bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of synchronous intramucosal gastric carcinoma with multiple lymph node metastases
Authors: Amada En , Kawakubo Hirofumi , Matsuda Satoru , Mayanagi Shuhei , Nakamura Rieko , Irino Tomoyuki , Wada Norihito , Mikami Shuji , Kitagawa Yuko
Published: April 2021

Background

In Japan, the prevalence of synchronous multiple intramucosal gastric carcinoma is reported to be 5–15%. Here is a case of a synchronous small gastric carcinoma fulfilling the definite indication and curative criteria for endoscopic submucosal dissection with multiple lymph node metastases.

Case presentation

A Japanese woman in her fifties with a history of endoscopic resection for mucosal poorly differentiated adenocarcinoma was evaluated, with the UICC TNM classification stage being cT1aN0M0 cStageIA. She had undergone total gastrectomy with D1 + lymph node dissection. Histopathological examination revealed 16 individual sporadic lesions in the gastric body, with maximum diameter 3 mm and localization in the lamina propria. Twenty-seven nodes were resected, and metastasis of the carcinoma was revealed in 24 nodes.

Conclusions

Undifferentiated intramucosal gastric cancer has a relatively high probability of lymph node metastasis; however, synchronous early lesions are often overlooked. Frequent follow-up examinations may increase the detection of multiple gastric cancers.
The effect of forearm rotation on radiographic measurements of the wrist: an experimental study using radiostereometric analyses on cadavers
Authors: Jensen Janni , Tromborg Hans B. , Rasmussen Benjamin S. B. , Gerke Oke , Torfing Trine , Precht Helle , Graumann Ole
Published: April 2021

Background

Although dorsal/palmar tilt, radial inclination (RI), and ulnar variance (UV) are measurements commonly performed in wrist radiographs, the impact of forearm rotation on those measurements during the radiographic procedure is uncertain. Our aim was to determine the impact of supination and pronation on the reliability of measurements of tilt, RI, and UV.

Methods

Tantalum markers were inserted into the distal radius of 21 unfractured cadaver forearms. The forearms were radiographed in different degrees of supination and pronation. The exact degree of rotation was calculated with radiostereometric analyses. Tilt, RI, and UV were measured by two independent readers in a random and anonymised fashion. Association between forearm rotation and radiographic measurements was examined using linear regression.

Results

Forearm rotation significantly impacted the radiographically measured tilt. One degree of supination and pronation respectively increased and decreased palmar tilt with 0.68° and 0.44°, observers 1 and 2, respectively. As opposed to observer 1, observer 2 found that RI was significantly impacted by rotation with a slope of 0.08. Ulnar variance was not significantly impacted by rotation with linear regression slopes of 0.01° (95% confidence interval [CI] − 0.02–0.05, p = 0.490) and 0.02° (95% CI − 0.02–0.07; p = 0.288), observer 1 and observer 2, respectively.

Conclusion

In unfractured forearms, the radiographically measured tilt was significantly affected by rotation. Palmar tilt increased with supination and decreased with pronation. Rotation significantly affected radial inclination, although of a magnitude that is probably not clinically relevant. No significant impact on UV was found.
Ovarian tissue freezing and activation after thawing: an update
Authors: Peng Li-fan
Published: April 2021

Background

With the growth of women’s age, ovarian failure can be caused by various factors. For the women who need chemotherapy because of cancer factors, the preservation of fertility is more urgent. The treatment of cancer is also a process in which all tissues and organs of the body are severely damaged, especially in the reproductive system.

Main body

As a new fertility preservation technology, autologous ovarian tissue cryopreservation and transplantation is developing rapidly and showing great potentiality in preserving ovarian endocrine function of young cervical cancer patients. Vitrification and slow freezing are two common techniques applied for ovarian tissue cryopreservation. Thus, cryopreserved/thawed ovarian tissue and transplantation act as an important method to preserve ovarian function during radiotherapy and chemotherapy, and ovarian cryopreservation by vitrification is a very effective and extensively used method to cryopreserve ovaries. The morphology of oocytes and granulosa cells and the structure of organelles were observed under the microscope of histology; the hormone content in the stratified culture medium of granulosa cells with the diameter of follicle was used to evaluate the development potential of ovarian tissue, and finally the ovarian tissue stimulation was determined by the technique of ovarian tissue transplantation.

Conclusions

Although there are some limitations, the team members still carry out this review to provide some references and suggestions for clinical decision-making and further clinical research.
Crossroad of infection and autoimmunity in acute liver failure: a case report
Authors: Roy Akash , Taneja Sunil , De Arka , Das Ashim , Duseja Ajay K. , Singh Virendra
Published: April 2021

Background

Acute liver failure (ALF) is a syndromic diagnosis, consisting of jaundice, coagulopathy, and any degree of encephalopathy in a patient without pre-existing liver disease within 26 weeks of the onset of symptoms. Autoimmune hepatitis has a wide range of presentations and can rarely present as ALF, which frequently tends to be autoantibody negative. Tropical infections like dengue, malaria, and leptospirosis, which present as mimickers of ALF, always remain a differential diagnosis of ALF and mandate an etiology specific management. In rare cases, such infections themselves act as a trigger for autoimmunity. We report a case of diagnostic crossroads of infection and autoimmunity, presenting as acute liver failure and describe the challenges in management.

Case presentation

A 25-year-old female presented with a syndromic diagnosis of acute liver failure with possibility of tropical illness-related ALF mimic on account of positive Leptospira serology. After initial improvement, there was a rebound worsening of liver functions which prompted a liver biopsy. Biopsy narrowed the differential to Leptospira-associated hepatitis and severe auto-immune hepatitis. Trial of low dose steroid was given which led to dramatic improvement.

Conclusion

Tropical infections can present as ALF mimics and can themselves act as triggers for autoimmunity. Distinguishing such cases from de-novo acute severe autoimmune hepatitis is difficult and requires therapeutic brinksmanship. An early trial of steroid is mandated but comes with its own challenges.
Damage control of a twin-column pier with a replaceable steel shear link in a cap beam under transverse seismic motion
Authors: Chen Weiting , Bai Xuemeng , Xu Tengfei , Ke Shanshan , Deng Kailai , Xie Haiqing
Published: April 2021

This paper proposes a novel twin-column pier with a steel shear link (SSL) installed in the cap beam to reduce seismic damage in the transverse direction. The SSL interrupts the rigid cap beam and relieves the coupled deformation of the two columns. Benefits of the yieldable SSL in the event of a strong earthquake are the longer effective deformation of a column and limited axial compressive load. A benchmark reinforced-concrete bridge is employed in a seismic performance evaluation to verify the damage reduction performance of the novel twin-column pier with an SSL. Five numerical models, calibrated in a physical component test, are built in ABAQUS; that is, one original bridge and four novel bridges with different SSLs and accompanying configurations. Modal analysis shows that introducing the SSL does not change the overall structural dynamic characteristics. The nonlinear dynamic analysis results indicate that adopting the SSL effectively reduces the peak compressive strain of the reinforced-concrete column, but energy dissipation from the SSL is negligible compared with the total inputted seismic energy. There is no evident change in the macro seismic response of the twin-column pier when using the SSL, such as overall drift and structural damping ratio. Moreover, a transverse continuous main girder is suggested for realizing an additional restoring moment at the column top, which further reduces compressive strain.
GenBio-MAPS as a Case Study to Understand and Address the Effects of Test-Taking Motivation in Low-Stakes Program Assessments
Authors: Uminski Crystal , Couch Brian A.
Published: April 2021

The effects of test-taking motivation on student behaviors and performance on the GenBio-MAPS program assessment were analyzed. Filtering recommendations that GenBio-MAPS administrators can use to reduce construct-irrelevant variance in test scores associated with low test-taking motivation are offered.-
Are Regulations Safe? Reflections From Developing a Digital Cancer Decision-Support Tool
Authors: McInerney Ciarán D. , Scott Beverly C. , Johnson Owen A.
Published: April 2021

PURPOSE

Informatics solutions to early diagnosis of cancer in primary care are increasingly prevalent, but it is not clear whether existing and planned standards and regulations sufficiently address patients' safety nor whether these standards are fit for purpose. We use a patient safety perspective to reflect on the development of a computerized cancer risk assessment tool embedded within a UK primary care electronic health record system.

METHODS

We developed a computerized version of the CAncer Prevention in ExetER studies risk assessment tool, in compliance with the European Union's Medical Device Regulations. The process of building this tool afforded an opportunity to reflect on clinical concerns and whether current regulations for medical devices are fit for purpose. We identified concerns for patient safety and developed nine practical recommendations to mitigate these concerns.

RESULTS

We noted that medical device regulations (1) were initially created for hardware devices rather than software, (2) offer one-shot approval rather than supporting iterative innovation and learning, (3) are biased toward loss-transfer approaches that attempt to manage the fallout of harm instead of mitigating hazards becoming harmful, and (4) are biased toward known hazards, despite unknown hazards being an expected consequence of health care as a complex adaptive system. Our nine recommendations focus on embedding less-reductionist and stronger system perspectives into regulations and standards.

CONCLUSION

Our intention is to share our experience to support research-led collaborative development of health informatics solutions in cancer. We argue that regulations in the European Union do not sufficiently address the complexity of healthcare information systems with consequences for patient safety. Future standards and regulations should continue to follow a system-based approach to risk, safety, and accident avoidance.
Patient Knowledge and Expectations About Return of Genomic Results in a Biomarker-Driven Master Protocol Trial (SWOG S1400GEN)
Authors: Roth Joshua A. , Trivedi Meghna S. , Gray Stacy W. , Patrick Donald L. , Delaney Debbie M. , Watabayashi Kate , Litwin Paul , Shah Parth , Crew Katherine D. , Yee Monica , Redman Mary W. , Unger Joseph M. , Papadimitrakopoulou Vassiliki , Johnson Judy , Kelly Karen , Gandara David , Herbst Roy S. , Hershman Dawn L. , Ramsey Scott D.
Published: April 2021

PURPOSE:

Biomarker-driven master protocols represent a new paradigm in oncology clinical trials, but their complex designs and wide-ranging genomic results returned can be difficult to communicate to participants. The objective of this pilot study was to evaluate patient knowledge and expectations related to return of genomic results in the Lung Cancer Master Protocol (Lung-MAP).

METHODS:

Eligible participants with previously treated advanced non–small-cell lung cancer were recruited from patients enrolled in Lung-MAP. Participants completed a 38-item telephone survey ≤ 30 days from Lung-MAP consent. The survey assessed understanding about the benefits and risks of Lung-MAP participation and knowledge of the potential uses of somatic testing results returned. Descriptive statistics and odds ratios for associations between demographic factors and correct responses to survey items were assessed.

RESULTS:

From August 1, 2017, to June 30, 2019, we recruited 207 participants with a median age of 67, 57.3% male, and 94.2% White. Most participants “strongly/somewhat agreed” with statements that they “received enough information to understand” Lung-MAP benefits (82.6%) and risks (69.5%). In items asking about potential uses of Lung-MAP genomic results, 87.0% correctly indicated that the results help to select cancer treatment, but < 20% correctly indicated that the results are not used to confirm cancer diagnosis, would not reveal risk of developing diseases besides cancer, and would not indicate if family members had increased cancer risk. There were no associations between sociodemographic factors and proportions providing correct responses.

CONCLUSION:

In a large National Clinical Trials Network biomarker-driven master protocol, most participants demonstrated incorrect knowledge and expectations about the uses of genomic results provided in the study despite most indicating that they had enough information to understand benefits and risks.
Begging for Rain: Economic and Social Effects of Climate in the Early Koryŏ Period
Authors: Kahm Howard , Lee Dennis
Published: April 2021

As in other premodern societies, the economy and society of Koryŏ Korea (918–1392) were greatly affected by climatological phenomena, particularly rain and drought. However, climate played a critical role in the early formation of Koryŏ, especially in reinforcing a sociocultural belief system that supported monarchical authority. The kings utilized a “menu” of rituals designed to appease Heaven and create favorable climate conditions, which legitimated the temporal and spiritual power of the king. The different rituals can be categorized as personal rituals, private rituals, and public rituals. While climate crises threatened the economic and social stability of Koryŏ society, they were also opportunities for the Koryŏ rulers to display and reaffirm their supreme economic and juridical authority. The kings demonstrated their power by reducing corvée labor and taxes, postponing or eliminating monastery construction, and commuting judicial punishments. While weather and climate were natural phenomena, the social responses to weather were encapsulated in a ritual system that reinforced both the personal responsibility of the king and popular belief in the power and authority of the king to affect the physical and metaphysical environment.
Two Incarnations, One Person: The Complexity of Kim Iryŏp’s Life
Authors: Kim Hwansoo
Published: April 2021

Kim Iryŏp (Kim Wŏnju, 1896‒1971) was a pioneering feminist and prolific writer who left lay life to become a Buddhist nun. The bifurcation of her life between the secular and religious has generated two separate narratives, with Korean feminist studies focusing on Iryŏp as a revolutionary thinker and Buddhist studies centering on Iryŏp as an influential Buddhist nun. When divided this way, the biography of each career reads more simply. However, by including two significant but unexplored pieces of her history that traverse the two halves of her narrative, Iryŏp emerges as a more complex figure. The first is her forty-five-year relationship with the Buddhist monk Paek Sŏng’uk (1897‒1981). The second is how she extended some of her early feminism into monastic life but said little about the marginalization of nuns in Buddhism’s highly patriarchal system. In both her relationship with Paek and her feminism, Iryŏp drew on the Buddhist teaching of nonself, in which the “big I” is beyond gender. Thus, Iryŏp repositions herself as having attained big I, while Paek remained stuck in “small I.” Yet, while she finds equality with monks through an androgynous big I, none of her writings contest Korean Buddhism’s androcentric institutional structure.
Truths of Traitors: Colonial Collaboration and Autobiographical Narratives in Postliberation Korea
Authors: Kim Ji Young
Published: April 2021

This article examines post-1945 autobiographical writings by alleged pro-Japanese collaborators, focusing on how these ex-colonized Korean writers represented their “shameful” pasts. Autobiographical narratives that confess to writers’ collaborations are customarily interpreted as excuses or self-justifications for collaboration that distort colonial memories. This customary reading of autobiographical writings, based on the factuality and sincerity of the narratives, seems to derive from a preceding literary practice of reading sosŏlga sosŏl (novels about novelists) during the late colonial period, a tacit contract between reader and author of expecting fiction to represent the author’s transparent life narrative. In challenging this mode of reading, this article traces the rhetorical styles and effects and the complexities of the political and ethical implications of two famous confessions of collaboration: Yi Kwangsu’s My Confession and Ch’ae Mansik’s “Sinner of the People.” In doing so, this article demonstrates how specific rhetorical devices produce the sincerity of the autobiographical texts and give closure to the dishonorable colonial past. The author presents a new approach to pro-Japanese collaboration by exploring the arduous task of closure, self-reflection, and decolonization undertaken by Korean writers in the postliberation period, when the decolonizing project was deemed a failure.
Προσδιορισμός των κυτταροκινών IL-17A, IL-17F και IL-22 σε ασθενείς με σπογγοειδή μυκητίαση
Authors: Παπαθεμελή Δέσποινα
Published: April 2021

Εισαγωγή: Είναι γνωστή η συμμετοχή των IL-17A, IL-17F και IL-22 σε πολλές φλεγμονώδεις και αυτοάνοσες παθήσεις. Οι γνώσεις μας ωστόσο για το ρόλο αυτών των κυτταροκινών στη σπογγοειδή μυκητίαση είναι περιορισμένες. Σκοπός μελέτης: Ο σκοπός αυτής της μελέτης είναι να εξετάσει τα επίπεδα έκφρασης των IL-17A, IL-17F και IL-22 σε δείγματα αίματος και ιστού ασθενών με σπογγοειδή μυκητίαση. Μέθοδοι: Χρησιμοποιήθηκαν δείγματα αίματος από 50 ασθενείς με σπογγοειδή μυκητίαση και 50 υγιείς μάρτυρες και δείγματα ιστού από βιοψίες δέρματος από 26 ασθενείς με σπογγοειδή μυκητίαση και 5 υγιείς μάρτυρες. Τα επίπεδα πρωτεϊνών αυτών των κυτταροκινών μετρήθηκαν σε δείγματα ορού με Multiplex ELISA και τα επίπεδα έκφρασης mRNA αυτών των κυτταροκινών μετρήθηκαν σε δείγματα αίματος και δέρματος με RT-PCR. Αποτελέσματα: Τα επίπεδα έκφρασης mRNA των IL-17A και IL-17F στο αίμα ήταν σημαντικά χαμηλότερα σε ασθενείς με σπογγοειδή μυκητίαση σε σύγκριση με υγιείς μάρτυρες (παραμετρικός έλεγχος: p=0.0089 και p=0.0004 αντιστοίχως, μη παραμετρικός έλεγχος: p=0.0069 και p=0.0006). Τα επίπεδα της IL-22 στον ορό καθώς και τα επίπεδα έκφρασης mRNA της IL-22 στον ιστό του δέρματος ήταν αυξημένα σε ασθενείς με σπογγοειδή μυκητίαση σε σύγκριση με υγιείς μάρτυρες (παραμετρικός έλεγχος: p=0.0076 και p=0.0319 αντιστοίχως, μη παραμετρικός έλεγχος: p=0.0165 και p=0.1435 αντιστοίχως). Συμπεράσματα: Τα αποτελέσματά μας υποδηλώνουν ότι τα χαμηλά επίπεδα IL-17A και IL-17F στη σπογγοειδή μυκητίαση μπορεί να συνδέονται με απώλεια της ανοσολογικής απάντησης που οδηγεί σε ογκογένεση. Τα αυξημένα επίπεδα της IL-22 καταδεικνύουν την πιθανή συμμετοχή της IL-22 στo μικροπεριβάλλον της νεοπλασίας.
Study of the structure and mechanical behavior of low-dimentional III-V semiconductor heterostructures
Authors: Φλωρίνη Νικολέττα
Published: April 2021

Το αντικείμενο της διδακτορικής διατριβής εντοπίζεται στην ολοκληρωμένη μελέτη των χαμηλοδιάστατων ημιαγωγικών ετεροδομών III-V ως προς την μορφολογία τους, την κρυσταλλική τους δομή, τα πεδία παραμόρφωσης και την χημική τους σύσταση. Για τον σκοπό αυτό μελετήθηκαν QDs ανεπτυγμένες σε υπόστρωμα GaAs, για χρήση σε εφαρμογές διατάξεων νανοφωτονικής και κβαντικής κρυπτογραφίας, και NWs ανεπτυγμένα σε υπόστρωμα Si για ενεργειακή χρήση σε προηγμένης γενιάς φωτοβολταϊκά στοιχεία. Συγκεκριμένα, οι κβαντικές τελείες αφορούν τόσο επιφανειακές όσο και εσωτερικές QDs ινδίου-αρσενικού (InAs) ανεπτυγμένες σύμφωνα με τον μηχανισμό στοιβάδων και νησίδων (Stranski-Krastanow) σε υπόστρωμα γαλλίου-αρσενικού (GaAs) (211)Β, ενώ τα νανονήματα αφορούν NWs γαλλίου-αρσενικού (GaAs), καθώς και NWs πυρήνα/φλοιού GaAs/ (In,Al)GaAs ανεπτυγμένα σε υποστρώματα πυριτίου (Si) (111). Όλες οι νανοδομές έχουν αναπτυχθεί με Επιταξία Μοριακών Δεσμών (Molecular Beam Epitaxy, MBE). Η ανάλυση της μορφολογίας, του δομικού και στοιχειακού χαρακτηρισμού πραγματοποιήθηκε χρησιμοποιώντας τεχνικές Ηλεκτρονικής Μικροσκοπίας Διέλευσης (Transmission Electron Microscopy, ΤΕΜ) και υψηλής διακριτικής ικανότητας ΤΕΜ (High-Resolution ΤΕΜ, ΗRΤΕΜ). Ταυτόχρονα, η ανάλυση της παραμόρφωσης στη νανοκλίμακα πραγματοποιήθηκε χρησιμοποιώντας την απεικονιστική πειραματική μέθοδο της Γεωμετρικής Ανάλυσης Φάσης (Geometric Phase Analysis, GPA), αντλώντας λεπτομερή πειραματικά δομικά στοιχεία των υπό μελέτη συστημάτων σε νανοσκοπικό και ατομικό επίπεδο, από παρατηρήσεις ΗRTEM. Στην ετεροεπιταξιακή ανάπτυξη η κατανομή των ελαστικών πεδίων τάσεων και παραμορφώσεων, καθώς και η χημική τους σύσταση έχουν σημαντικό αντίκτυπο στις οποτοηλεκτρονικές τους ιδιότητες. Για τον σκοπό αυτό, ακολούθησαν υπολογισμοί-προσομοιώσεις των πεδίων τάσης-παραμόρφωσης και η αποτύπωση τους σε δυο ή/και τρεις διαστάσεις (2D – 3D) με την υπολογιστική μέθοδο των Πεπερασμένων Στοιχείων (Finite Elements Method, FEM). Επιπλέον, πραγματοποιήθηκαν συμπληρωματικές παρατηρήσεις ΤΕΜ Σάρωσης (Scanning TEM, STEM) και in-situ Φασματοσκοπίας Ενεργειακού Διασκορπισμού Ακτίνων-Χ (Energy Dispersive X-Ray Spectroscopy, EDS) για τον μορφολογικό χαρακτηρισμό και τον τοπικό προσδιορισμό της χημικής σύστασης των NWs πυρήνα/φλοιού, αντίστοιχα.
Ελληνικός κινηματογράφος (1914 - 1974)
Authors: Δημητρομανωλάκης Γεώργιος
Published: April 2021

Η παρούσα ερευνητική εργασία έχει ως θέμα την πρόσληψη του ελληνικού κινηματογράφου της περιόδου 1914 - 1974, καθώς και τη σύνδεση μεταξύ τεχνολογικής εξέλιξης και πρόσληψης. Διερευνώνται οι σημαντικότερες εκφάνσεις της πρόσληψης των ταινιών, αλλά και ευρύτερα των οπτικοακουστικών δημιουργιών και μέσων. Η έρευνα εξειδικεύεται στην ανάδειξη του τρόπου με τον οποίο η προσληπτική διαδικασία στον κινηματογράφο συνδέεται τόσο με τα διαθέσιμα τεχνικά μέσα παραγωγής και την εξέλιξη της τεχνολογίας, όσο και με τα κοινωνικά, οικονομικά και πολιτισμικά συμφραζόμενα κάθε ιστορικής περιόδου. Η πρόσληψη του ελληνικού κινηματογράφου μελετάται μέσα από το πρίσμα της Θεωρίας της Υποδοχής. Η μελέτη της πρόσληψης των ταινιών αποτελεί μέθοδο διερεύνησης του νοήματος, όπως αυτό συνδιαμορφώνεται μέσα από την κοινωνική, τεχνολογική, ιστορική και πολιτισμική του διάσταση. Μας υποδεικνύει θεατές και αθέατες πλευρές του πολιτισμού μας, σε συγκεκριμένες χρονικές και ιστορικής σημασίας περιόδους. Επιπλέον, ο τρόπος χρήσης και εμπορικής εκμετάλλευσης των νέων - κάθε φορά - τεχνολογιών και εφαρμογών, όπως στη συγκεκριμένη περίπτωση ο κινηματογράφος, αποτελεί μια σύνθετη κοινωνική, οικονομική, ιδεολογική και πολιτισμική διεργασία που χρήζει διερεύνησης στο πλαίσιο της ιστορικής έρευνας.
An assessment of anxiety towards COVID-19 among Nigerian general population using the Fear of COVID-19 scale
Authors: ALUH DEBORAH , Mosanya Adaobi , Onuoha Chidinma , Anosike Chibueze , Onuigbo Ebele
Published: April 2021

Aim of the study

The study sought to assess the fear of COVID-19 among the general population and suggested ways to reduce anxiety levels.

Subject or material and methods

A web-based cross-sectional survey was designed using Google forms to collect data. Participants were recruited using a convenience snowballing technique. The questionnaire contained 3 sections on Socio-demographic data, the Fear of COVID-9 scale, and an open-ended question on suggested ways to mitigate anxiety towards COVID-19. For the open-ended question, scores were grouped based on the similarity of thematic content. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0.

Results

A total of 1011 respondents completed the survey. The Mean Sum Fear of Corona was 18.28±5.909 out of a possible maximum score of 35. More than half (53.6%, n = 542) of the respondents had ‘Low fear’ of COVID-19. There was an increasing fear of COVID-19 with increasing educational qualification, however, this was not statistically significant. Respondents with health-related occupations had less anxiety towards COVID-19 compared to people in non-health related occupations (17.83±5.85 Vs. 18.54±5.91).

Discussion

When respondents were asked to suggest ways anxiety towards COVID-19 could be reduced, one-third of them (34%, n =344) responded that public enlightenment programs with accurate information on the virus should be embarked on.

Conclusions

Overall, there was a low fear of COVID-19 among the general Nigerian population surveyed in this study. Public enlightenment and limited consumption of news on COVID-19 were the most suggested ways to abate fear of the virus.
Study of correlates of depression among health care workers during COVID-19 epidemic
Authors: Patel Vishal , Pandey Sunayna , Patel Falguni , Jani Arpit , Tiwari Deepak , Thakrar Rajendrakumar
Published: April 2021

Aim of the study

Study aimed to find out the prevalence and risk factors of depression among the health care workers during COVID-19 outbreak.

Subject or material and methods

This was a three month, cross-sectional, observational, single center study of heath care workers of a notified COVID-19 hospital. Study objectives were explained to health care workers, and written consent was obtained. Patient health questionnaire-9 (PHQ-9), DSM-5 Criterion of major depressive disorder and Structured Clinical Interview for DSM-5 were used to diagnose the depression. Descriptive statistics, chi-square test and binary logistic regression were used for analysis of variables

Results

Overall 18.78% health workers reported major depressive disorder.Nearly three fourth of the old age participants had moderate to severe depression. 20.69% of married subjects had major depression. Medical health workers reported more depression . One third of the front line workers had major depression. 51% of the participants with medical co-morbidity reported Major depression as compared to only 12% in those without any medical co-morbidity.33% of subjects watching COVID-19 news very frequently in a day had major depression

Discussion

The prevalence of depression ranges from 9 to 35% in various studies. . Among them living in joint family, married, elderly, presence of medical illness, frontline work, frequently watching COVID-19 news, excessive fear of COVID-19, and medical health worker emerged as statistically significant variables associated with major depression

Conclusions

The prevalence of depression is high among health care workers while performing duties during COVID-19 outbreak. Early diagnosis and treatment of depression would be crucial during this difficult time.
Assessing Algorithmic Fairness with Unobserved Protected Class Using Data Combination
Authors: Kallus Nathan , Mao Xiaojie , Zhou Angela
Published: April 2021

The increasing impact of algorithmic decisions on people’s lives compels us to scrutinize their fairness and, in particular, the disparate impacts that ostensibly color-blind algorithms can have on different groups. Examples include credit decisioning, hiring, advertising, criminal justice, personalized medicine, and targeted policy making, where in some cases legislative or regulatory frameworks for fairness exist and define specific protected classes. In this paper we study a fundamental challenge to assessing disparate impacts in practice: protected class membership is often not observed in the data. This is particularly a problem in lending and healthcare. We consider the use of an auxiliary data set, such as the U.S. census, to construct models that predict the protected class from proxy variables, such as surname and geolocation. We show that even with such data, a variety of common disparity measures are generally unidentifiable, providing a new perspective on the documented biases of popular proxy-based methods. We provide exact characterizations of the tightest possible set of all possible true disparities that are consistent with the data (and possibly additional assumptions). We further provide optimization-based algorithms for computing and visualizing these sets and statistical tools to assess sampling uncertainty. Together, these enable reliable and robust assessments of disparities—an important tool when disparity assessment can have far-reaching policy implications. We demonstrate this in two case studies with real data: mortgage lending and personalized medicine dosing.

This paper was accepted by Hamid Nazerzadeh, Management Science Special Section on Data-Driven Prescriptive Analytics.
Challenges and complexities of discharge planning from a district nursing perspective
Authors: Lino Pedro
Published: April 2021

Over the past 30 years, the Government has been promoting the transition of care from the acute setting to the community setting. Within the community setting, district nurses are described in the latest reports as endorsers of the care close to home. However, with the surge in hospital discharge, the district nursing workforce is faced with further pressure to cope with the drive to move care into the community. The purpose of this extended literature review (ELR) was to deconstruct the available data on the challenges and hurdles experienced by district nurses to manage hospital discharge. On reviewing the selected data, it was found that fragmented communication between secondary and primary sectors poses problems for effective care in the community. Additionally, the lack of understanding of the district nursing service and its remits creates obstacles for effective hospital discharge. Some practical solutions to resolve these problems are proposed.
Lymphoedema after head and neck cancer treatment: an overview for clinical practice
Authors: Jeans Claire , Brown Bena , Ward Elizabeth C , Vertigan Anne E
Published: April 2021

Lymphoedema is a disorder of the lymphatic system that presents as an atypical swelling and accumulation of protein-rich fluid within the interstitial spaces. Head and neck lymphoedema (HNL) is highly prevalent in patients who have been treated for head and neck cancer (HNC) and may manifest externally on the face and neck; internally within the oral cavity, pharynx or larynx; or as a combination of both. HNL is known to contribute to a wide range of physical, functional and psychological issues, and presents several unique challenges in terms of its management. This review article provides an overview of HNL for clinicians and aims to improve awareness of this condition and the impact it has on patients.
Midwives' substance use
Authors: Pezaro Sally , Maher Karen
Published: April 2021

One year on from the first COVID-19 lockdown, is substance use amongst midwives more or less problematic?
Enigma of maternity service safety improvements and increasing expression of patient dissatisfaction
Authors: Sholapurkar Shashikant L
Published: April 2021

There have been gradual and continual improvements in maternity care in the UK. This has been paradoxically accompanied by increasing censure by authorities for adverse outcomes and public expression of dissatisfaction. Serious maternal and perinatal adverse outcomes have a devastating effect. Grieving families need an honest explanation, continued support and reassurance that lessons are being sought and learnt. Additionally, the public would welcome the acknowledgement of limitations of healthcare and the science itself; and that the adverse outcomes can be minimised but not eradicated. Blame culture is harmful to the clinicians, healthcare system and, ultimately, patients. The controversial issue of intrapartum fetal monitoring best illustrates the urgent need to reform mistaken science in addition to organisational and cultural improvements. Most enquiries do not critique bad science or guidelines but only birth attendants. The healthcare outcomes must continue to improve through investigations, reviews, openness, medical progress and by helping the clinicians to mitigate the limitations of scientific knowledge, resources and human factors.
Birth in the 21st century
Authors: Mareca Alba
Published: April 2021

A documentary explains what childbirth is through the experiences of five women at a public hospital in Spain
Are BAME communities really reluctant to take the COVID-19 vaccination?
Authors: Roye Julie
Published: April 2021

Julie Roye explores the widely reported vaccine hesitancy among BAME communities and considers how it can be addressed
Heatwave distortion correction using an improved reference sample compensation method and multispectral digital image correlation
Authors: Zhang Xiaoying , Li Chenzhuo , Yu Liping , Pan Bing
Published: April 2021

Heatwave distortions, caused by unevenly distributed temperature and refractive index in the optical path, unavoidably occur in high-temperature digital image correlation (DIC) measurement. To eliminate these distortions, a multispectral DIC-aided reference sample compensation method is proposed. The proposed method first adheres a correcting transparent glass (decorated with fluorescent speckle patterns) onto the test specimen (sprayed with red speckle patterns). Then, by illuminating the specimen with ultraviolet- and red-light sources, the blue light excited from the correcting glass and the red light reflected from the specimen surface can be captured by a 3CCD camera, forming a color image. After separating the recorded color images into red and blue subimages, the original and the correcting displacement fields can be calculated from these two sets of subimages using the subset-based local 2D-DIC algorithm. By point-to-point subtracting the correcting displacement fields from the original ones, the heatwave distortions can be eliminated, and the corrected real displacement fields can be obtained. For validation, static heatwave experiments show the feasibility and accuracy of the proposed method in correcting heatwave distortions. A uniaxial tensile test of an aluminum specimen with a central hole was also performed, further confirming the practicality of the proposed method in correcting heatwave distortions and revealing heatwave-hidden deformation.
Vibration reconstruction and optical feedback parameter evaluation based on the direction discrimination in self-mixing interferometry
Authors: Ri Chol-Yong , Choe Jin-Hyok , Ri Hwa-Ryong , Pak Chol-Min , Ri Kyong-Rim , O Jin-Myong
Published: April 2021

Laser diode-based self-mixing interferometry (SMI) is a promising technique for noncontact sensing and its industry. In this paper, a phase unwrapping method in the several optical feedback levels is proposed based on displacement direction. A novel, to the best of our knowledge, method for evaluating the optical feedback factor C simultaneously with the linewidth enhancement is proposed by taking into account the effect of the accuracy of the linewidth enhancement

α

on the evaluated method for C based on the differential feature of vibration reconstruction signal. Simulations and experiments are conducted to verify the proposed method.
Dynamic switching of coaxial focus based on terahertz meta-lens
Authors: Yin Shan , Liang Yuanda , Zeng Dehui , Tian Yangyang , Zhong Peng , Guo Ling , Huang Wei , Zhang Wentao
Published: April 2021

We propose an active meta-lens that can dynamically switch the coaxial focus on three statuses with the external optical pump. The meta-lens composes of two concentric sets of complementary split-ring resonator (CSRR) arrays, which function at different focal lengths, atop the silicon on sapphire substrate. With specifically structured phase distribution, the meta-lens can form completely separated double foci simultaneously. Through illuminating the internal or external CSRR arrays individually with patterned optical pump, the meta-lens switches to single focus at different points. The proposed design provides a new avenue for developing terahertz multifunctional devices applied in microscope imaging and tomography.
Functional optoretinography: concurrent OCT monitoring of intrinsic signal amplitude and phase dynamics in human photoreceptors
Authors: Ma Guangying , Son Taeyoon , Kim Tae-Hoon , Yao Xincheng
Published: April 2021

Intrinsic optical signal (IOS) imaging promises a noninvasive method for objective assessment of retinal function. This study demonstrates concurrent optical coherence tomography (OCT) of amplitude-IOS and phase-IOS changes in human photoreceptors. A new procedure for differential-phase-mapping (DPM) is validated to enable depth-resolved phase-IOS imaging. Dynamic OCT revealed rapid amplitude-IOS and phase-IOS changes, which occur almost right away after the stimulus onset. These IOS changes were predominantly observed within the photoreceptor outer segment (OS), particularly two boundaries connecting to the inner segment and retinal pigment epithelium. The comparative analysis supports that both amplitude-IOS and phase-IOS attribute to transient OS morphological change associated with phototransduction activation in retinal photoreceptors. A simulation modeling is proposed to discuss the relationship between the photoreceptor OS length and phase-IOS changes.
Opposing roles for Egalitarian and Staufen in transport, anchoring and localization of oskar mRNA in the Drosophila oocyte
Authors: Mohr Sabine , Kenny Andrew , Lam Simon T. Y. , Morgan Miles B. , Smibert Craig A. , Lipshitz Howard D. , Macdonald Paul M.
Published: April 2021

Localization ofoskarmRNA includes two distinct phases: transport from nurse cells to the oocyte, a process typically accompanied by cortical anchoring in the oocyte, followed by posterior localization within the oocyte. Signals within theoskar3’ UTR directing transport are individually weak, a feature previously hypothesized to facilitate exchange between the different localization machineries. We show that alteration of the SL2a stem-loop structure containing theoskartransport and anchoring signal (TAS) removes an inhibitory effect such thatin vitrobinding by the RNA transport factor, Egalitarian, is elevated as isin vivotransport from the nurse cells into the oocyte. Cortical anchoring within the oocyte is also enhanced, interfering with posterior localization. We also show that mutation of Staufen recognized structures (SRSs), predicted binding sites for Staufen, disrupts posterior localization ofoskarmRNA just as instaufenmutants. Two SRSs in SL2a, one overlapping the Egalitarian binding site, are inferred to mediate Staufen-dependent inhibition of TAS anchoring activity, thereby promoting posterior localization. The other three SRSs in theoskar3’ UTR are also required for posterior localization, including two located distant from any known transport signal. Staufen, thus, plays multiple roles in localization ofoskarmRNA.
The impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study
Authors: Mbuagbaw Lawrence , Logie Carmen H. , Thabane Lehana , Smaill Fiona , Smieja Marek , Burchell Ann N. , Rachlis Beth , Tarride Jean-Eric , Kroch Abigail , Mazzulli Tony , Alvarez Elizabeth , Lawson Daeria O. , Nguyen Francis , Perez Richard , Seow Hsien
Published: April 2021

Background

Knowledge of HIV drug resistance informs the choice of regimens and ensures that the most efficacious options are selected. In January 2014, a policy change to routine resistance testing was implemented in Ontario, Canada. The objective of this study was to investigate the policy change impact of routine resistance testing in people with HIV in Ontario, Canada since January 2014.

Methods

We used data on people with HIV living in Ontario from administrative databases of the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO), and ran ordinary least squares (OLS) models of interrupted time series to measure the levels and trends of 2-year mortality, 2-year hospitalizations and 2-year emergency department visits before (2005–2013) and after the policy change (2014–2017). Outcomes were collected in biannual periods, generating 18 periods before the intervention and 8 periods after. We included a control series of people who did not receive a resistance test within 3 months of HIV diagnosis.

Results

Data included 12,996 people with HIV, of which 8881 (68.3%) were diagnosed between 2005 and 2013, and 4115 (31.7%) were diagnosed between 2014 and 2017. Policy change to routine resistance testing within 3 months of HIV diagnosis led to a decreasing trend in 2-year mortality of 0.8% every six months compared to the control group. No significant differences in hospitalizations or emergency department visits were noted.

Interpretation

The policy of routine resistance testing within three months of diagnosis is beneficial at the population level.
Metabolite profiles associated with disease progression in influenza infection
Authors: Wendt Chris H. , Castro-Pearson Sandra , Proper Jennifer , Pett Sarah , Griffin Timothy J. , Kan Virginia , Carbone Javier , Koulouris Nikolaos , Reilly Cavan , Neaton James D. ,   for the INSIGHT FLU003 Plus Study Group
Published: April 2021

Background

We performed metabolomic profiling to identify metabolites that correlate with disease progression and death.

Methods

We performed a study of adults hospitalized with Influenza A(H1N1)pdm09. Cases (n = 32) were defined by a composite outcome of death or transfer to the intensive care unit during the 60-day follow-up period. Controls (n = 64) were survivors who did not require transfer to the ICU. Four hundred and eight metabolites from eight families were measured on plasma sample at enrollment using a mass spectrometry based Biocrates platform. Conditional logistic regression was used to summarize the association of the individual metabolites and families with the composite outcome and its major two components.

Results

The ten metabolites with the strongest association with disease progression belonged to five different metabolite families with sphingolipids being the most common. The acylcarnitines, glycerides, sphingolipids and biogenic metabolite families had the largest odds ratios based on the composite endpoint. The tryptophan odds ratio for the composite is largely associated with death (OR 17.33: 95% CI, 1.60–187.76).

Conclusions

Individuals that develop disease progression when infected with Influenza H1N1 have a metabolite signature that differs from survivors. Low levels of tryptophan had a strong association with death.

Registry

ClinicalTrials.gov Identifier: NCT01056185
Smoking may be more harmful to vasospastic angina patients who take antiplatelet agents due to the interaction: Results of Korean prospective multi-center cohort
Authors: Cho Seong-Sik , Jo Sang-Ho , Kim Hyun-Jin , Lee Min-Ho , Seo Won-Woo , Kim Hack-Lyoung , Lee Kwan Yong , Yang Tae-Hyun , Her Sung-Ho , Han Seung Hwan , Lee Byoung-Kwon , Park Keun-Ho , Rha Seung-Woon , Gwon Hyeon-Cheol , Choi Dong-Ju , Baek Sang Hong
Published: April 2021

Background

The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated.

Methods

VA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1.

Results

Patients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales.

Conclusions

Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.
Operating bedside cardiac ultrasound program in emergency medicine residency: A retrospective observation study from the perspective of performance improvement
Authors: Kim Ki Hong , Jung Jae Yun , Park Joong Wan , Lee Min Sung , Lee Yong Hee
Published: April 2021

Background

Point-of-care ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician’s performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents.

Methods

Retrospective observational study using the point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements.

Results

During the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value <0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association.

Conclusions

Bedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.
Can smart policies solve the sand mining problem?
Authors: Hübler Michael , Pothen Frank
Published: April 2021

While sand has become a scarce essential resource for construction and land reclamation worldwide, its extraction causes severe ecological damage and high social costs. To derive policy solutions to this paramount global challenge with broad applicability, this model-based analysis exemplarily studies sand trade from Southeast Asia to Singapore. Accordingly, a coordinated transboundary sand output tax reduces sand mining to a large extent, while the economic costs are small for the sand importer and slightly positive for the exporters. As a novel policy implementation approach, a “Sand Extraction Allowances Trading Scheme” is proposed, which helps sustainably balance the importer’s economic growth with the exporters’ economic development.