bluuebunny/crossref_metadata_2025 huggingface dataset:
Third-Party Data Fusion to Estimate Freeway Performance Measures
Authors: Khan Sakib Mahmud , Patire Anthony David
Published: July 2021

Transportation agencies monitor freeway performance using various measures such as VMT (vehicle-miles traveled), VHD (vehicle-hours of delay), and VHT (vehicle-hours traveled). They typically rely on data from point detectors to estimate these freeway performance measures. Point detectors such as inductive loops cannot capture the travel time for a corridor, leading to inaccurate performance measure estimation. This research develops a hybrid method, which estimates freeway performance measures using a mix of probe vehicle data provided by third-party vendors and data from traditional point detectors. Using a simulated model of a freeway (Interstate-210), the overall framework using multiple data sources is evaluated and compared with the traditional point detector-based estimation method. In the traditional method, point speeds are estimated with the flow and occupancy values using g-factors. Data from 5% of the total vehicles are used to generate the third-party provided travel time data. The analysis is conducted for multiple scenarios, including peak and off-peak periods. Results suggest that fusing probe vehicle data from third-party vendors with data from point detectors can help transportation agencies estimate performance measures better than the traditional method, in scenarios that have noticeable traffic demand on freeways.
A Spatial Comparison of Roadway Lighting and Nonmotorist Crashes in Cambridge, MA
Authors: Hennessy Emily Rose , Ai Chengbo
Published: July 2021

Dark lighting conditions, including those occurring at dawn and dusk, are correlated with increased nonmotorist crash frequency owing to reduced visibility, but little research has been done that investigates the spatial relationship between roadway lights and nonmotorist crashes on a community scale. This research used kernel density estimation methods to calculate the commonalities between geolocated streetlight data and non-motorist-vehicle crashes from 2010 to 2018 in Cambridge, Massachusetts. It was observed that dawn, dusk, and darkness showed a significant correlation between nonmotorist crashes and the absence of roadway lighting, all exceeding the control analysis undertaken with crashes occurring in daylight. The Getis-Ord [Formula: see text] hot spot cluster analysis indicated that areas with the greatest density of streetlights were associated with fewer nonmotorist crash hot spots. Future research seeks to corroborate these findings with data from other cities and to assess roadway lighting as a facet of pedestrian network connectivity.
Validating and Calibrating the Highway Capacity Manual Arterial Travel Time Reliability Methodology
Authors: Tufuor Ernest , Rilett Laurence , Murphy Sean
Published: July 2021

The 6th edition of the Highway Capacity Manual (HCM6) introduced a methodology for estimating and forecasting arterial travel time (TT) distributions (TTD) and their associated travel time reliability (TTR) metrics. Recently, it was shown that the HCM6 severely underestimated both the TTD and the TTR metrics for a test network in Lincoln, NE, U.S. Subsequently, it was shown that the underestimation issue could be eliminated through a proposed calibration methodology. Because this validation and calibration work was done on a single, relatively short section of arterial roadway there is an open research question on whether this finding applies to longer and more congested arterial roadways. The goal of this paper is to validate and calibrate the HCM6 TTR methodology on five arterial roadway testbeds that are longer and more congested than the original testbed. Empirical data from the National Performance Management Research Data Set (NPMRDS) which is managed by INRIX was used to represent the ground truth. Similar to the original study, it was found that the HCM6 TTR methodology severely underestimated the TTDs, and their respective TTR metrics, on all five testbeds. This is problematic, because the HCM6 methodology indicates that the corridors had more reliable TT than the empirical data would suggest. It was also shown that the calibration methodology eliminated this underestimation. It is recommended that users of the HCM6 TTR methodology validate and, if necessary, calibrate the model using local empirical travel data.
Inside the Wuhan cabin hospital: Contending narratives during the COVID-19 pandemic
Authors: Litzinger Ralph , Ni Yanping
Published: July 2021

This article examines the making and circulation of vlogs on the Chinese platform Douyin during the Wuhan lockdown. We specifically draw attention to vlogs made in mobile cabin hospitals. Constructed between February and March in 2020, cabin hospitals were part of the state’s isolation and quarantine efforts, and these hospitals created spaces of confinement within a city under lockdown. The vlogs that we refer to are often bursting with energy, optimism, and play, and seem to be expressive of new modalities of care and social relationality. But they are also appropriated by the Chinese state, who used them as examples of ‘positive energy’ (正能量), and to promote the collective commitment to contain the virus. Focusing on the videos, blogs, and narrative storytelling of Li Jing, we show how the state appropriated her work to further its attempt to control the meaning of life and death during the ‘people’s war’ on the coronavirus. These and other state appropriations must also be understood within the context of the state’s involvement in platforms such as Douyin and the ‘platformization’ of everyday life both before and during the Wuhan lockdown.
Situated perspectives on the city: a reflection on scaling participation through design
Authors: De Carli Beatrice , Frediani Alexandre Apsan
Published: July 2021

This article explores the relationship between design methodologies and the scaling of participation in cities. The article recognizes that the scaling of community-led informal settlement upgrading is a central concern in the broader debate on scaling participation, and it interrogates the potential contribution of design methodologies in connecting localized, community-led upgrading initiatives outwards and upwards. We discuss these ideas by drawing on our own experience of devising and facilitating a number of participatory design and planning initiatives titled Change by Design with the non-profit organization Architecture Sans Frontières – UK (ASF-UK). Reflecting on this experience, we argue that the inclusion of a design-based, city-level perspective in localized upgrading initiatives can be a powerful conceptual and practical tool to support horizontal, vertical and deep scaling; and we highlight the importance of constructing this design tool in an embodied and situated manner, so that scaling processes remain firmly grounded in everyday lives and experiences.
On the use of artificial neural networks to model the performance and emissions of a heavy-duty natural gas spark ignition engine
Authors: Huang Qiao , Liu Jinlong , Ulishney Christopher , Dumitrescu Cosmin E
Published: July 2021

The use of computational models for internal combustion engine development is ubiquitous. Numerical simulations using simpler to complex physical models can predict engine’s performance and emissions, but they require large computational capabilities. By comparison, statistical methodologies are more economical tools in terms of time and resources. This paper investigated the use of an artificial neural network algorithm to simulate the nonlinear combustion process inside the cylinder. Three engine control variables (i.e. spark timing, mixture equivalence ratio, and engine speed) were set as the model inputs. Outputs included peak cylinder pressure and its location, maximum pressure rise rate, indicated mean effective pressure, ignition lag, combustion phasing, burn duration, exhaust temperature, and engine-out emissions (i.e. nitrogen oxides, carbon monoxide, and unburned hydrocarbons). Eighty percent of the experimental data from a heavy-duty natural gas spark ignition engine were utilized to train the model. The perceptions accurately learned the combustion characteristics and predicted engine responses with acceptable errors, evidenced by close-to-unity coefficient of determination and close-to-zero root-mean-square error. Moreover, the regressors captured the effect of key operating variables on the engine response, suggesting the well-trained models successfully identified the complex relationships and can help assist engine analysis. Overall, the neural network algorithm was appropriate for the application investigated in this study.
Predictors of Economically Disadvantaged Vertical Transfer Students' Academic Performance and Retention: A Scoping Review
Authors: Yazdani Neshat , McCallen Leigh S. , Hoyt Lindsay T. , Brown Joshua L.
Published: July 2021

Approximately 30% of students who enter the postsecondary education system do so through 2-year colleges. The majority of these students intend to earn a bachelor's degree, but most leave college before earning a diploma from a 4-year institution. The discrepancy between bachelor's degree aspirations and degree attainment rates of students who enter through 2-year colleges suggests that vertical transfer students—those who transfer from 2- to 4-year colleges—face unique obstacles to academic performance and retention that affect their likelihood of earning a bachelor's degree. Similar barriers exist for economically disadvantaged students, who may be more likely to enter the postsecondary education system through 2-year colleges. This scoping review synthesizes the literature on factors influencing economically disadvantaged vertical transfer students' academic performance in the first year posttransfer and retention between the first and second year posttransfer. Implications for 2- and 4-year institutions and recommendations for future research are discussed.
Biodegradable and conductive PVA/CNT nanofibrous membranes used in nerve conduit applications
Authors: Jhang Jia-Ci , Lin Jia-Horng , Lou Ching-Wen , Chen Yueh-Sheng
Published: July 2021

The recovery of impaired peripheral nerves is often not as expected, which makes the development of nerve conduits trendy nowadays. To enable the neural messages effectively being delivered as well as to prevent the secondary damage during the removal of nerve conduits, the conductivity and biodegradability are two essential requirements for ideal nerve conduits. In this study, electrospinning is used to produce polyvinyl alcohol (PVA)/carbon nanotubes (CNT) electrospun films, after which the morphology analysis, electrical property, water contact angle, and biological characteristics of the membranes are investigated, thereby determining the optimal nerve conduits based on the employment of electrospinning, PVA, and CNT. The test results indicate that with 0.25 wt% of PVA, the electrospun films exhibit comparatively lower resistance of 25.3 ohm, good fibrous morphology with a diameter being 1 μm. In addition, the electrospun films are cytotoxicity-free and facilitate the growth of cells. It is observed in the MMT assay that after co-cultured with cells for three days, PVA/CNT electrospinning fibrous membranes exhibit a cellular viability that is 18.5 times greater than that of the control group on Day 1. According to all property evaluations, PVA/CNT electrospinning fibrous membranes are a qualified candidate for the use of nervous conduits.
Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin’s tumor after partial parotidectomy
Authors: Lee Esther , Badger Christopher , Mamidi Ishwarya S , Benito Daniel A , Li Lilun , Goodman Joseph F , Thakkar Punam G , Joshi Arjun
Published: July 2021

Introduction

Warthin’s tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin’s tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey’s syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions.

Case report

We present a patient with multifocal Warthin’s tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy.

Discussion

Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey’s syndrome and negate the need for fat grafting for defect reconstruction.

Conclusion

UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.
Clinical accuracy of non-contact forehead infrared thermometer and infrared tympanic thermometer in postoperative adult patients: A comparative study.
Authors: Kameda Norihiro
Published: July 2021

Core temperature monitoring is important for the assessment and prevention of possible postoperative complications. The aim of the present study was to examine the agreement between the core temperature values and the forehead, tympanic membrane and axillary values in postoperative adult patients in clinical practice. The study measured the core temperature of 65 patients undergoing scheduled abdominal surgery using SpotOn™ and compared these with those obtained using non-contact forehead infrared, infrared tympanic and axillary thermometers. Correlation and Bland–Altman analyses were conducted for these comparisons. All temperatures were recorded at 4h intervals after postoperative arrival to the ward. Forehead temperature recordings showed a good correlation with the core temperature with excellent accuracy and was comparable to the tympanic temperature. Both forehead and tympanic thermometers can rapidly and effectively measure the core temperature during early postoperative period. Considering patients’ safety, non-contact forehead infrared thermometers may be useful for postoperative monitoring.
Spreading Environmental Awareness Through Environmental Education in Schools: The Case Study of a Sikkimese Green School
Authors: Thapa Jwala D.
Published: July 2021

The subject of environmental education (EE) in India, also known as environment studies (EVS), was introduced through the intervention of the Supreme Court of India (SC). At that time, there was also global recognition towards the creation of ‘environmental citizens’ through inculcating environmental awareness in school-going children, with the motto of ‘catch them young’.

Since then, EE in India has seen an evolution in itself through enveloping the studies of various topics related to the natural environment. However, one of the concerns has been that it is taught in a theoretical manner and that since it is not treated as a graded subject, schools have not given it the importance it deserves. However, the study of a green school of the Himalayan state of Sikkim shows that active participation of state machinery, coupled with a practical interpretation of its principles, can lead to positive results. It also shows that the creation of environmental citizens needs a holistic approach, through both amalgamation of theory with practice and syllabus with stringent state intervention and results-oriented action.

This article, which uses doctrinal, as well as field research, techniques of interview and observation, looks into these aspects through studying a school in a mountain village of West Sikkim in India.
Adapting Pandemic Practices for the Future: Blended Learning Model for Online Advocacy Training in Pakistan
Authors: Awan Hadia
Published: July 2021

The challenge of teaching a skill-based course online, during pandemic unfolded lasting/ground-breaking opportunities for teachers and students of law alike. For the advocacy skills' training course, a suit for dissolution of marriage was selected and training was divided into 12 steps. The pre-planned semester calendar of the University was followed, but in the virtual learning environment (VLE), sessions were held mostly synchronously by using an indigenized blended learning (BL) model. Station rotation (SR) and the flipped classroom (FC) were also indigenized for effective use. Indigenization of BL was done. SR was done by creating stations comprising research areas involved in the trial for dissolution of a marriage. The FC was used to make students learn lectures beforehand, and all simulations, role-plays and activities were done in class. On-spot grading was done on assessment rubrics by using standard observation forms, generated based on extracted principles. All rubrics and standard forms were shared and discussed with students to build trust in the VLE. The asynchronous mode was also used, but only for the sake of supplemented learning. The grading policy was revised, and the curves of summative and formative assessments were flattened. A total of 45 students were trained, out of whom 26 scored A, four A–, two B, five B+, one B–, one C, one C+, one C– and four got F (for not participating at all). The outcome was encouraging. After completion of the semester, the need assessment survey culminated in a hands-on training session for the Faculty of Law (FoL). Participants designed courses using the BL model and found the methodology effective for future use in regular classes.
Compensatory Mechanism for Miscarriage of Justice in Cases of Prolonged Delay: The Case of India
Authors: Mishra Abhinav
Published: July 2021

There have been several studies on the issue of justice delayed, but no rigid step has been taken in lieu of the victims who suffer as a result of such dawdling processes. Despite the existence of a vast number of provisions in our current legal system, current legal remedies do tend to create an ex gratia obligation but not a statutory obligation for the state to compensate the victims of miscarriage of justice. There is a persistent need for an explicit and detailed law on this subject. The idea underlying this research is to portray the need for a rigid compensatory mechanism for prolonged delays in judicial processes and decisions. Thereby construing a need for strong legislative action towards this issue and reflect upon the grey area in Indian Legal Framework.
Drug Abuse and Drug Trafficking: Non-Traditional Security Threats in Post-Soviet Central Asia
Authors: Biswas Subrata
Published: July 2021

The post-cold war world has become susceptible to multiple non-traditional security threats that are no less formidable than the traditional security threats. Drug trafficking poses one such serious non-traditional security threat and drug abuse provides its fuel. Not only do the drugs destroy the very fabric of human resource in a region where trafficking operates and thereby reduces communities to hollow card-boxes, but such trafficking also generates loads of dirty money which fosters the growth of non-State actors engaged in subversive activities. This article argues that following the fall of the erstwhile Soviet empire, the entire Central Asia region has become a hotbed of such non-traditional security threats which is being nourished by an enormous demand for drug abuse in Russia and the scenario spells trouble for India as well. The article also contemplates a constructive role for Russia in this regard.
Use of the Keystone Perforator Flap Closure for the Anterolateral Thigh Free Flap Donor Site
Authors: Kumbla Pallavi A. , Thorburn Ashley Q. , Makwana Shreyas , Mino Matthew , Zakhary Joseph , Myers René P.
Published: July 2021

Objective:

The anterolateral thigh (ALT) flap is a workhorse in microsurgical reconstruction. However, a flap width greater than 8 centimeters limits primary closure and discourages some surgeons from using this flap for larger defects to avoid a large and unsightly skin grafted donor site. ALT donor site closure can be made even more challenging when a more circular shaped flap is required.

Methods:

This study examines the use of the keystone perforator flap to close large ALT free flap donor sites in 6 patients who underwent reconstruction for various purposes who otherwise would have required donor site skin grafting.

Results:

Average flap dimensions were 10.5 cm × 17 cm and mean keystone flap dimensions were 12.2 cm × 22.5 cm. Average operative time of cases was 528.3 minutes and average BMI of patients was 24.8 kg/m2. There was 1 case of partial keystone flap dehiscence that required local wound care, and 1 case of drain replacement for thigh seroma.

Conclusions:

This series demonstrates that keystone perforator flap closure allows the thigh to maintain a relatively normal appearance, reduces postoperative pain associated with skin grafting, and can be performed in higher BMI patients with minimal complications and without increasing operative time or sensory or motor deficits. This series to date also has the largest defects closed with keystone flaps demonstrating the feasibility of this type of closure in very large ALT donor sites.
Platelet EVs contain an active proteasome involved in protein processing for antigen presentation via MHC-I molecules
Authors: Marcoux Genevieve , Laroche Audrée , Hasse Stephan , Bellio Marie , Mbarik Maroua , Tamagne Marie , Allaeys Isabelle , Zufferey Anne , Lévesque Tania , Rebetz Johan , Karakeussian-Rimbaud Annie , Turgeon Julie , Bourgoin Sylvain G. , Hamzeh-Cognasse Hind , Cognasse Fabrice , Kapur Rick , Semple John W. , Hébert Marie-Josée , Pirenne France , Overkleeft Herman S. , Florea Bogdan I. , Dieude Mélanie , Vingert Benoît , Boilard Eric
Published: July 2021

In addition to their hemostatic role, platelets play a significant role in immunity. Once activated, platelets release extracellular vesicles (EVs) formed by the budding of their cytoplasmic membranes. Because of their heterogeneity, platelet EVs (PEVs) are thought to perform diverse functions. It is unknown, however, whether the proteasome is transferred from platelets to PEVs or whether its function is retained. We hypothesized that functional protein processing and antigen presentation machinery are transferred to PEVs by activated platelets. Using molecular and functional assays, we found that the active 20S proteasome was enriched in PEVs, along with major histocompatibility complex class I (MHC-I) and lymphocyte costimulatory molecules (CD40L and OX40L). Proteasome-containing PEVs were identified in healthy donor blood, but did not increase in platelet concentrates that caused adverse transfusion reactions. They were augmented, however, after immune complex injections in mice. The complete biodistribution of murine PEVs after injection into mice revealed that they principally reached lymphoid organs, such as spleen and lymph nodes, in addition to the bone marrow, and to a lesser extent, liver and lungs. The PEV proteasome processed exogenous ovalbumin (OVA) and loaded its antigenic peptide onto MHC-I molecules, which promoted OVA-specific CD8+ T-lymphocyte proliferation. These results suggest that PEVs contribute to adaptive immunity through cross-presentation of antigens and have privileged access to immune cells through the lymphatic system, a tissue location that is inaccessible to platelets.
Novel mechanisms of action contributing to benralizumab's potent anti-eosinophilic activity
Authors: Dagher Rania , Kumar Varsha , Copenhaver Alan M. , Gallagher Sandra , Ghaedi Mahboobe , Boyd Jonathan , Newbold Paul , Humbles Alison A. , Kolbeck Roland
Published: July 2021

Background

Benralizumab is a humanised, anti-interleukin-5 receptor α monoclonal antibody with anti-eosinophilic activity. Lack of fucose (afucosylation) increases its affinity to CD16a and significantly enhances antibody-dependent cell-mediated cytotoxicity by natural killer (NK) cells. Although benralizumab proved clinically efficacious in clinical trials for patients with severe asthma and hypereosinophilic syndrome, in-depth characterisation of its anti-eosinophilic mechanisms of action remains elusive.

Methods

Here, we further investigated the mechanisms involved in benralizumab's anti-eosinophilic activities by employing relevant primary human autologous cell co-cultures and real-time-lapse imaging combined with flow cytometry.

Results

In the presence of NK cells, benralizumab induced potent eosinophil apoptosis as demonstrated by the upstream induction of Caspase-3/7 and upregulation of cytochromec. In addition, we uncovered a previously unrecognised mechanism whereby benralizumab can induce eosinophil phagocytosis/efferocytosis by macrophages, a process called antibody-dependent cellular phagocytosis. Using live cell imaging, we unravelled the stepwise processes leading to eosinophil apoptosis and uptake by activated macrophages. Through careful observations of cellular co-culture assays, we identified a novel role for macrophage-derived tumour necrosis factor (TNF) to further enhance benralizumab-mediated eosinophil apoptosis through activation of TNF receptor 1 on eosinophils. TNF-induced eosinophil apoptosis was associated with cytochromecupregulation, mitochondrial membrane depolarisation and increased Caspase-3/7 activity. Moreover, activated NK cells were found to amplify this axis through the secretion of interferon-γ, subsequently driving TNF expression by macrophages.

Conclusions

Our data provide deeper insights into the timely appearance of events leading to benralizumab-induced eosinophil apoptosis and suggest that additional mechanisms may contribute to the potent anti-eosinophilic activity of benralizumabin vivo. Importantly, afucosylation of benralizumab strongly enhanced its potency for all mechanisms investigated.
Feasibility and clinical utility of ambulatory cough monitoring in an outpatient clinical setting: a real-world retrospective evaluation
Authors: Vertigan Anne E. , Kapela Sarah L. , Birring Surinder S. , Gibson Peter G.
Published: July 2021

Research question

Objective quantification of cough is rarely utilised outside of research settings and the role of cough frequency monitoring in clinical practice has not been established. This study examined the clinical utility of cough frequency monitoring in an outpatient clinical setting.

Methods

The study involved a retrospective review of cough monitor data. Participants included 174 patients referred for treatment of cough and upper airway symptoms (103 chronic cough; 50 inducible laryngeal obstruction; 21 severe asthma) and 15 controls. Measures, taken prior to treatment, included 24-h ambulatory cough frequency using the Leicester Cough Monitor, the Leicester Cough Questionnaire and Laryngeal Hypersensitivity Questionnaire. Post-treatment data were available for 50 participants. Feasibility and clinical utility were also reported.

Results

Analysis time per recording was up to 10 min. 75% of participants could use the monitors correctly, and most (93%) recordings were interpretable. The geometric mean cough frequency in patients was 10.1±2.9 (mean±sd) compared to 2.4±2.0 for healthy controls (p=0.003). There was no significant difference in cough frequency between clinical groups (p=0.080). Cough frequency decreased significantly following treatment (p<0.001). There was a moderate correlation between cough frequency and both cough quality of life and laryngeal hypersensitivity. Cough frequency monitoring was responsive to therapy and able to discriminate differences in cough frequency between diseases.

Conclusion

While ambulatory cough frequency monitoring remains a research tool, it provides useful clinical data that can assist in patient management. Logistical issues may preclude use in some clinical settings, and additional time needs to be allocated to the process.
Mild traumatic brain injury affects the features of migraine
Authors: Ishii Ryotaro , Schwedt Todd J. , Trivedi Meesha , Dumkrieger Gina , Cortez Melissa M. , Brennan K. C. , Digre Kathleen , Dodick David W.
Published: July 2021

Background

Headache is one of the most common symptoms after concussion, and mild traumatic brain injury (mTBI) is a risk factor for chronic migraine (CM). However, there remains a paucity of data regarding the impact of mTBI on migraine-related symptoms and clinical course.

Methods

Of 2161 migraine patients who participated in the American Registry for Migraine Research between February 2016 and March 2020, 1098 completed questions assessing history of TBI (50.8%). Forty-four patients reported a history of moderate to severe TBI, 413 patients reported a history of mTBI. Patients’ demographics, headache symptoms and triggers, history of physical abuse, allodynia symptoms (ASC-12), migraine disability (MIDAS), depression (PHQ-2), and anxiety (GAD-7) were compared between migraine groups with (n = 413) and without (n = 641) a history of mTBI. Either the chi-square-test or Fisher’s exact test, as appropriate, was used for the analyses of categorical variables. The Mann-Whitney test was used for the analyses of continuous variables. Logistic regression models were used to compare variables of interest while adjusting for age, gender, and CM.

Results

A significantly higher proportion of patients with mTBI had CM (74.3% [307/413] vs. 65.8% [422/641], P = 0.004), had never been married or were divorced (36.6% [147/402] vs. 29.4% [187/636], P = 0.007), self-reported a history of physical abuse (24.3% [84/345] vs. 14.3% [70/491], P <  0.001), had mild to severe anxiety (50.5% [205/406] vs. 41.0% [258/630], P = 0.003), had headache-related vertigo (23.0% [95/413] vs. 15.9% [102/640], P = 0.009), and difficulty finding words (43.0% [174/405] vs. 32.9% [208/633], P <  0.001) in more than half their attacks, and headaches triggered by lack of sleep (39.4% [155/393] vs. 32.6% [198/607], P = 0.018) and reading (6.6% [26/393] vs. 3.0% [18/607], P = 0.016), compared to patients without mTBI. Patients with mTBI had significantly greater ASC-12 scores (median [interquartile range]; 5 [1–9] vs. 4 [1–7], P < 0.001), MIDAS scores (42 [18–85] vs. 34.5 [15–72], P = 0.034), and PHQ-2 scores (1 [0–2] vs. 1 [0–2], P = 0.012).

Conclusion

Patients with a history of mTBI are more likely to have a self-reported a history of physical abuse, vertigo, and allodynia during headache attacks, headaches triggered by lack of sleep and reading, greater headache burden and headache disability, and symptoms of anxiety and depression. This study suggests that a history of mTBI is associated with the phenotype, burden, clinical course, and associated comorbid diseases in patients with migraine, and highlights the importance of inquiring about a lifetime history of mTBI in patients being evaluated for migraine.
A prenatal group based phone counseling intervention to improve breastfeeding rates and complementary feeding: a randomized, controlled pilot and feasibility trial
Authors: Cauble Jennifer S. , Herman Amy , Wick Jo , Goetz Jeannine , Daley Christine M. , Sullivan Debra K. , Hull Holly R.
Published: July 2021

Background

Despite numerous benefits for both mom and baby, few infants are exclusively breastfed for the recommended first six months. Additionally, infants are given solids too early. Prenatal education increases rates of breastfeeding initiation and we hypothesize it can also improve exclusive breastfeeding rates and prevent the early introduction of solids. We conducted a randomized controlled pilot and feasibility trial to understand the feasibility and maternal acceptance of a prenatal behavioral lifestyle intervention (PBLI) delivered via group based phone counseling (GBPC) and its effectiveness on rates of exclusive breastfeeding up to six months postpartum. Secondary aims included rates of any breastfeeding up to six months, rates of early introduction of solids, and infant feeding progression.

Methods

Forty-one pregnant women were recruited from a Kansas City Metropolitan Obstetrics and Gynecology office and randomly assigned to a usual care group or a PBLI. Women in the PBLI participated in six GBPC sessions where they learned about breastfeeding and introducing solids. Feeding questionnaires to assess breastfeeding and introduction of solids were sent at two weeks, two months, four months, and six months postpartum. Structured interviews were also conducted after the intervention and at six months postpartum to assess maternal acceptance and intervention feasibility.

Results

Participants overwhelmingly found the intervention acceptable and beneficial.

Rates of exclusive breastfeeding and any breastfeeding did not differ between groups at any time point. No between group differences were found for early introduction of solids or infant feeding progression.

Conclusions

Mothers discontinue breastfeeding earlier than recommended despite high rates of initiation. A PBLI delivered via GBP is feasible, acceptable to participants, and showed positive impacts such as maternal empowerment for both breastfeeding and introducing solids. Future interventions should incorporate both prenatal and postpartum components.

Trial registration

Study protocols were approved by the University of Kansas Medical Center’s Human Subjects Committee (STUDY00140506) and registered at ClinicalTrials.gov on 02/22/2018 (NCT03442517, retrospectively registered). All participants gave written informed consent prior to data collection.
Systemic characterization of alternative splicing related to prognosis and immune infiltration in malignant mesothelioma
Authors: Lai Jinzhi , Yang Hainan , Xu Tianwen
Published: July 2021

Background

Malignant mesothelioma (MM) is a relatively rare and highly lethal tumor with few treatment options. Thus, it is important to identify prognostic markers that can help clinicians diagnose mesothelioma earlier and assess disease activity more accurately. Alternative splicing (AS) events have been recognized as critical signatures for tumor diagnosis and treatment in multiple cancers, including MM.

Methods

We systematically examined the AS events and clinical information of 83 MM samples from TCGA database. Univariate Cox regression analysis was used to identify AS events associated with overall survival. LASSO analyses followed by multivariate Cox regression analyses were conducted to construct the prognostic signatures and assess the accuracy of these prognostic signatures by receiver operating characteristic (ROC) curve and Kaplan–Meier survival analyses. The ImmuCellAI and ssGSEA algorithms were used to assess the degrees of immune cell infiltration in MM samples. The survival-related splicing regulatory network was established based on the correlation between survival-related AS events and splicing factors (SFs).

Results

A total of 3976 AS events associated with overall survival were identified by univariate Cox regression analysis, and ES events accounted for the greatest proportion. We constructed prognostic signatures based on survival-related AS events. The prognostic signatures proved to be an efficient predictor with an area under the curve (AUC) greater than 0.9. Additionally, the risk score based on 6 key AS events proved to be an independent prognostic factor, and a nomogram composed of 6 key AS events was established. We found that the risk score was significantly decreased in patients with the epithelioid subtype. In addition, unsupervised clustering clearly showed that the risk score was associated with immune cell infiltration. The abundances of cytotoxic T (Tc) cells, natural killer (NK) cells and T-helper 17 (Th17) cells were higher in the high-risk group, whereas the abundances of induced regulatory T (iTreg) cells were lower in the high-risk group. Finally, we identified 3 SFs (HSPB1, INTS1 and LUC7L2) that were significantly associated with MM patient survival and then constructed a regulatory network between the 3 SFs and survival-related AS to reveal potential regulatory mechanisms in MM.

Conclusion

Our study provided a prognostic signature based on 6 key events, representing a better effective tumor-specific diagnostic and prognostic marker than the TNM staging system. AS events that are correlated with the immune system may be potential therapeutic targets for MM.
Seasonal modulation of antibody response to diphtheria-tetanus-pertussis vaccination in infants: a cohort study in rural Gambia
Authors: Okala Sandra G. , Darboe Momodou K. , Sosseh Fatou , Sonko Bakary , Faye-Joof Tisbeh , Prentice Andrew M. , Moore Sophie E.
Published: July 2021

Background

In rural Gambia, rates of malnutrition and infection are higher during the annual rainy/‘hungry’ season (June–October) in comparison to the dry/‘harvest’ season (November–May). The effects of this seasonal pattern on an infant’s immune development and their capacity to respond to childhood vaccinations remain unclear. The aim of the current analysis was to determine whether antibody responses to diphtheria-tetanus-pertussis (DTP) vaccinations in infants differ between seasons.

Methods

Infants received the DTP vaccine at 8, 12 and 16 weeks of age and antibody titres were measured in blood samples collected at 12 (n = 710) and 24 (n = 662) weeks of age. Mean DTP antibody titres, adjusted for maternal and infant confounders, were compared by t-tests and the effect sizes of the mean differences were calculated between seasons at mid-gestation (20 weeks gestation) and first vaccination (8 weeks of infant age).

Results

A smaller number of infants received their first vaccination during the rainy/hungry season months compared to the dry/harvest season (n = 224 vs. n = 486). At 12 weeks, infants vaccinated during the rainy/hungry season had lower weight-for-length Z-scores (p = 0.01) and were more likely to be anaemic (p < 0.001). Their mothers, however, were pregnant mostly during the dry/harvest season, had higher weight gain (p < 0.001) and were less likely to be anaemic during pregnancy (p < 0.001). At 12 weeks, infants vaccinated during the rainy/hungry season had significantly higher mean diphtheria, tetanus and pertussis antibody titres; by 62.3, 16.9 and 19.7%, respectively (all, p < 0.001). However, at 24 weeks, they had lower mean anti-diphtheria titres (by 20.6%, p < 0.001) compared with infants vaccinated during the dry/harvest season, and no differences were observed in mean tetanus and pertussis antibody titres by vaccination season.

Conclusions

Infant antibody response to the primary dose of the DTP vaccine was influenced by both season of pregnancy and infancy, although effects were diminished following three doses. Environmental exposures, including nutrition, to both the mother and infant are hypothesised as likely drivers of these seasonal effects.
Pre-graduation grade inflation in medical training in Turkey: a longitudinal study from 2005 to 2020
Authors: Karadag Engin
Published: July 2021

Background

Grade inflation which is known as the awarding of higher grades than students deserve in higher education has been observed since the 1960s. There is comprehensive evidence that document the allegations, prevalence, and severity of grade inflation in higher education in universities around the world for the past 10 years.

Methods

This study analyzes the change in the ratio of graduates with a “very good (>2.99)” degree in medical education in Turkey within a 15-year-long period in terms of the grade inflation (when all other factors are constant), and factors that affect the overall achievement grades. The analyses were carried out using the grade point average (GPA) of 9,618 students who graduated from the medical schools of 25 Turkish universities, and grades of 288,540 students for 7,597 courses. In doing so, the “real” university random effects estimator modelling considering the differences in universities with correlation, ANOVA, t-test and ANCOVA analyses were carried out.

Results

The results revealed that there was a marginal increase in grades in medical training before graduation. Twenty-nine percent grade inflation was detected in line with the relevant findings in literature and this figure is one of the highest that has been reported so far. It was also detected that the ratio of graduates with a “very good (>2.99)” degree was 17% in 2005 and it increased to 46% in 2020. Additionally, the class size, academic rank of the instructors, grades, course contents, types of the universities (public & non-profit private), accreditation of the program, and the age of the medical schools were considered as important determinants of the difference in course grades.

Conclusion

These results show that both the uncontrolled expansion of medical schools in Turkey and the decrease in quality cause a significant increase in grades. Moreover, an important finding is that accreditation slows down the grade inflation. Both the course grades following the accreditation process and the inflation in the graduation grades (grade inflation) slowed down significantly in the accredited medical schools. This finding is an important example for the necessity of accreditation for universities, which is referred to as the “gold standard” to improve the quality of medical education.
The relationship between attendance and academic performance of undergraduate medical students during surgical clerkship
Authors: Al Shenawi Hamdi , Yaghan Rami , Almarabheh Amer , Al Shenawi Noor
Published: July 2021

Background

The current study aimed to evaluate the previously unexplored correlation between undergraduate medical students’ attendance during their surgical clerkship and their academic performance. It also aimed to explore any difference in the attendance rate between male and female students and whether this difference, if present, affects the academic performance.

Methods

A retrospective descriptive cross-sectional study has been conducted on 331 undergraduate medical students during their surgical clerkships at the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU), Bahrain from September 2018 to June 2020.

Results

There was a positive statistically significant correlation between students’ attendance during surgical clerkship and academic performance (r = 0.360, P <  0.01). Mean attendance rate was greater in each increasing category of academic performance: 47.95% in the weak category (less than 65%, n = 42), 57.62% in the good performance category (65% to less than 75%, n = 108), 67.82% in the very good performance category (75% to less than 85%, n = 126), 83.16% in the excellent performance category (85% and above, n = 55). The mean attendance rate of male students was 59.76% (SD = 25.73), compared to 66.92% (SD = 24.30) in the female students. T-test indicated that the difference between the mean attendance of the two groups of the students (male, female) was statistically significant (t = 2.483, p <  0.05). On the other hand, the difference between the mean academic performance for the two groups of students, male & female, (t = 0.284, p = 0.777) was not statistically significant.

Conclusions

Our study showed a significant relationship between undergraduate medical students’ attendance during their surgical clerkship and their academic performance. Further studies are needed to stratify this correlation according to clinical and theoretical teaching activities. No significant difference was observed in academic performance between female and male students.
Web-based support for individuals with type 2 diabetes - a feasibility study
Authors: Taloyan Marina , Kia Meybod , Lamian Fahimeh , Peterson Magnus , Rydwik Elisabeth
Published: July 2021

Background

Self-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The primary aim of the study was to evaluate the feasibility and describe patients’ and caregivers’ experiences of using the web- and smartphone-based system Triabetes. The secondary aim was to investigate if the use of the system could improve patients’ clinical outcomes.

Methods

Feasibility was assessed with describing recruitment rate and the participant´s views of using the system. Laboratory and anthropometry data were also collected.

Results

The study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it easier and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values.

Conclusions

Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful but suggested several improvements. Summarized lessons learned from this study are following: (1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; (2) the tool must be easy and less time consuming to use; (3) the technical structure needs to be improved and automatic recording of data must be improved.
Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report
Authors: Pezzuto Federica , Vimercati Luigi , Fortarezza Francesco , Marzullo Andrea , Pennella Antonio , Cavone Domenica , Punzi Alessandra , Caporusso Concetta , d’Amati Antonio , Lettini Teresa , Serio Gabriella
Published: July 2021

Introduction

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare malignant neoplasm with poor survival that shares some similarities with the best-known pleural variant, pleural mesothelioma. The recent European Reference Network on Rare Adult Cancers (EURACAN)/International Association for the Study of Lung Cancer (IASLC) proposals attempted to improve the histological diagnosis and patient risk stratification. Herein, we investigated whether the pathology recommendations and suggestions of the pleural proposals were applicable to diffuse malignant peritoneal mesothelioma.

Methods

Fifty multiple laparoscopic biopsies of DMPM were consecutively collected at the Pathology Unit of the University of Bari. A two-tier system, i.e., low, and high grade, was used to categorize 34 epithelioid DMPMs. Architectural patterns, cytological features and stromal changes were also reported. Immunohistochemistry was performed for BRCA1-associated protein 1 (BAP1), programmed death-ligand 1 (PD-L1), and Ki67, while fluorescence in situ hybridization (FISH) was performed for p16/cyclin-dependent kinase inhibitor 2A (CDKN2A).

Results

High-grade epithelioid mesothelioma, high Ki67, and p16/CDKN2A deletion were significantly associated with short survival (p = 0.004, p < 0.0001, and p = 0.002, respectively). BAP1 loss and PD-L1 negativity were the most common findings. Multivariate analysis revealed that the nuclear grading system and p16 deletion significantly correlated with survival (p = 0.003 each).

Conclusions

The present study examined the prognostic significance of several factors proposed for pleural mesothelioma in an extra pleural site. Notably, the introduction of a grading system may provide better risk stratification in epithelioid DMPM. Ki67, BAP1 and p16/CDKN2A should also be measured whenever possible. A detailed report with all supportive data would allow us to collect sufficient information for use in further studies on larger case series.