bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability testing of the Persian low-vision quality-of-life questionnaire based on Rasch analysis
Authors: Momeni Moghaddam Hamed , Heravian Shandiz Javad , Wolffsohn James S , Karimpour Maliheh
Published: September 2023

Objective:

Low-vision quality-of-life (LVQOL) questionnaire was recently translated to Persian. Its model fit and construct validity were assessed by exploratory and confirmatory analysis for adults with visual impairment, before. In this study, we aimed to test the reliability of the Persian LVQOL questionnaire based on Rasch analysis.

Methods:

Overall, 100 low-vision patients and 100 demographic statue-matched control subjects were participated for evaluating reliability aspects. All the participants were asked to complete the Persian LVQOL questionnaire. The low-vision group was asked to fill out the LVQOL 3 months after rehabilitation to determine how rehabilitation changed the quality of life. Rasch analyses of the survey items were conducted using WINSTEPS.

Results:

All items fitted the Rasch model. Point-measure correlations values varied from .13 to .70, providing a preliminary indication of adequate construct validity. All factor loadings found more than .4. infit values for all other participants were in the acceptable range. All items obtained infit and outfit MSQ values of < 2.0. Patients’ abilities relative to the item difficulty were analyzed. Item difficulty was estimated and item characteristic curves were included. Sufficient unidimensionality, hierarchical order, and equal interval scaring were obtained.

Conclusion:

The Persian LVQOL questionnaire was reliable enough and it will be valuable in both clinical practice and research.
Using Adult Learning Theory to Explore Student Perceptions of the Flipped Class Method
Authors: Garner Benjamin , Shank Nathan
Published: September 2023

Flipped classes have been gaining in popularity in recent years, and yet only a handful of marketing education papers have examined flipped class methods. In a time when creative methods for engaging students online and in-person are critical, this study analyzes open-ended, qualitative student comments from a flipped class course to explore the benefits and drawbacks of this method. This paper will also examine the qualitative student feedback through the lens of adult learning theory (ALT) to see the ways in which student comments overlap with best practices in the adult learning field. Three sections of a business communication course were converted into a flipped class, and qualitative responses from 84 students were analyzed. This research will help fill a much-needed gap in the marketing education literature by providing key insights into flipped class approaches while also connecting them with ALTs, which have heretofore remained under-explored in marketing education.
Spontaneous rupture of the spleen at full term during pregnancy: a case report
Authors: Xu Heng , Lu Jia-Ping
Published: September 2023

Spontaneous rupture of the spleen during pregnancy is a rare, fatal disease. This condition is easily misdiagnosed as uterine rupture, placental abruption, or other obstetric diseases; and if a timely diagnosis is not made and effective treatment instituted, serious sequelae rapidly develop, including hemorrhagic shock and maternal and fetal death. Here, we report a case of spontaneous splenic rupture in a woman in her third trimester of pregnancy. Furthermore, through a literature review, we discuss the possible presentations, symptoms, and causes of splenic rupture during pregnancy, in the hope of facilitating the early diagnosis and treatment of this condition.
Experimental investigation of the effect of functionalized graphene on the creep behavior of epoxy
Authors: Bakbak Okan , Colak Ozgen
Published: September 2023

The objective of the current work was to investigate the creep behavior of functionalized graphene (f-GNF)-epoxy nanocomposite. Time and temperature-dependent mechanical behaviors were investigated by performing creep tests at three different stress levels and two different temperatures. Graphene produced by the electric arc discharge method was functionalized with Triton X-100 by a non-covalent method. Then, f-GNF-epoxy nanocomposites are produced by using the Three Roll Milling (3RM) method to eliminate nanofiller agglomeration. By performing quasi-static compression tests, stress levels for creep tests are determined as 50, 100, and 200 MPa to guarantee the viscoelastic deformation regime, around yield, and the viscoplastic deformation regime, respectively. The results indicate significant creep resistance in the nanocomposite with 0.1 wt% f-GNF. Depending on temperature and stress level, the effect of f-GNF is more pronounced at higher stresses and temperatures. f-GNFs have a significant effect on inhibiting the mobility of polymer chains, resulting improvements in the creep modulus. This indicates that thermally activated processes controlling the creep rate are in part inhibited by the presence of f-GNF. In the creep tests carried out for 2 h, a maximum improvement of 85% was observed in the creep modulus of epoxy-nanocomposite compared to pure epoxy at room temperature.
Comparative performance investigation and sustainability assessment in electrical discharge machining of SS316 using different dielectrics
Authors: Sethy Sunita , Rana Jaydev , Sharma Priyaranjan , Das Sudhansu Ranjan
Published: September 2023

In electrical discharge machining, the material removal phenomenon is heavily influenced by the breakdown strength of the dielectric fluid and the inter-electrode gap monitoring. This innovative research addresses a comparative performance evaluation and sustainability assessment between biodegradable palm oil and conventional EDM oil during machining of stainless steel (SS-316) using copper electrode. The cutting performance is investigated by comprehensive result analysis of various machinability aspects including material removal rate, surface integrity, tool wear rate, radial overcut of machined components. According to the findings, machining with palm oil dielectric outperformed the usual EDM oil with regards to improved material removal, surface morphology and finish, increased machined surface hardness with minimum surface crack density and hole overcut. Pyrolysis of conventional EDM dielectric oil leads to deposition of thin film carbon on bottom surface of the copper electrode which prevents the quick tool wear due to its higher breakdown voltage. The total machining cost expenditure per component under palm oil (INR383) is reduced by 11% than expenditure in traditional EDM oil (INR426). Compared to EDM oil, machining under biodegradable palm oil as dielectric fluid is better socio-economical viable and environmental conscious to enhance sustainability.
Energy management strategy of fuel cell vehicles with hybrid energy sources: A novel framework via deep reinforcement learning and transfer learning
Authors: Zhou Jianhao , Guo Aijun , Wang Jie , Wang Chunyan , Zhao Wanzhong
Published: September 2023

This study presents a multicriteria energy management strategy (EMS) for hybrid energy sources (HES) composed of fuel cell/battery/supercapacitor hybrid power system for logistics trucks, which uses a model-free deep reinforcement learning (DRL) algorithm, namely deterministic strategy gradient (DDPG), to improve the portability and reusability of the system. The proposed EMS is capable of reducing the hydrogen consumption cost, the degradation of fuel cell and battery, as well as sustaining the state of charge (SOC) of battery and supercapacitor. The results of the study found that the total cost was reduced by 9.5% compared to equivalence consumption minimization strategy (ECMS) based EMS under the WLTP driving cycle. A novel deep transfer learning (DTL) based framework for DRL-based EMS is further elaborated and evaluated by four metrics. Two DTL techniques including policy transfer and experience transfer are leveraged to transfer the EMS from original logistic truck to a B-class passenger car powered by fuel cell and battery. The results indicate that the proposed DTL framework is an appropriate approach to transfer EMSs from different vehicle model with various power topology. The convergence speed of DTL-based EMS is apparently accelerated over 50% in comparison to DRL-based EMS. Besides, the fuel optimality, robustness, convergence, and generalization stability for DTL-based EMS is also improved.
Health prediction of reciprocating endodontic instrument based on the machine learning and exponential degradation models
Authors: Thakur Vinod Singh , Kankar Pavan Kumar , Parey Anand , Jain Arpit , Jain Prashant Kumar
Published: September 2023

This study proposes an intelligent health prediction and fault prognosis of the endodontic file during the root canal treatment. Root canal treatment is the procedure of disinfecting the infected pulp through the canal with the help of an endodontic instrument. Force signals are acquired with the help of a dynamometer during the canal preparation, and statistical features are extracted. The extracted features are selected through the window-wise feature extraction process. Characteristic features for endodontic file prognostics include time-domain features of the signals are evaluated. The extracted feature has inappropriate information, that is, noise between the signals; hence the smoothing of the feature is required at this stage to observe a trend in the signals. Based on the smoothing feature and post-processing of the feature, defined the health index to calculate the health condition of the endodontic instruments. A machine learning algorithm and exponential degradation model are used to predict the health of the endodontic instrument during the root canal treatment. This model is used to forecast the degradation of the endodontic file so that actions can be taken before actual failures happen. The proposed methodology can analyze the failures and micro-crack initiation of the endodontic instruments. Endodontics practitioners can use the machine learning models as well as an exponential model for estimating the health condition of the endodontic instrument. This study may help the clinician to progress the efficiency of the root canal treatment and the competence of the endodontic instruments.
HLA Fully-Mismatched Sibling-Derived CD7 CAR-T Therapy Bridging to Haploidentical Hematopoietic Stem Cell Transplantation for Hepatosplenic γδ T-cell Lymphoma
Authors: Xu Xueer , Zu Cheng , Zhang Mingming , Xiao Pingnan , Hong Ruimin , Feng Jingjing , Xu Huijun , Cui Jiazhen , Yu Jian , Shi Jimin , Wei Guoqing , Chang Alex H. , Huang He , Hu Yongxian
Published: September 2023

While chimeric antigen receptor (CAR)-T-cell therapy has demonstrated remarkable effectiveness in the treatment of B-cell lymphomas and leukemias, research on T-cell malignancies is still limited. Here, we reported a patient with hepatosplenic γδ T-cell lymphoma refractory to multiple lines of chemotherapy, who eventually achieved first complete remission with flow cytometry-confirmed minimal residual disease negativity after human leukocyte antigen (HLA) fully-mismatched sibling-derived CD7 CAR-T therapy. However, given the allogeneic nature, CAR-T cells dropped rapidly after a peak of 83.4% of circulating T-cells. Cytokine release syndrome, cytopenia, and infections occurred but were manageable after treatments. After the consolidative haploidentical hematopoietic stem cell transplantation (HSCT), the patient remained in remission at the end of the follow-up (13 months post-CAR-T infusion). This is the first case of relapsed/refractory hepatosplenic γδ T-cell lymphoma who achieved lasting CR after HLA fully-mismatched sibling-derived CD7 CAR-T therapy bridging to haploidentical HSCT.
Seepage-stress combined experiment and damage model of rock in different loading and unloading paths
Authors: Zheng Zhi , Xu Hongyu , Wang Wei , Zhang Qiang , Wang Yujie , Sun Qiancheng , Tao Honghui , Han Xiaofeng
Published: September 2023

In the excavation of water-related underground projects such as hydropower and energy reserves, the surrounding rock surfers complex stress path and stress state redistribution, resulting in damage and failure under the hydro-mechanical coupling condition. However, the rock hydro-mechanical coupling characteristics under complex stress paths are unclear and corresponding theoretical models are scarce. In this study, a series of tests such as triaxial compression, unloading confining pressure and cyclic loading and unloading were carried out to study the effects of different stress paths, stress levels and seepage pressure on rock deformation, strength, failure and permeability. Based on test results, the damage evolutions under three different testing paths were analyzed, a new seepage-stress coupling statistical damage model which can better simulate the compaction stage is proposed. The prediction results of the proposed model under different stress paths are in good agreement with the experimental results. Under different stress paths, the fitting relationship between parameters R0 and n and σeff is similar and has good correlation.
Intergenerational Continuity of Childhood Adversity and Its Underlying Mechanisms Among Teen Mothers and Their Offspring
Authors: Yoon Yoewon , Cederbaum Julie A , Duan Lei , Lee Jungeun Olivia
Published: September 2023

The present study investigates how parenting stress mediates the intergenerational continuity of childhood adversity in teenage mothers. Childhood adversity experiences of caregivers significantly affect their offspring’s exposure to childhood adversity. However, little is known about the mechanisms linking childhood adversity across generations. The study measures how parental distress and parent-child dysfunctional interaction mediate the association between teen mothers’ childhood adversity and their offspring’s adversity, measuring when the offspring reached 11.5 years of age. The results revealed that parental distress, but not parent-child dysfunctional interaction, mediated the association between teen mothers’ child abuse and their offspring’s household dysfunction. This suggests that parental distress may be a crucial intervention target to prevent the intergenerational continuity of childhood adversity. The findings imply that efforts to prevent the intergenerational continuity of childhood adversity may be more successful if the public and professionals have a broader understanding of the associations between early adversity and parenting contexts. In conclusion, the study shed light on the potential mechanisms underlying the intergenerational continuity of childhood adversity and highlights the importance of targeting parenting stress, specifically parental distress, as an intervention strategy to prevent the perpetuation of childhood adversity across generations.
Effects of Tiered SWPBIS Fidelity on Exclusionary Discipline Outcomes for Students With Disabilities: A Conceptual Replication
Authors: Fleming Jesse I. , Grasley-Boy Nicolette M. , Gage Nicholas A. , Lombardo Michael , Anderson Lucas
Published: September 2023

School-wide positive behavior interventions and supports (SWPBIS) is a tiered framework that supports the academic, social, and behavioral needs of students. In this study, we conducted a conceptual replication of Grasley-Boy et al. (2022a) and used a series of two-level linear multilevel analyses to examine the impact of SWPBIS fidelity on 10 exclusionary discipline outcomes for students with disabilities (SWD). Specifically, we compared schools that implemented multiple SWPBIS tiers with fidelity to schools that only implemented Tier 1 with fidelity from a sample of 558 schools in 113 districts in California. Findings indicate a statistically significant decrease in multiple out-of-school suspension categories as well as referrals to law enforcement for SWD in schools that implemented all tiers with fidelity. We provide recommendations for using findings to inform school efforts to reduce exclusionary discipline for SWD.
Love, Simon and failure: Challenging normative discourses and femmephobia in gay youth representations
Authors: Davies Adam WJ
Published: September 2023

Contemporary and mainstream representations of gender and sexual minorities within pop culture provide an opportunity for marginalized narratives and stories to reach audiences otherwise excluded. As gay adolescent youth narratives become normalized within mainstream representations, ideas of coming out, the invisibilization of gay femininities, and the privileging of gender normativity within gay young adulthood percolate in film and media. This article presents an interpretive analysis of the regulation of femininity—femmephobia—within Love, Simon through depictions of Simon (the main gay adolescent character) and Ethan (Simon’s feminine gay peer). Using femme theory and “fag discourses,” this article problematizes femmephobic depictions of gay adolescence. Moreover, this article argues that Ethan's position as a “femme failure,” and thus an exemplar of femme resistance, offers opportunities for challenging femmephobic gender relations amongst gay adolescence in media and pop culture.
The meaningfulness of challenging the controlled drinking discourse. An autoethnographic study
Authors: Tønnessen Siw Heidi
Published: September 2023

Being able to control ones drinking is an expression of attitudes in most western societies towards the act of drinking, and if losing control, one breaks with these attitudes. This is what I call the “controlled drinking discourse.” Loss of control can be understood as any drinking of alcohol which starts a chain of reaction that is felt as a physical and psychological demand for alcohol. This is a description of how I related to alcohol for years until a complete crisis of meaning in my life in 2014. In recovery research, different kinds of “doings” are well documented as meaningful, while meaningful ways of thinking is less explored. Ways of thinking is influenced by available discourses. Through an autoethnographic approach, I explore ways of thinking with use of an analytical framework focusing on the relationship between discourses, narratives, and small stories. I also discuss theories on non-drinking, alcoholism, and recovery. Doing a discursively shift in thinking by accepting that controlled drinking is not possible, is for me a meaningful and self-sustainable way of thinking, which keeps me sober and away from crisis of meaning in my life.
More Than Meets the Eye: Human Versus Computer in the Neuroimaging of Temporal Lobe Epilepsy
Authors: Widdess-Walsh Peter
Published: September 2023

[Box: see text]
Psychosocial and Glycemic Benefits for Insulin-Using Adults With Type 2 Diabetes After Six Months of Pump Therapy: A Quasi-Experimental Approach
Authors: Polonsky William H. , Soriano Emily C.
Published: September 2023

Background:

Continuous subcutaneous insulin infusion (CSII) use in adults with type 1 diabetes offers psychosocial and clinical benefits, but little is known about its impact on such outcomes in the type 2 diabetes (T2D) population. To address this gap, we conducted a quasi-experimental prospective study to assess psychosocial, glycemic, and behavioral changes over six months in T2D adults on multiple daily injections (MDI) who were interested in starting Omnipod DASH, comparing those who did versus did not start on it.

Methods:

In total, 458 adults with T2D completed baseline questionnaires assessing psychosocial dimensions (eg, diabetes distress), clinical metrics (eg, HbA1c [glycosylated hemoglobin]), and behavioral measures (eg, missed mealtime boluses). Six months later, 220 (48.0%) completed the same questionnaire again. To examine differences in outcomes over time between those who began CSII (n = 176) versus those who remained on MDI (n = 44), a latent change score approach was used.

Results:

The CSII users reported greater gains than MDI users on all major psychosocial metrics, including overall well-being ( P < .001) diabetes distress ( P < .001), perceived T2D impact on quality of life ( P = .003), and hypoglycemic worries and concerns ( P < .001). The CSII users similarly reported a larger decline in HbA1c than MDI users ( P < .05) and greater declines in two critical self-care behaviors: number of missed mealtime boluses ( P < .001) and number of days of perceived overeating ( P = .001).

Conclusions:

The introduction of CSII (Omnipod DASH) in T2D adults can contribute to significant psychosocial, glycemic, and behavioral benefits, indicating that broader use of CSII in the T2D population may be of value.
Implementing unique identification technology: The journey and success story of Aadhaar in India
Authors: MC Arthi , Shanmugam Kavitha
Published: September 2023

The Aadhaar number has become a basic identification system for all Indian residents and is used for all purposes from air ticket booking, to ration cards and opening bank accounts. The purpose of Aadhaar in India started with a basic need to provide access to public services and Government benefits. But currently, Aadhaar is considered as a high potential, technology-enabled unique identification system that upholds the financial inclusion agenda for the Government of India. Further, its usage is growing day by day like making UPI transactions with only the Aadhaar number and linking many financial systems with Aadhaar. Implementing Aadhaar in a massive country like India is not an easy task but the Unique Identification Authority of India achieved it effectively with strong backing from the Government. This case discusses the origin, features, penetration and growth of Aadhaar and its role in financial inclusion. It also examines similar identification systems in other countries. The case deliberates the challenges faced in the implementation of Aadhaar in India.
Hegemonic fundamentalism in Wichita, Kansas: The Defenders of the Christian Faith, 1926-1931
Authors: Rooks P. J.
Published: September 2023

In 1926, Gerald Winrod, who was already a deeply committed Protestant revivalist and Chautauqua evangelist, founded The Defenders of the Christian Faith to battle the rise of the modern, liberal lifestyle. Winrod was one of several members of the newly formed World Christian Fundamentals Association who insisted upon a literal interpretation of the Bible and believed in subservience for women and Blacks as divinely sanctioned. This article elaborates findings from a case study of Winrod’s writings and particularly explores syncretic theological elements drawn from Calvinist and Arminian religious traditions that appear to have appealed to the new fundamentalists for their usefulness in sustaining the social privileges of white, Christian men.
Smart Urban Forest Management in East Africa: The Case of Nairobi and Kampala Cities
Authors: Chisika Sylvester Ngome , Yeom Chunho
Published: September 2023

Digital technologies are increasingly being incorporated in the management and governance of urban forests to provide the information needed for sustainable and more livable cities. However, there is scarce information on the documented lessons from applying these digital technologies for urban forestry management in many developing countries. This study addressed this challenge using a literature review in the case of Nairobi, Kenya, and Kampala, Uganda. The results substantiate that urban forests are important city assets enhancing ecological stability and sustainable development. As such, the digital technologies of urban forest management practices are rapidly expanding in the two cities to enhance urban forestry and create new opportunities for sustainable development. Both cities have differentiated integration of digital technologies in the vegetative, community support, and resource management components of urban forest governance and management, with important information and lessons being generated for city authorities and policymakers. In general, the technology implementation level in Kampala city is higher than in Nairobi City. This differentiation could be attributed to differences in the socio-political contexts of the two cities, which present different enablers and barriers to technology application in urban forestry. Nevertheless, more location-specific practices and experiences with a focus on how to diversify opinions and actors in digital technologies should be pursued.
Words Matter: Measuring the Co-Operative Identity Crisis
Authors: Pigeon Marc-Andre , Rixon Daphne
Published: September 2023

Identity is at the core of a rich body of business communications research, spanning studies on organizational identity, branding, and corporate social responsibility. This work has, however, neglected the question of corporate identity from the perspective of co-operatives—democratically-controlled businesses owned and controlled by their users—and the existential challenge posed by an operating environment often hostile to the business model. At the same time, the question of identity permeates the scholarly organizational and co-operative literature, shaping studies into co-operative identity crises, isomorphism, and from a transactions-cost economics perspective, the co-operative lifecycle. Bridging these literatures, we develop a first-ever conceptual dictionary of terms that we associate with co-operative and investor-owned firms (IOFs). Using text-as-data techniques, we apply the dictionary to a 15-year sample of credit union (a type of co-operative) and bank (IOFs) annual report texts. The resulting model ranks credit unions and banks on a co-op versus IOF firm scale and identifies credit unions that may be at risk of losing their identity because of their use of IOF language. To validate our results, we employ a variety of strategies, including novel machine learning models. Generally, these strategies support the findings from our dictionary model but also suggest the model may not be picking up on some creeping isomorphic pressures on credit unions to conform to IOF language. We conclude by noting that identity questions have important real-world implications, noting potential legal and public policy implications (e.g., loss of preferential tax measures) and pointing to literature that associates co-operative “identity crises” with business failures and demutualizations which, in turn, can lead to higher consumer prices.
Vaping-induced acute epiglottitis: a case report
Authors: Khorrami Amir , Khorrami Mohammad Ali , Gheriani Heitham
Published: September 2023

Background

E-cigarette use, or vaping, is an alternative nicotine delivery system that is becoming increasingly prevalent in adolescents and young adults. There is currently a lack of comprehensive research on the adverse effects of vaping on the upper airway.

Acute epiglottitis is a potentially life-threatening condition that can lead to airway obstruction. It is commonly caused by bacterial infections such as streptococci, staphylococcus, and Moraxella. Adult patients with acute epiglottitis mainly present with odynophagia, dysphagia, and respiratory difficulties. The diagnosis of epiglottitis is made by direct laryngoscopy, and the mainstay of treatment is antibiotics.

Bozella et al. (2020) reported a case of subacute non-infectious epiglottitis associated with e-cigarette use in a pediatric patient (Pediatrics 145(3), 2020). Here we present a case of acute epiglottitis in a healthy young adult after vaping, with a negative infectious workup. To our knowledge, there has been no such reported case of epiglottitis associated with e-cigarette use in an adult patient.

Case description

A previously healthy 29-year-old male with daily e-cigarette use presented to the emergency department with a severe sore throat, dysphagia, mild hoarseness, and shortness of breath, especially when lying supine. A lateral neck soft tissue radiograph revealed a thickened epiglottis with a thumb sign. Direct bedside laryngoscopy showed a swollen epiglottis, partially obstructing the supraglottic region confirming the diagnosis of acute epiglottitis. Throat and nasal swabs were negative for streptococcus and COVID-19 infection, respectively. The patient’s condition improved significantly after receiving intravenous Dexamethasone and antibiotics for 2 days. Repeat laryngoscopy showed the resolution of epiglottis swelling, and subjective symptoms had resolved entirely 2 weeks following the start of the treatment.

Conclusions

Although bacterial infections usually cause acute epiglottitis, this case presents the second report of this condition associated with vaping with negative microbiological investigations. Therefore, we recommend that physicians consider non-infectious causes such as vaping in their differential diagnosis for patients with acute and subacute epiglottitis. More research is warranted on the utility of antibiotics in treating vaping-induced epiglottitis.
Mobility as a Service (MaaS) in the Global South: research findings, gaps, and directions
Authors: Hasselwander Marc , Bigotte Joao F.
Published: September 2023

Background

Mobility as a Service (MaaS) – bundled mobility and transport services accessible on-demand and on a single platform – has been a popular research topic in recent years. Most MaaS studies, however, are embedded in the context of cities in the Global North, where most of the existing MaaS schemes are operational.

Purpose

The purpose of this paper is to give an overview of first findings of studies in the Global South. We aim to answer the following questions: Is MaaS likely to gain traction in the Global South? How does MaaS in the Global South differ from the known model? Can MaaS mitigate transport problems in the Global South?

Methodology

We conducted a systematic literature review with a thematic analysis and narrative synthesis. In total, we identified 23 relevant papers that were included for full-text analysis.

Findings

A qualitative synthesis of the analyzed papers suggests that: (i) there is a considerable demand and preference for integrated, app-based mobility services and that both public and private actors are likely to push the MaaS concept; (ii) however, different regulatory frameworks, available infrastructures, and user preferences, among others, require an adjusted MaaS model; and (iii) there is initial evidence that MaaS can indeed promote more sustainable mobility behavior in the developing world, although these findings require further validation from MaaS pilots and comprehensive simulation studies.
Causal associations between thyroid cancer and IgA nephropathy: a Mendelian randomization study
Authors: Mei Ziwei , Li Fuhao , Chen Ruizhen , Xiao Zilong , Cai Dongsheng , Jin Lie , Qian Xu , Wang Yucheng , Chen Jun
Published: September 2023

Background

The incidence of kidney disease caused by thyroid cancer is rising worldwide. Observational studies cannot recognize whether thyroid cancer is independently associated with kidney disease. We performed the Mendelian randomization (MR) approach to genetically investigate the causality of thyroid cancer on immunoglobulin A nephropathy (IgAN).

Methods and results

We explored the causal effect of thyroid cancer on IgAN by MR analysis. Fifty-two genetic loci and single nucleotide polymorphisms were related to thyroid cancer. The primary approach in this MR analysis was the inverse variance weighted (IVW) method, and MR‒Egger was the secondary method. Weighted mode and penalized weighted median were used to analyze the sensitivity. In this study, the random-effect IVW models showed the causal impact of genetically predicted thyroid cancer across the IgAN risk (OR, 1.191; 95% CI, 1.131–1.253, P < 0.001). Similar results were also obtained in the weighted mode method (OR, 1.048; 95% CI, 0.980–1.120, P = 0.179) and penalized weighted median (OR, 1.185; 95% CI, 1.110–1.264, P < 0.001). However, the MR‒Egger method revealed that thyroid cancer decreased the risk of IgAN, but this difference was not significant (OR, 0.948; 95% CI, 0.855–1.051, P = 0.316). The leave-one-out sensitivity analysis did not reveal the driving influence of any individual SNP on the association between thyroid cancer and IgAN.

Conclusion

The IVW model indicated a significant causality of thyroid cancer with IgAN. However, MR‒Egger had a point estimation in the opposite direction. According to the MR principle, the evidence of this study did not support a stable significant causal association between thyroid cancer and IgAN. The results still need to be confirmed by future studies.
Disease progression model anchored around clinical diagnosis in longitudinal cohorts: example of Alzheimer’s disease and related dementia
Authors: Lespinasse Jérémie , Dufouil Carole , Proust-Lima Cécile
Published: September 2023

Background

Alzheimer’s disease and related dementia (ADRD) are characterized by multiple and progressive anatomo-clinical changes including accumulation of abnormal proteins in the brain, brain atrophy and severe cognitive impairment. Understanding the sequence and timing of these changes is of primary importance to gain insight into the disease natural history and ultimately allow earlier diagnosis. Yet, modeling changes over disease course from cohort data is challenging as the usual timescales (time since inclusion, chronological age) are inappropriate and time-to-clinical diagnosis is available on small subsamples of participants with short follow-up durations prior to diagnosis. One solution to circumvent this challenge is to define the disease time as a latent variable.

Methods

We developed a multivariate mixed model approach that realigns individual trajectories into the latent disease time to describe disease progression. In contrast with the existing literature, our methodology exploits the clinical diagnosis information as a partially observed and approximate reference to guide the estimation of the latent disease time. The model estimation was carried out in the Bayesian Framework using Stan. We applied the methodology to the MEMENTO study, a French multicentric clinic-based cohort of 2186 participants with 5-year intensive follow-up. Repeated measures of 12 ADRD markers stemmed from cerebrospinal fluid (CSF), brain imaging and cognitive tests were analyzed.

Results

The estimated latent disease time spanned over twenty years before the clinical diagnosis. Considering the profile of a woman aged 70 with a high level of education and APOE4 carrier (the main genetic risk factor for ADRD), CSF markers of tau proteins accumulation preceded markers of brain atrophy by 5 years and cognitive decline by 10 years. However we observed that individual characteristics could substantially modify the sequence and timing of these changes, in particular for CSF level of A$$\beta _{42}$$

β
42

.

Conclusion

By leveraging the available clinical diagnosis timing information, our disease progression model does not only realign trajectories into the most homogeneous way. It accounts for the inherent residual inter-individual variability in dementia progression to describe the long-term anatomo-clinical degradations according to the years preceding clinical diagnosis, and to provide clinically meaningful information on the sequence of events.

Trial registration

clinicaltrials.gov, NCT01926249. Registered on 16 August 2013.
Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia
Authors: Hafiz Taghreed A. , Alanazi Sarah , Alghamdi Shahad S. , Mubaraki Murad A. , Aljabr Waleed , Madkhali Nouf , Alharbi Sarah R. , Binkhamis Khalifa , Alotaibi Fawzia
Published: September 2023

Background and objectives

Klebsiella pneumoniae (K. pneumoniae) is the second leading cause of community-acquired and hospital-acquired gram-negative bloodstream infection (BSI). This study aimed to assess the epidemiological and microbial-resistance characteristics and clinical factors associated with K. pneumoniae BSI in Saudi Arabia.

Materials and Methods

Data of 152 K. pneumoniae isolates diagnosed between January 2019 and January 2020 at King Fahad Medical City, Riyadh, Saudi Arabia were evaluated retrospectively. Clinical records of the patients were collected and analysed statistically.

Results

In total, 152 cases of K. pneumoniae BSI were identified. Adult patients (66.4%) were at a higher risk of developing the infection than paediatric patients (33.6%). The rate of infection was slightly higher in women than in men. Neurological disorders were the predominant underlying conditions for the acquisition of K. pneumoniae BSI, at all ages. Most of the deceased patients were adults with multi-organ dysfunction. Klebsiella pneumoniae showed disturbing resistance to amoxicillin-clavulanate and cefuroxime (72.4%), ceftazidime (67.8), cephalothin (76.3%), and to Carbapenems (36.1%).

Conclusions

The impact of K. pneumoniae BSI was seen not only at the patient level, but also at the community level, and was related to multi-drug resistant infection. These findings provide a better understanding of microbial resistance and its association with patient clinical outcomes.
The role of Gestational Diabetes Mellitus and pelvic floor 3D-ultrasound assessment during pregnancy predicting urinary incontinence: a prospective cohort study
Authors: Sartorao Filho Carlos Izaias , Nunes Sthefanie K. , Magyori Adriely B.M. , Calderon Iracema M.P. , Barbosa Angelica M.P. , Rudge Marilza V.C.
Published: September 2023

Postpartum urinary incontinence may have a severe impact on women’s health. Despite pregnancy and parturition being the most recognized risk factors, methods to identify new pregnant predictor risk factors are needed. Our study investigated the Gestational Diabetes Mellitus, clinical and pelvic floor 3D-ultrasound markers in pregnant women as predictors for 6–18 months of urinary incontinence. This prospective cohort study included nulliparous pregnant women submitted to Gestational Diabetes Mellitus screening in the second trimester. Pelvic floor 3D Ultrasound was performed at the second and third trimesters of gestation to evaluate the pelvic floor muscles and functions. Clinical data, the ICIQ-SF, and ISI questionnaires for urinary incontinence were applied in the third trimester and 6–18 months postpartum. Univariate analysis (P < .20) to extract risk factors variables and multivariate logistic regression analysis (P < .05) to obtain the adjusted relative ratio for urinary incontinence were performed. A total of 93 participants concluded the follow-up. Using the variables obtained by univariate analysis and after adjustments for potential confounders, multivariate analysis revealed that Gestational Diabetes Mellitus exposure was a solid and independent risk factor for 6–18 months of urinary incontinence (Adjusted RR 8.08; 95%CI 1.17–55.87; P:0.034). In addition, a higher Hiatal area observed in distension maneuver from the second to third trimester was negatively associated (Adjusted RR 0.96; 95%CI 0.93–0.99; P:0.023). In conclusion, Gestational Diabetes Mellitus was positively associated with 6–18 months of urinary incontinence, and higher Hiatal area distension was negatively associated.
Refractory post-surgical cystoid macular edema managed following suprachoroidal microcatheterization and delivery of triamcinolone
Authors: de Smet Marc D. , Goncerut Matthieu , Asmus Friedrich , Yamamoto Ron
Published: September 2023

Background

Post-surgical macular edema (ME) is a common cause of prolonged visual impairment. Here we report on the feasibility and clinical outcomes from the use of a novel suprachoroidal microcatheter to treat post-surgical chronic ME by the posterior suprachoroidal placement of a triamcinolone acetonide (TA) suspension.

Methods

Two patients were catheterized with the Oxulumis suprachoroidal delivery system on two separate occasions starting 5 and 10 mm posterior to the limbus. The catheter only remains in the suprachoroidal space for the time of the drug administration. Visual acuity and spectral domain optical coherence tomography (SD-OCT) changes were followed over several weeks to months to determine the duration of ME resolution.

Results

Suprachoroidal microcatheterization for posterior delivery of triamcinolone was possible in all attempts using the illuminated Oxulumis catheter. No reflux, scleral or choroidal trauma was observed. There was no intraocular pressure rise during the follow-up period. The triamcinolone deposit was visible on infrared imaging and on SD-OCT a choroidal elevation was visible. Both progressively disappeared over time. A rapid resolution of ME associated with improved vision was observed following each injection for 3 to 7 months with a TA dose of 2.4 mg or 4 mg.

Conclusions

In these patients with poorly responsive ME, posterior suprachoroidal TA led to a visible suprachoroidal drug deposit and prolonged visual improvement. The Oxulumis microcatheterization device performed as expected and was not associated with any complications.
Refraction and ocular biometric parameters of preschool children in the Beijing whole childhood eye study: the first-year report
Authors: Zhu Bidan , Sun Yunyun , Wang Shana , Qin Xi , Li Lei , Du Bei , Fu Jing , Wei Ruihua
Published: September 2023

Background

Prevention of myopia should begin before school age. However, few population-based cohort studies have investigated refractive status in preschool children with cycloplegia. This study aimed to investigate the post-COVID-19 refraction and ocular biometric parameters of preschool children in Beijing Tongzhou District.

Methods

A population-based cohort study of kindergarten children in Tongzhou District, Beijing, commenced in November 2021. The present study reports data from the first year of the aforementioned population-based study. We selected children aged 3–6 years from nine kindergartens. Biometric parameters, including axial length (AL), anterior chamber depth (ACD), and corneal radius of curvature (CR), were collected before cycloplegia. Cycloplegic refraction was also measured. The spherical equivalent (SE), lens power (LP), and AL-to-CR ratio were calculated. Multiple linear regression analysis was used to analyse the correlation between refraction and ocular biometric parameters.

Results

A total of 1,505 children completed the examination, and a mean SE of 1.24 ± 0.91 D was found. The overall prevalence of myopia was 1.93%. The mean AL, ACD, CR, LP, and AL-to-CR ratio were 22.24 ± 0.70 mm, 3.28 ± 0.26 mm, 7.77 ± 0.26 mm, 26.01 ± 1.56 D, and 2.86 ± 0.07, respectively. Longer AL, deeper ACD, larger AL-to-CR ratio, and lower LP were associated with older age; the CR was not significantly different among different ages. In the multiple linear regression analysis, after adjusting for sex and age, the model that included AL, CR, and LP explained 87% of the SE variation. No differences were observed in the prevalence of myopia or the SE in this particular age range.

Conclusion

The findings of this study suggest that a large proportion of preschool children in Beijing are mildly hyperopic, with a considerably low prevalence of myopia. In preschool children, refractive development was found to present mild hyperopia rather than emmetropia or myopia, a phenomenon that is characteristic of this age range.
Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991–2016
Authors: Florentin Sharon , Rosca Paola , Reuveni Inbal , Haled Razek , Neumark Yehuda
Published: September 2023

Background

Members of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010.

Methods

The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991–2016 (at least once in 2010–2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991–2000, Period2: 2001–2009, Period3: 2010–2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days.

Results

The proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001).

Conclusions

The findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.