bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis
Authors: Negeri Zelalem F , Levis Brooke , Sun Ying , He Chen , Krishnan Ankur , Wu Yin , Bhandari Parash Mani , Neupane Dipika , Brehaut Eliana , Benedetti Andrea , Thombs Brett D
Published: October 2021

Objective

To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups.

Design

Systematic review and individual participant data meta-analysis.

Data sources

Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018.

Review methods

Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics.

Results

Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older.

Conclusions

Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool atwww.depressionscreening100.com/phq.

Study registration

PROSPERO CRD42014010673.
Prevalence of and risk factors for non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt
Authors: Tomah Shaheen , Hamdy Osama , Abuelmagd Megahed M , Hassan Attia H , Alkhouri Naim , Al-Badri Marwa R , Gardner Hannah , Eldib Ahmed H , Eid Elsayed A
Published: October 2021

Objective

Limited literature has examined the epidemiology of non-alcoholic fatty liver disease (NAFLD) and fibrosis among young adults in Egypt, a country with one of the highest obesity rates globally. We assessed the prevalence of steatosis and fibrosis among college students in Egypt.

Design

In this cross-sectional study, we recruited students unaware of having fatty liver via a call-for-participation at a private university in the Dakahlia governorate of Egypt. Primary outcomes were the prevalence of steatosis as determined by the controlled attenuation parameter component of transient elastography and fibrosis as determined by the liver stiffness measurement component of transient elastography. Secondary outcomes were clinical parameters and socioeconomic factors associated with the presence and severity of steatosis and fibrosis.

Results

Of 132 participants evaluated for the study, 120 (91%) were included (median (IQR) age, 20 (19–21) years; 65 (54.2%) female). A total of 38 participants (31.6%) had steatosis, among whom 22 (57.9%) had S3 (severe) steatosis. There was a higher risk for steatosis in persons with overweight (adjusted OR 9.67, 95% CI (2.94 to 31.7, p<0.0001) and obesity (adjusted OR 13.87, 95% CI 4.41 to 43.6, p<0.0001) compared with lean persons. Moreover, higher level of parental education was associated with progressing steatosis stages (S1–S3). Six (5%) participants had transient elastography values equivalent to F2–F3 fibrosis (four with F2 fibrosis (≥7.9 kPa), and two with F3 fibrosis (≥8.8 kPa)).

Conclusion

In this cohort of college students in Egypt, around 1 in 3 had steatosis, and 1 in 20 had moderate-to-advanced fibrosis, an established risk factor for hepatic and extrahepatic morbidity and mortality. These data underscore the urgency to address the silent epidemic of NAFLD among young adults in the Middle East-North Africa region.
Intake of marine n-3 polyunsaturated fatty acids and the risk of rheumatoid arthritis: protocol for a cohort study using data from the Danish Diet, Cancer and Health cohort and Danish health registers
Authors: Soussi Bolette Gylden , Bork Christian Sørensen , Kristensen Salome , Lundbye-Christensen Søren , Duch Kirsten , Cordtz René Lindholm , Christensen Jeppe Hagstrup , Schmidt Erik Berg , Dreyer Lene
Published: October 2021

Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory joint disease with multifactorial aetiology. Smoking is a well-established lifestyle risk factor, but diet may also have an impact on the risk of RA. Intake of the major marine n-3 polyunsaturated fatty acids in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been hypothesised to lower the risk of RA due to their anti-inflammatory effects, although based on limited knowledge. Therefore, we aim to investigate the associations between dietary intake of EPA and DHA and the risk of incident RA.

Methods and analysis

A cohort study. The follow-up design will be based on data from the Danish Diet, Cancer and Health cohort, which was established between 1993 and 1997. The participants will be followed through record linkage using nationwide registers including the Danish Civil Registration System, the Danish National Patient Registry and the Danish National Prescription Registry using the unique Civil Personal Registration number. Time-to-event analyses will be conducted with RA as the outcome of interest. The participants will be followed from inclusion until date of RA diagnosis, death, emigration or end of follow-up. HRs with 95% CIs obtained using Cox proportional hazard regression models, with age as underlying time scale and adjustment for established and potential risk factors, will be used as measures of association.

Ethics and dissemination

The study has been approved by the Data Protection Committee of Northern Jutland, Denmark (2019-87) and the North Denmark Region Committee on Health Research Ethics (N-20190031). Study results will be disseminated through peer-reviewed journals and presentations at international conferences.
Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study
Authors: Nair Manisha , Chhabra Shakuntala , Choudhury Saswati Sanyal , Deka Dipika , Deka Gitanjali , Kakoty Swapna D , Kumar Pramod , Mahanta Pranabika , Medhi Robin , Rani Anjali , Rao Seeresha , Roy Indrani , Solomi V Carolin , Talukdar Ratna Kanta , Zahir Farzana , Kansal Nimmi , Arora Anil , Opondo Charles , Armitage Jane , Laffan Michael , Stanworth Simon , Quigley Maria , Baigent Colin , Knight Marian , Kurinczuk Jennifer J
Published: October 2021

Objectives

To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7–9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth.

Design

A prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth.

Setting

Ten hospitals across four states in India.

Participants

1342 pregnant women.

Intervention

Not applicable.

Methods

Hb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models.

Outcomes measures

Adjusted OR with 95% CI.

Results

In women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×109/L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH.

Conclusion

Altered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation.
Ovarian Cancer Epidemiology, Healthcare Access and Disparities (ORCHiD): methodology for a population-based study of black, Hispanic and white patients with ovarian cancer
Authors: Akinyemiju Tomi , Deveaux April , Wilson Lauren , Gupta Anjali , Joshi Ashwini , Bevel Malcolm , Omeogu Chioma , Ohamadike Onyinye , Huang Bin , Pisu Maria , Liang Margaret , McFatrich Molly , Daniell Erin , Fish Laura Jane , Ward Kevin , Schymura Maria , Berchuck Andrew , Potosky Arnold L
Published: October 2021

Introduction

Less than 40% of patients with ovarian cancer (OC) in the USA receive stage-appropriate guideline-adherent surgery and chemotherapy. Black patients with cancer report greater depression, pain and fatigue than white patients. Lack of access to healthcare likely contributes to low treatment rates and racial differences in outcomes. The Ovarian Cancer Epidemiology, Healthcare Access and Disparities study aims to characterise healthcare access (HCA) across five specific dimensions—Availability, Affordability, Accessibility, Accommodation and Acceptability—among black, Hispanic and white patients with OC, evaluate the impact of HCA on quality of treatment, supportive care and survival, and explore biological mechanisms that may contribute to OC disparities.

Methods and analysis

We will use the Surveillance Epidemiology and Ends Results dataset linked with Medicare claims data from 9744 patients with OC ages 65 years and older. We will recruit 1641 patients with OC (413 black, 299 Hispanic and 929 white) from cancer registries in nine US states. We will examine HCA dimensions in relation to three main outcomes: (1) receipt of quality, guideline adherent initial treatment and supportive care, (2) quality of life based on patient-reported outcomes and (3) survival. We will obtain saliva and vaginal microbiome samples to examine prognostic biomarkers. We will use hierarchical regression models to estimate the impact of HCA dimensions across patient, neighbourhood, provider and hospital levels, with random effects to account for clustering. Multilevel structural equation models will estimate the total, direct and indirect effects of race on treatment mediated through HCA dimensions.

Ethics and dissemination

Result dissemination will occur through presentations at national meetings and in collaboration with collaborators, community partners and colleagues across othercancer centres. We will disclose findings to key stakeholders, including scientists, providers and community members. This study has been approved by the Duke Institutional Review Board (Pro00101872). Safety considerations include protection of patient privacy. All disseminated data will be deidentified and summarised.
The impact of a time target on older patients attending the emergency department
Authors: Mason Sue
Published: October 2021

Introduction

The 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.

Methods

Routine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.

Results

A total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).

Conclusions

There are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.
Antiplatelet therapy and outcome in COVID-19: the Health Outcome Predictive Evaluation Registry
Authors: Santoro Francesco , Nuñez-Gil Ivan Javier , Vitale Enrica , Viana-Llamas Maria C , Reche-Martinez Begoña , Romero-Pareja Rodolfo , Feltez Guzman Gisela , Fernandez Rozas Inmaculada , Uribarri Aitor , Becerra-Muñoz Víctor Manuel , Alfonso-Rodriguez Emilio , Garcia-Aguado Marcos , Huang Jia , Ortega-Armas María Elizabeth , Garcia Prieto Juan F , Corral Rubio Eva Maria , Ugo Fabrizio , Bianco Matteo , Mulet Alba , Raposeiras-Roubin Sergio , Jativa Mendez Jorge Luis , Espejo Paeres Carolina , Albarrán Adrián Rodríguez , Marín Francisco , Guerra Federico , Akin Ibrahim , Cortese Bernardo , Ramakrishna Harish , Macaya Carlos , Fernandez-Ortiz Antonio , Brunetti Natale Daniele
Published: October 2021

Background

Standard therapy for COVID-19 is continuously evolving. Autopsy studies showed high prevalence of platelet-fibrin-rich microthrombi in several organs. The aim of the study was therefore to evaluate the safety and efficacy of antiplatelet therapy (APT) in hospitalised patients with COVID-19 and its impact on survival.

Methods

7824 consecutive patients with COVID-19 were enrolled in a multicentre international prospective registry (Health Outcome Predictive Evaluation-COVID-19 Registry). Clinical data and in-hospital complications were recorded. Data on APT, including aspirin and other antiplatelet drugs, were obtained for each patient.

Results

During hospitalisation, 730 (9%) patients received single APT (93%, n=680) or dual APT (7%, n=50). Patients treated with APT were older (74±12 years vs 63±17 years, p<0.01), more frequently male (68% vs 57%, p<0.01) and had higher prevalence of diabetes (39% vs 16%, p<0.01). Patients treated with APT showed no differences in terms of in-hospital mortality (18% vs 19%, p=0.64), need for invasive ventilation (8.7% vs 8.5%, p=0.88), embolic events (2.9% vs 2.5% p=0.34) and bleeding (2.1% vs 2.4%, p=0.43), but had shorter duration of mechanical ventilation (8±5 days vs 11±7 days, p=0.01); however, when comparing patients with APT versus no APT and no anticoagulation therapy, APT was associated with lower mortality rates (log-rank p<0.01, relative risk 0.79, 95% CI 0.70 to 0.94). On multivariable analysis, in-hospital APT was associated with lower mortality risk (relative risk 0.39, 95% CI 0.32 to 0.48, p<0.01).

Conclusions

APT during hospitalisation for COVID-19 could be associated with lower mortality risk and shorter duration of mechanical ventilation, without increased risk of bleeding.

Trial registration number

NCT04334291.
Insight into intraindividual variability across neuropsychological tests and its association with cognitive dysfunction in patients with lupus
Authors: He Jennifer Wei , Diaz Martinez Juan Pablo , Bingham Kathleen , Su Jiandong , Kakvan Mahta , Tartaglia Maria Carmela , Ruttan Lesley , Beaton Dorcas , Wither Joan , Choi May Y , Fritzler Marvin J , Anderson Nicole , Bonilla Dennisse , Green Robin , Katz Patricia , Touma Zahi
Published: October 2021

Objective

Dispersion, or variability in an individual’s performance across multiple tasks at a single assessment visit, has been associated with cognitive dysfunction (CD) in many neurodegenerative and neurodevelopmental disorders. We aimed to compute a dispersion score using neuropsychological battery (NB) tests and determine its association with CD in patients with SLE.

Methods

CD was defined as a z-score of ≤−1.5 on ≥2 domains of the NB. To compute a type of dispersion score known as the intraindividual SD (ISD), the SD of age-adjusted and sex-adjusted z-scores was calculated for each visit in each patient. To estimate the association between ISD and cognitive status (CD and non-CD), we used multilevel logistic regression, adjusting for clinically important covariates.

Results

A total of 301 adult patients with SLE completed the NB at baseline, 187 of whom were reassessed at 6 months and 189 at 12 months. CD was observed in 35.2% of patients at baseline, 27.8% at 6 months and 28.0% at 12 months. Prior to covariate adjustment, the mean ISD for non-CD was 1.10±0.31 compared with 1.50±0.70 for CD. After adjusting for ethnicity, education, employment, socioeconomic status and anxiety/depression, there was a statistically significant association between ISD and CD (OR for one-unit increase in ISD: 13.56, 95% CI 4.80 to 38.31; OR for 1/10th-unit increase in ISD: 1.30, 95% CI 1.17 to 1.44). Findings were valid across multiple sensitivity analyses.

Conclusion

This is the first study to show that patients with SLE who were classified as having CD by the NB had more variability across the NB tests (ie, higher ISD score) compared with those who were not classified as having CD.
Heritable human genome editing is ‘currently not permitted’, but it is no longer ‘prohibited’: so says the ISSCR
Authors: Baylis Françoise
Published: October 2021

The Guidelines for Stem Cell Research and Clinical Translation, recently issued by the International Society for Stem Cell Research (ISSCR), include a number of substantive revisions. Significant changes include: (1) the bifurcation of ‘Category 3 Prohibited research activities’ in the 2016 Guidelines into ‘Category 3A Research activities currently not permitted’ and ‘Category 3B Prohibited research activities’ in the 2021 guidelines and (2) the move of heritable human genome editing research out of the ‘prohibited’ category and into the ‘currently not permitted’ category. These changes are noteworthy because of the absence of a clear demarcation line between the two categories insofar as, by definition, that which is ‘prohibited’ is ‘currently not permitted’, and vice versa. Permanence is not part of the definition of ‘prohibition’. In principle, a prohibition can be rescinded at any time. This begs the question ‘Why make a policy change that has no apparent practical effect?’ One hypothesis is that the recategorisation of specific ‘prohibited’ research activities as ‘currently not permitted’ is meant to seed intuitions about which prohibited research activities should ‘soon’ be permitted subject to specialised scientific and ethics review and approval.
Extended cost–benefit analysis of tobacco taxation in Brazil
Authors: Divino Jose Angelo , Ehrl Philipp , Candido Osvaldo , Valadao Marcos Aurelio Pereira
Published: October 2021

Background

Brazil has experienced a persistent and substantial reduction in the prevalence of smoking in the population since 2006 due to increased taxes on tobacco and other tobacco control policies. Despite the effectiveness of these measures, however, the socioeconomic costs of smoking are still very high. Tobacco taxation in Brazil plays an important role among the measures adopted to curb tobacco use.

Methods

The study combines data from the National Household Sample Survey of 2008 and the National Health Survey of 2013 and applies cross-section, pooled, and probit estimations, to estimate price elasticities of tobacco consumption by distinct population cohorts. The paper presents a comprehensive cost–benefit analysis resulting from a one-time tax increase on manufactured cigarettes using estimated conditional price elasticity of cigarette consumption and probability of smoking by income and age quartiles.

Findings

Each 10% price increase (BRL 0.54), due to higher tobacco taxes, reduces cigarette consumption by about 5%, and for poor smokers, it would lead to net income gains by about BRL 39.00 per month (in 2019 values). The highest net income effects were observed for the younger, aged between 15 and 29 years, and for middle-aged individuals, between 40 and 59 years old. Higher tobacco taxes lead to lower medical expenses on tobacco-related diseases and a longer, healthier and more productive life. Most importantly, this policy is progressive, as its economic effects are stronger for the poorer than for the richer according to the income quartiles.

Conclusions

A tax increase that rises cigarette prices generates significant social benefits by reducing tobacco spending and medical expenses on tobacco-related diseases and raising future years of life and net income. The total benefits for the individual and the society go way beyond the public finance improvement.
The effects of upstream flexible barrier on the debris flow entrainment and impact dynamics on a terminal barrier
Authors: Vicari Hervé , Ng Charles W.W. , Nordal Steinar , Thakur Vikas , De Silva W.A. Roanga K. , Liu Haiming , Choi Clarence E.
Published: October 2021

The destructive nature of debris flows is mainly caused by flow bulking from entrainment of an erodible channel bed. To arrest these flows, multiple flexible barriers are commonly installed along the predicted flow path. Despite the importance of an erodible bed, its effects are generally ignored when designing barriers. In this study, three unique experiments were carried out in a 28 m long flume to investigate the impact of a debris flow on both single and dual flexible barriers installed in a channel with a 6 m long erodible soil bed. Initial debris volumes of 2.5 and 6 m3 were modelled. For the test setting adopted, a small upstream flexible barrier before the erodible bed separates the flow into several surges via overflow. The smaller surges reduce bed entrainment by 70% and impact force on the terminal barrier by 94% compared to the case without an upstream flexible barrier. However, debris overflowing the deformed flexible upstream barrier induces a centrifugal force that results in a dynamic pressure coefficient that is up to 2.2 times higher than those recommended in guidelines. This suggests that although compact upstream flexible barriers can be effective for controlling bed entrainment, they should be carefully designed to withstand higher impact forces.
Microplastics in lakes and rivers: an issue of emerging significance to limnology
Authors: D’Avignon Genevieve , Gregory-Eaves Irene , Ricciardi Anthony
Published: October 2021

Microplastics, i.e., plastic particles in the size range of planktonic organisms, have been found in the water columns and sediments of lakes and rivers globally. The number and mass of plastic particles drifting through a river can exceed those of living organisms such as zooplankton and fish larvae. In freshwater sediments, concentrations of microplastics reach the same magnitude as in the world’s most contaminated marine sediments. Such particles are derived from a unique biogeochemical cycle that ultimately influences productivity, biodiversity, and ecosystem functioning. Furthermore, microplastics act as vectors of toxic substances to invertebrates, fishes, herpetofauna, and waterfowl. We contend that the concentration of this distinct particle component is an ecologically significant parameter of inland waterbodies because of its ubiquity, environmental persistence, and interactions with key ecological processes. No environmental field survey that has searched for microplastics has yet failed to detect their presence. Standardized limnological protocols are needed to compare spatio-temporal variation in the concentration of microplastics within and across watersheds. Data obtained from such protocols would facilitate environmental monitoring and inform policy for managing plastic waste; furthermore, they would enable more accurate modeling of contaminant cycling and the development of a global plastic budget that identifies sources, distribution and circulation pathways, reservoir size, and retention times.
A New High-Performance 4-Bit Code Converter and Parity Checker Using Mixed Logic Design
Authors: Kommu Chaitanya , Rani A. Daisy
Published: October 2021

In modern communications, code converters and accurate data transmission are essential. This paper presents a new code converter (i.e., Binary to Gray and Gray to Binary) and Parity Checker using mixed logic design. Mixed modeling will be better to achieve low power, high speed and fewer transistors instead of considering a single logic style for array structures. It is important to note that additional metal layers are required for implementation. The HSPICE simulations have been done on these circuits with various supply voltages and frequencies. The existing circuits are compared with mixed logic design circuits and found that the proposed designs show better performance. Especially when compared with FS_XOR1 (which produces better results than others), the power consumption of Mixed logic design is reduced by 5.40%, the speed is improved by 14.89% and PDP is also decreased by 19.48% in the case of Binary to Gray. Moreover, significant improvements can be seen with other existing designs.
A complete list of minimal diagrams of an oriented alternating knot
Authors: Ernst C. , Hart C. , Menezes T. , Price D.
Published: October 2021

By the Tait Flyping Conjecture, all possible minimal diagrams of an alternating knot are related by a finite sequence of flypes. We use this fact for an algorithm to produce all possible minimal diagrams of an oriented alternating prime knot type. Starting with any given oriented minimal alternating diagram of a prime knot, the algorithm performs flypes exhaustively until all other possible minimal diagrams of the oriented knot type have been produced. Results for all distinct alternating prime knot types up to 16 crossings are shown. In addition, prime knot families are discussed that have either a small or a very large number of distinct minimal diagrams.
Reliability Evaluation and Cost Optimization of Solar Road Studs
Authors: Ram Mangey , Bhandari Ashok Singh , Kumar Akshay
Published: October 2021

Roads have always been the main source of transportation all over the world. Easy accessibility and more safety are the most important features of road transportation. Improvements in these areas are constantly required and invited. Solar road studs are one of the remarkable improvements in road safety. Solar road studs use solar energy, which is the most sustainable and pollution-free source of energy that provides reliable power supplies and fuel diversification. Solar road studs are flashing solar cell-powered LED lighting devices used in road construction to delineate road edges and centerlines. This research work is dedicated to evaluating the reliability measures which include availability, mean time to failure (MTTF), cost analysis, and sensitivity analysis with their graphical representation by using the Markov process. Along with reliability assessment, Particle Swarm Optimization (PSO) technique is applied to optimize the cost of the system.
On the domination number of a graph and its block graph
Authors: Murugan E. , Paulraj Joseph J.
Published: October 2021

Let [Formula: see text] be a graph. A subset [Formula: see text] of [Formula: see text] is called a dominating set of [Formula: see text] if every vertex not in [Formula: see text] is adjacent to some vertex in [Formula: see text] The domination number [Formula: see text] of [Formula: see text] is the minimum cardinality taken over all dominating sets of [Formula: see text] The block graph [Formula: see text] of a graph [Formula: see text] is a graph whose vertex set is the set of blocks in [Formula: see text] and two vertices of [Formula: see text] are adjacent if and only if the corresponding blocks have a common cut vertex in [Formula: see text] In this paper, we investigate the lower and upper bounds for the sum of domination number of a graph and its block graph and characterize the extremal graphs.
Role of the renal androgen receptor in sex differences in ammonia metabolism
Authors: Harris Autumn N. , Castro Rebeca A. , Lee Hyun-Wook , Verlander Jill W. , Weiner I. David
Published: October 2021

Sexual dimorphisms in ammonia metabolism involve androgen receptor (AR)-dependent signaling pathways in male, but not female, kidneys that lead to altered proximal tubule (PT), phosphoenolpyruvate carboxykinase, and thick ascending limb Na+-K+-2Cl− cotransporter expression. Adaptive responses in Na+/H+ exchanger 3 and electrogenic Na+-bicarbonate cotransporter 1-A expression limit the magnitude of the effect on ammonia excretion. Finally, the greater kidney size and PT volume density in male mice is the result of PT androgen signaling through AR.
Application of Image Recognition Method Based on Diffusion Equation in Film and Television Production
Authors: Guo Liyuan
Published: October 2021

On the basis of studying the basic theory of anisotropic diffusion equation, this paper focuses on the application of anisotropic diffusion equation in image recognition film production. In order to further improve the application performance of P-M (Perona-Malik) anisotropic diffusion model, an improved P-M anisotropic diffusion model is proposed in this paper, and its application in image ultrasonic image noise reduction is discussed. The experimental results show that the model can effectively suppress the speckle noise and preserve the edge features of the image. Based on the image recognition technology, an image frame testing system is designed and implemented. The method of image recognition diffusion equation is used to extract and recognize the multilayer feature points of the test object according to the design of artificial neural network. To a certain extent, it improves the accuracy of image recognition and the audience rating of film and television. Use visual features of the film and television play in similarity calculation for simple movement scene segmentation problem, at the same time, the camera to obtain information, use the lens frame vision measuring the change of motion of the camera, and use weighted diffusion equation and the visual similarity of lens similarity calculation and motion information, by considering the camera motion of image recognition, effectively solve the sports scene of oversegmentation problem such as fighting and chasing.
The Rise of IGFBP4 in People with Obstructive Sleep Apnea and Multilevel Sleep Surgery Recovers Its Basal Levels
Authors: Alterki Abdulmohsen , Al Shawaf Eman , Al-Khairi Irina , Cherian Preethi , Sriraman Devarajan , Hammad Maha , Thanaraj Thangavel A. , Ebrahim Mahmoud A. K. , Al-Mulla Fahd , Abu-Farha Mohamed , Abubaker Jehad
Published: October 2021

IGFBP4 is the smallest member of the insulin-like growth factor binding protein family (IGFBP). It is a hepatic protein that plays a role in modulating the activity and bioavailability of IGF-I. The expression of IGFBP4 was found to increase under conditions of hypoxia. Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic episodes of intermittent hypoxia and fragmented sleep. Our aim was to quantify levels of circulating IGFBP1, IGFBP2, IGFBP3, IGFBP4, and IGFBP7 in fasting plasma samples of 69 Kuwaiti participants and explore its correlation with indices of OSA. The quantification was performed using multiplexing assay. The study involved 28 controls and 41 patients with OSA. Levels of circulating IGFBP4 were significantly higher in people with OSA (

289.74
±
23.30

 ng/ml) compared to the control group (

217.60
±
21.74

 ng/ml,

p
=
0.028

). The increase in IGFBP4 correlated significantly and positively with AHI (

r
=
.574

,

p
=
.01

) and AI (

r
=
.794

,

p
=
.001

) in people with moderate and severe OSA. There was a significant decline in circulating IGFBP4 after 3 months of surgery (

225.89
±
18.16

 ng/ml,

p
=
0.012

). This was accompanied by a prominent improvement in OSA (AHI

8.97
±
2.37

events/h,

p
=
0.001

). In this study, our data showed a significant increase in circulating IGFBP4 in people with OSA. We also report a significant positive correlation between IGFBP4 and indices of OSA at baseline, which suggests IGFBP4 as a potential diagnostic biomarker for OSA. There was a significant improvement in OSA after 3 months of surgical intervention, which concurred with a significant decline in IGFBP4 levels. Altogether, the detected change suggests a potential link between IGFBP4 and OSA or an OSA-related factor, whereby OSA might play a role in triggering the induction of IGFBP4 expression.
Fault Diagnosis of Rolling Bearing Based on Improved VMD and KNN
Authors: Lu Quanbo , Shen Xinqi , Wang Xiujun , Li Mei , Li Jia , Zhang Mengzhou
Published: October 2021

Variational modal decomposition (VMD) has the end effect, which makes it difficult to efficiently obtain fault eigenvalues from rolling bearing fault signals. Inspired by the mirror extension, an improved VMD is proposed. This method combines VMD and mirror extension. The mirror extension is a basic algorithm to inhibit the end effect. A comparison is made with empirical mode decomposition (EMD) for fault diagnosis. Experiments show that the improved VMD outperforms EMD in extracting the fault eigenvalues. The performance of the new algorithm is proven to be effective in real-life mechanical fault diagnosis. Furthermore, in this article, combining with singular value decomposition (SVD), fault eigenvalues are extracted. In this way, fault classification is realized by K-nearest neighbor (KNN). Compared with EMD, the proposed approach has advantages in the recognition rate, which can accurately identify fault types.
Related Psychosocial Factors and Delivery Mode of Depression and Anxiety in Primipara in Late Pregnancy
Authors: Chen Xingying , Hong Fangfang , Wang Dandan , Bai Bingyan , Xia Yue , Wang Chenjie
Published: October 2021

Studies in recent years show that the delivery process, the choice of delivery mode, and the delivery outcome of primiparas are affected by their mental state. With the transformation of the medical model from the single biomedical model to the biopsychosocial medical model, the influence of social psychological factors on maternal psychological state has aroused heated discussion among clinical scholars. In this study, 480 cases of normal primiparas who had regular prenatal examination and delivered in hospital were selected as the research object. The Hospital Anxiety and Depression Scale (HAD) was used to record the depressive anxiety state of all study subjects in the third trimester, and we analyzed the effects of age, education background of pregnant women and their spouses, the nature of jobs, family income, prenatal and pregnancy health status, medical insurance status, attend pregnant women’s school, and accompanying status of family member on their depressive anxiety state. The influence of depression and anxiety on delivery mode was analyzed. The result showed that the age, health status during prenatal and pregnancy, accompanying status of family members, and attend pregnant women’s school are the independent risk factors affecting depression and anxiety status of primiparas during late pregnancy. Antenatal depression and anxiety have certain influence on the choice of the delivery mode of pregnant women. Targeted psychological intervention for primiparas with high-risk factors is helpful to improve their psychological state and reduce the rate of cesarean section.
Robust Synchronization Control of Uncertain Fractional-Order Chaotic Systems via Disturbance Observer
Authors: Xue Kaijuan , Huangfu Yongbing
Published: October 2021

This paper studies the synchronization of two different fractional-order chaotic systems through the fractional-order control method, which can ensure that the synchronization error converges to a sufficiently small compact set. Afterwards, the disturbance observer of the synchronization control scheme based on adaptive parameters is designed to predict unknown disturbances. The Lyapunov function method is used to verify the appropriateness of the disturbance observer design and the convergence of the synchronization error, and then the feasibility of the control scheme is obtained. Finally, our simulation studies verify and clarify the proposed method.
Antiproliferative Effect of Grammatophyllum speciosum Ethanolic Extract and Its Bioactive Compound on Human Breast Cancer Cells
Authors: Chowjarean Verisa , Sadabpod Kamala
Published: October 2021

Background/Aim. Grammatophyllum speciosum Blume exhibits various promising pharmacological activities. However, its effect on breast cancer has not been determined. Materials and Methods. The antiproliferation effects of the G. speciosum pseudobulb ethanolic extract (GSE) and isovitexin (bioactive constituent) were investigated on the MCF-7 human breast cancer cell line using MTT and colony formation assay. The expression levels of proliferation-regulatory proteins were determined by western blotting. Results. Noncytotoxic concentrations of GSE significantly suppressed the proliferation of MCF-7 cells. Tumor colony formation decreased in both number and size. The level of phosphorylated AKT and β-catenin was suppressed by GSE treatment. Antiproliferation was observed in isovitexin-treated MCF-7 cells in the form of inhibited colony formation and reduced expression of phosphorylated AKT and β-catenin protein. Conclusions. This study demonstrates the novel effect of G. speciosum as an antiproliferative via suppression of the AKT/β-catenin-dependent pathway. This may prompt further investigation of this plant in breast cancer therapy.
Acute Extrapyramidal Side Effects from Smoked Haloperidol
Authors: Pham Angeline , Lee Joo-Young , Miller Christopher W. T.
Published: October 2021

Introduction. Haloperidol is a dopamine receptor antagonist used to treat patients with psychotic disorders. Especially at high doses, haloperidol carries a higher risk of extrapyramidal symptoms (EPS) compared to second-generation antipsychotics. Few cases of haloperidol misuse are found in the medical literature. Case Presentation. We describe a patient with schizophrenia who smoked marijuana mixed with crushed haloperidol tablets. After the smoking of cannabis and haloperidol, the patient presented to the emergency department (ED) with suicidal ideation, psychosis, and acute dystonia. With the administration of intramuscular diphenhydramine at the ED, the dystonia resolved in less than an hour. To our knowledge, this is the first report on haloperidol misuse by smoking. Conclusion. Clinicians should be aware that patients might misuse prescribed antipsychotics via unconventional routes, potentially combined with other substances.
Study on the Temporal and Spatial Differentiation of Provincial Tourism Efficiency in Eastern China and Influencing Factors
Authors: Wang Huadi , Xu Shaogui , Xie Qiuyi , Fan Jianying , Zhou Nianxing
Published: October 2021

Tourism efficiency can be used to effectively measure the utilization of regional tourism resources and the state of tourism economic development. Based on the super efficiency DEA model, Malmquist index, and spatial econometric model, this article measures the static and dynamic tourism efficiency of 11 provinces and cities in eastern China for 2010 to 2019. In combining ArcGIS 10.0 and MATLAB 2016b software, this article studies the temporal and spatial differentiation of tourism efficiency in eastern provinces and cities and influencing factors. The results show that (1) the overall tourism efficiency of eastern provinces is at a high level and relatively stable, but the regional distribution is quite varied, and problems of spatial imbalance are prominent; (2) the overall tourism efficiency of eastern provinces is increasing, and the change index of technical efficiency contributes the most, followed by the change index of scale efficiency; and (3) industrial status, traffic conditions, tourism resource endowment, and the labour force are the main factors affecting the temporal and spatial differentiation of tourism efficiency in eastern provinces and cities, while the level of economic development and information technology have no significant impact.
Corneal Subbasal Plexus in Eyes with Fuchs’ Endothelial Corneal Dystrophy after Two Different Endothelial Surgeries
Authors: Abicca Irene , Gilardi Marta , Giannini Daniela , Colabelli Gisoldi Rossella Anna Maria , Pocobelli Augusto , Schiano Lomoriello Domenico
Published: October 2021

Purpose. To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs’ endothelial corneal dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods. We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results. Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant (

P

 = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson’ chi-square, 0.755). Conclusions. Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.
Design of Remote Real-Time Positioning Method for Long-Distance Running under Wireless Network Technology
Authors: Xia Xu
Published: October 2021

Aiming at the problems of low precision, long time, and poor effect of current remote real-time motion location methods, a long-distance real-time motion location method based on wireless network technology was proposed. Through the analysis of wireless network technology, the basic structure and positioning technology of wireless sensor networks are studied. In addition, this paper adopts the core matrix Isomap node location algorithm based on partial least squares (PLS). The distance of geodesic between long-distance running nodes is used to characterize the dissimilarity between nodes, and the sample contribution rate of the partial least squares method is used to find and eliminate the phenomenon of short circuits in long-distance running fields. High-dimensional feature interval is mapped by centroid transformation and kernel transformation. The experimental results show that the method can improve the positioning accuracy and shorten the positioning time effectively.
Combating Oxidative Stress and Inflammation in COVID‐19 by Molecular Hydrogen Therapy: Mechanisms and Perspectives
Authors: Alwazeer Duried , Liu Franky Fuh-Ching , Wu Xiao Yu , LeBaron Tyler W.
Published: October 2021

COVID‐19 is a widespread global pandemic with nearly 185 million confirmed cases and about four million deaths. It is caused by an infection with the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), which primarily affects the alveolar type II pneumocytes. The infection induces pathological responses including increased inflammation, oxidative stress, and apoptosis. This situation results in impaired gas exchange, hypoxia, and other sequelae that lead to multisystem organ failure and death. As summarized in this article, many interventions and therapeutics have been proposed and investigated to combat the viral infection‐induced inflammation and oxidative stress that contributes to the etiology and pathogenesis of COVID‐19. However, these methods have not significantly improved treatment outcomes. This may partly be attributable to their inability at restoring redox and inflammatory homeostasis, for which molecular hydrogen (H2), an emerging novel medical gas, may complement. Herein, we systematically review the antioxidative, anti‐inflammatory, and antiapoptotic mechanisms of H2. Its small molecular size and nonpolarity allow H2 to rapidly diffuse through cell membranes and penetrate cellular organelles. H2 has been demonstrated to suppress NF‐κB inflammatory signaling and induce the Nrf2/Keap1 antioxidant pathway, as well as to improve mitochondrial function and enhance cellular bioenergetics. Many preclinical and clinical studies have demonstrated the beneficial effects of H2 in varying diseases, including COVID‐19. However, the exact mechanisms, primary modes of action, and its true clinical effects remain to be delineated and verified. Accordingly, additional mechanistic and clinical research into this novel medical gas to combat COVID‐19 complications is warranted.