have the potential to raise stakeholder awareness and engagement, resulting in more effective resistance management.
Microbiota and metabolites alterations in proximal and distal gastric cancer patients
Authors: Yang Yan , Dai Daofeng , Jin Wen , Huang Yingying , Zhang Yingzi , Chen Yiran , Wang Wankun , Lin Wu , Chen Xiangliu , Zhang Jing , Wang Haohao , Zhang Haibin , Teng Lisong
Published: September 2022

Background

Globally, gastric cancer is the third most common cancer and the third leading cause of cancer death. Proximal and distal gastric cancers have distinct clinical and biological behaviors. The microbial composition and metabolic differences in proximal and distal gastric cancers have not been fully studied and discussed.

Methods

In this study, the gastric microbiome of 13 proximal gastric cancer tissues, 16 distal gastric cancer tissues, and their matched non-tumor tissues were characterized using 16S rRNA amplicon sequencing. Additionally, 10 proximal gastric cancer tissues, 11 distal gastric cancer tissues, and their matched non-tumor tissues were assessed by untargeted metabolomics.

Results

There was no significant difference in microbial diversity and richness between the proximal and distal gastric cancer tissues. At the genus level, the abundance of Rikenellaceae_RC9_gut_group, Porphyromonas, Catonella, Proteus, Oribacterium, and Moraxella were significantly increased in Proximal T, whereas that of Methylobacterium_Methylorubrum was significantly increased in Distal T. The untargeted metabolomics analysis revealed 30 discriminative metabolites between Distal T and Distal N. In contrast, there were only 4 discriminative metabolites between Proximal T and Proximal N. In distal gastric cancer, different metabolites were scattered through multiple pathway, including the sphingolipid signaling pathway, arginine biosynthesis, protein digestion and absorption, alanine, aspartate and, glutamate metabolism, etc.In proximal gastric cancer, differential microbial metabolites were mainly related to hormone metabolism.

Conclusion

Methylobacterium-Methylorubrum was significantly increased in Distal T, positively correlated with cancer-promoting metabolites, and negatively correlated with cancer-inhibiting metabolites. Rikenellaceae_RC_gut_group was significantly increased in Proximal T and positively correlated with cancer-promoting metabolites. Further studies regarding the functions of the above-mentioned microorganisms and metabolites were warranted as the results may reveal the different mechanisms underlying the occurrence and development of proximal and distal gastric cancers and provide a basis for future treatments.

Importance

First, the differences in microbial composition and metabolites between the proximal and distal gastric cancers were described; then, the correlation between microbiota and metabolites was preliminarily discussed. These microbes and metabolites deserve further investigations as they may reveal the different mechanisms involved in the occurrence and development of proximal and distal gastric cancers and provide a basis for future treatments.