bluuebunny/crossref_metadata_2025 huggingface dataset:
The societal cost of treatment-seeking patients with borderline personality disorder in Germany
Authors: Wagner Till , Assmann Nele , Köhne Sandra , Schaich Anja , Alvarez-Fischer Daniel , Borgwardt Stefan , Arntz Arnoud , Schweiger Ulrich , Fassbinder Eva
Published: October 2021

According to previous research, borderline personality disorder (BPD) is associated with high cost-of-illness. However, there is still a shortage of cost-of-illness-studies assessing costs from a broad societal perspective, including direct and indirect costs. Further, there are considerable differences in the results among the existing studies. In the present study, 167 German men and women seeking specialized outpatient treatment for BPD were included. We assessed societal cost-of-illness bottom-up through structured face-to-face interviews and encompassed a wide range of cost components. All costs were calculated for the 2015 price level. Cost-of-illness amounted to € 31,130 per patient and year preceding disorder-specific outpatient treatment. € 17,044 (54.8%) were direct costs that were mostly related to hospital treatment. Indirect costs amounted to € 14,086 (45.2%). Within indirect costs, costs related to work disability were the most crucial cost driver. The present study underlines the tremendous economic burden of BPD. According to the present study, both the direct and indirect costs are of significant importance for the societal costs associated with BPD. Besides the need for more disorder-specific treatment facilities for men and women with BPD, we assume that education and employment are topics that should be specifically targeted and individually supported at an early stage of treatment.

Trial Registration: German Clinical Trial Registration, DRKS00011534, Date of Registration: 11/01/2017, retrospectively registered.
The epidemiology of uveal melanoma in Germany: a nationwide report of incidence and survival between 2009 and 2015
Authors: Alfaar Ahmad Samir , Saad Anas , Wiedemann Peter , Rehak Matus
Published: October 2021

Purpose

To calculate the overall incidence of uveal melanoma in Germany and to compare incidences in different German states. In addition, we computed the overall and cancer-specific survival rates nationwide.

Methods

Incidence data for the period between 2009 and 2015, covering the entire German population, was collected through the German Center for Cancer Registry. ICD-O-3 topography codes C69.3-C69.4 and histology codes for melanoma subtypes were used to collect the incidence data. Confidence Intervals with a level of 95% (95% CI) were calculated for rates. Survival was calculated using the Kaplan–Meier. The log-rank test was used for survival comparisons.

Results

This study comprised 3654 patients with uveal melanomas, including 467 (12.8%) with iridial and ciliary body tumors. The overall age-standardized incidence rate (ASIR) was 6.41 person per million. Generally, the ASIR was higher in males than females (6.67 (95% CI 6.37–6.98) vs. 6.16 (95% CI 5.88–6.45 per million). Higher crude incidence rates were noted in the northeastern states (12.5 per million (95% CI 10.5–14.7) in Mecklenburg-Vorpommern) compared with the southwestern states (2.1 per million (95% CI 1.7–2.6) in Hessen). The 5-year overall survival stood at 47%, while the cancer-specific survival stood at 84%. Multivariate analysis showed that women, younger patients, and patients living in Berlin achieved significantly higher overall survival.

Conclusion

Overall ASIR of uveal melanoma in Germany indicates that the disease is more common in males and that it follows the same geographical distribution previously noted in central European countries, with the highest incidence in northern parts of Germany.
Online signature verification using signature down-sampling and signer-dependent sampling frequency
Authors: Saleem Mohammad , Kovari Bence
Published: October 2021

Online signature verification considers signatures as time sequences of different measurements of the signing instrument. These signals are captured on digital devices and therefore consist of a discrete number of samples. To enrich or simplify this information, several verifiers employ resampling and interpolation as a preprocessing step to improve their results; however, their design decisions may be difficult to generalize. This study investigates the direct effect of the sampling rate of the input signals on the accuracy of online signature verification systems without using interpolation techniques and proposes a novel online signature verification system based on a signer-dependent sampling frequency. Twenty verifier configurations were created for five different public signature databases and a variety of popular preprocessing approaches and evaluated for 20–40 different sampling rates. Our results show that there is an optimal range for the sampling frequency and the number of sample points that minimizes the error rate of a verifier. A sampling frequency range of 15–50 Hz and a signature point count of 60–240 provided the best accuracies in our experiments. As expected, lower ranges showed inaccurate results; interestingly, however, higher frequencies often decreased the verification accuracy. The results show that one can achieve better or at least the same verification accuracies faster by down-sampling the online signatures before further processing. The proposed system achieved competitive results to state-of-the-art systems for different databases by using the optimal sampling frequency. We also studied the effect of choosing individual sampling frequencies for each signer and proposed a signature verification system based on signer-dependent sampling frequency. The proposed system was tested using 500 different verification methods and improved the accuracy in 92% of the test cases compared to the usage of the original frequency.
Effects of COVID-19 lockdown on low back pain intensity in chronic low back pain patients: results of the multicenter CONFI-LOMB study
Authors: Bailly Florian , Genevay Stéphane , Foltz Violaine , Bohm-Sigrand Amélie , Zagala Alain , Nizard Julien , Petit Audrey
Published: October 2021

Purpose

The COVID-19 pandemic and the extended lockdown are associated with numerous changes in behavior and lifestyles. The objective was to assess the impact of the first lockdown on LBP course among chronic LBP patients.

Methods

Descriptive and analytical, cross-sectional, multicenter study, conducted by questionnaire from mid-May to end of June 2020 among patients treated for chronic LBP in 6 French and 1 Swiss center. Collected data concerned changes in LBP intensity during lockdown, lockdown experience, physical activity (PA) practice and sedentary lifestyle prior and during lockdown, recourse to care, consumption of psychoactive substances for LBP, and professional activity and its conditions during lockdown.

Results

360 participants (58.6% women, 52.1 ± 13.4 years) were included of which 65% were active (63% keep on working of which 54% teleworked). LBP got worse in 41.1%, mean VAS went from 49.5 ± 21.6 before to 53.5 ± 22.4 during lockdown (p < 0.001) and needed increase of treatment by 29% but very few people increased their consumption psychoactive substances for analgesia. Half of participants had well-experienced lockdown. Findings revealed a significant decrease in PA and increase of sedentary during lockdown (p < 0.0001). Good experience of lockdown was associated with LBP improvement (OR = 0.6 [0.3–0.9]) and decrease of PA with LBP worsening (OR = 1.9 [1.1–3.2]). Teleworking was also associated with LBP worsening. Gender, age, or BMI did not influence LBP course.

Conclusion

These findings indicate that chronic LBP people suffered from increase in self-perceived LBP during lockdown and help to better understand the factors associated with their condition.
Compositional learning of mutually recursive procedural systems
Authors: Frohme Markus , Steffen Bernhard
Published: October 2021

This paper presents a compositional approach to active automata learning of Systems of Procedural Automata (SPAs), an extension of Deterministic Finite Automata (DFAs) to systems of DFAs that can mutually call each other. SPAs are of high practical relevance, as they allow one to efficiently learn intuitive recursive models of recursive programs after an easy instrumentation that makes calls and returns observable. Key to our approach is the simultaneous inference of individual DFAs for each of the involved procedures via expansion and projection: membership queries for the individual DFAs are expanded to membership queries of the entire SPA, and global counterexample traces are transformed into counterexamples for the DFAs of concerned procedures. This reduces the inference of SPAs to a simultaneous inference of the DFAs for the involved procedures for which we can utilize various existing regular learning algorithms. The inferred models are easy to understand and allow for an intuitive display of the procedural system under learning that reveals its recursive structure. We implemented the algorithm within the LearnLib framework in order to provide a ready-to-use tool for practical application which is publicly available on GitHub for experimentation.
Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity
Authors: Palmieri Mauro , Pesce Alessandro , Zancana Giuseppa , Armocida Daniele , Maiese Aniello , Cirelli Carlo , Santoro Antonio , Frati Paola , Fineschi Vittorio , Frati Alessandro
Published: October 2021

Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.
Evaluation of field visit planning heuristics during rapid needs assessment in an uncertain post-disaster environment
Authors: Hakimifar Mohammadmehdi , Balcik Burcu , Fikar Christian , Hemmelmayr Vera , Wakolbinger Tina
Published: October 2021

A Rapid Needs Assessment process is carried out immediately after the onset of a disaster to investigate the disaster’s impact on affected communities, usually through field visits. Reviewing practical humanitarian guidelines reveals that there is a great need for decision support for field visit planning in order to utilize resources more efficiently at the time of great need. Furthermore, in practice, there is a tendency to use simple methods, rather than advanced solution methodologies and software; this is due to the lack of available computational tools and resources on the ground, lack of experienced technical staff, and also the chaotic nature of the post-disaster environment. We present simple heuristic algorithms inspired by the general procedure explained in practical humanitarian guidelines for site selection and routing decisions of the assessment teams while planning and executing the field visits. By simple, we mean methods that can be implemented by practitioners in the field using primary resources such as a paper map of the area and accessible software (e.g., Microsoft Excel). We test the performance of proposed heuristic algorithms, within a simulation environment , which enables us to incorporate various uncertain aspects of the post-disaster environment in the field, ranging from travel time and community assessment time to accessibility of sites and availability of community groups. We assess the performance of proposed heuristics based on real-world data from the 2011 Van earthquake in Turkey. Our results show that selecting sites based on an approximate knowledge of community groups’ existence leads to significantly better results than selecting sites randomly. In addition, updating initial routes while receiving more information also positively affects the performance of the field visit plan and leads to higher coverage of community groups than an alternative strategy where inaccessible sites and unavailable community groups are simply skipped and the initial plan is followed. Uncertainties in travel time and community assessment time adversely affect the community group coverage. In general, the performance of more sophisticated methods requiring more information deteriorates more than the performance of simple methods when the level of uncertainty increases.
Hitchhiking or hang gliding? Dispersal strategies of two cereal-feeding eriophyoid mite species
Authors: Majer Agnieszka , Laska Alicja , Hein Gary , Kuczyński Lechosław , Skoracka Anna
Published: October 2021

Dispersal shapes the dynamics of populations, their genetic structure and species distribution; therefore, knowledge of an organisms’ dispersal abilities is crucial, especially in economically important and invasive species. In this study, we investigated dispersal strategies of two phytophagous eriophyoid mite species:Aceria tosichella(wheat curl mite, WCM) andAbacarus hystrix(cereal rust mite, CRM). Both species are obligatory plant parasites that infest cereals and are of economic significance. We investigated their dispersal success using different dispersal agents: wind and vectors. We hypothesised that in both mite species the main mode of dispersal is moving via wind, whereas phoretic dispersal is rather accidental, as the majority of eriophyoid mite species do not possess clear morphological or behavioural adaptations for phoresy. Results confirmed our predictions that both species dispersed mainly with wind currents. Additionally, WCM was found to have a higher dispersal success than CRM. Thus, this study contributes to our understanding of the high invasive potential of WCM.
Blockchain-enabled real-time SLA monitoring for cloud-hosted services
Authors: Khan Kashif Mehboob , Arshad Junaid , Iqbal Waheed , Abdullah Sidrah , Zaib Hassan
Published: October 2021

Cloud computing is an important technology for businesses and individual users to obtain computing resources over the Internet on-demand and flexibly. Although cloud computing has been adopted across diverse applications, the owners of time-and-performance critical applications require cloud service providers’ guarantees about their services, such as availability and response times. Service Level Agreements (SLAs) are a mechanism to communicate and enforce such guarantees typically represented as service level objectives (SLOs), and financial penalties are imposed on SLO violations. Due to delays and inaccuracies caused by manual processing, an automatic method to periodically verify SLA terms in a transparent and trustworthy manner is fundamental to effective SLA monitoring, leading to the acceptance and credibility of such service to the customers of cloud services. This paper presents a blockchain-based distributed infrastructure that leverages fundamental blockchain properties to achieve immutable and trustworthy SLA monitoring within cloud services. The paper carries out an in-depth empirical investigation for the scalability of the proposed system in order to address the challenge of transparently enforcing real-time monitoring of cloud-hosted services leveraging blockchain technology. This will enable all the stakeholders to enforce accurate execution of SLA without any imprecisions and delays by maintaining an immutable ledger publicly across blockchain network. The experimentation takes into consideration several attributes of blockchain which are critical in achieving optimum performance. The paper also investigates key characteristics of these factors and their impact to the behaviour of the system for further scaling it up under various cases for increased service utilization.
Mint: MDL-based approach for Mining INTeresting Numerical Pattern Sets
Authors: Makhalova Tatiana , Kuznetsov Sergei O. , Napoli Amedeo
Published: October 2021

Pattern mining is well established in data mining research, especially for mining binary datasets. Surprisingly, there is much less work about numerical pattern mining and this research area remains under-explored. In this paper we proposeMint, an efficient MDL-based algorithm for mining numerical datasets. The MDL principle is a robust and reliable framework widely used in pattern mining, and as well in subgroup discovery. InMintwe reuse MDL for discovering useful patterns and returning a set of non-redundant overlapping patterns with well-defined boundaries and covering meaningful groups of objects.Mintis not alone in the category of numerical pattern miners based on MDL. In the experiments presented in the paper we show thatMintoutperforms competitors among which IPD,RealKrimp, andSlim.
Using structural equation modelling for understanding relationships influencing the middle school technology teacher’s attitudes toward STEAM education in Korea
Authors: Kim Young-Heung , Na Seung-Il
Published: October 2021

The purpose of this study was to investigate the structural relationship between technology teachers’ attitudes toward STEAM education and the cooperation of instructional resources collaboration, school educational change receptivity, and instructional expertise and instructional efficacy. The population comprised about 3500 technology teachers working in middle schools in Korea, and the sample size was set at 650. Data were collected in parallel with postal surveys and online surveys. A total of 650 copies were distributed, of which 409 were recovered, and 283 copies were used for analysis after data cleaning. The Mplus 7 program was used for data analysis, and the significance level was set at 5%. First, we found that the suitability of the structural model established to clarify technology teachers’ attitudes toward STEAM education, instructional resource collaboration, school educational change receptivity, instructional expertise, and instructional efficacy was generally good, so the relationship between the variables was reasonably confirmed. Second, school educational change receptivity and instructional efficacy were found to have a direct effect on attitudes toward STEAM education. Third, the teachers’ instructional resources collaboration was confirmed to influence their attitudes toward STEAM education by mediating the school educational change receptivity and instructional efficacy, and their instructional expertise mediated their instructional efficacy. Fourth, school educational change receptivity was confirmed to influence attitudes toward STEAM education through the dual media of instructional expertise and instructional efficacy. Finally, instructional resource collaboration was confirmed to influence attitudes toward STEAM education through school educational change receptivity, instructional expertise, and instructional efficacy.
Is group work beneficial for producing creative designs in STEM design education?
Authors: Han Ji , Park Dongmyung , Hua Min , Childs Peter R. N.
Published: October 2021

Creativity is a significant element in design education, and frequently a significant competency during recruitment for design professions. Group work and individual work are widely employed in higher education. Many studies have highlighted the merits of employing group work in design education, cultivating collaborative design abilities and fostering sought-after employability skills. Although the benefits of group work in design practice and education are widely recognised, few studies have shown evidence that group work outperforms individual work regarding creative design activities in higher education contexts. Therefore, the aim of this research is to explore whether group or individual work is more beneficial for fostering students in generating creative designs in STEM design education. A case study, involving two cohorts of second-year undergraduate students studying a UK Engineering degree Industrial Design programme, is reported. The case study compares the design outputs produced by the two cohorts tackling the same design challenge in a product design module but employing individual and group work, respectively. The case study results show that no significant differences have been found between the design outputs produced by group work and individual work, considering novelty, usefulness and overall creativity. Further analysis reveals that a student’s academic performance is not significantly related to the level of creativity of the design produced. This research indicates design educators should employ both group and individual work to complement each other in design education, and suggests potential solutions to enhance students’ design creativity.
Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA-MI-VT phase Ib/II study
Authors: Carbucicchio Corrado , Andreini Daniele , Piperno Gaia , Catto Valentina , Conte Edoardo , Cattani Federica , Bonomi Alice , Rondi Elena , Piccolo Consiglia , Vigorito Sabrina , Ferrari Annamaria , Pepa Matteo , Giuliani Mattia , Mushtaq Saima , Scarà Antonio , Calò Leonardo , Gorini Alessandra , Veglia Fabrizio , Pontone Gianluca , Pepi Mauro , Tremoli Elena , Orecchia Roberto , Pompilio Giulio , Tondo Claudio , Jereczek-Fossa Barbara Alicja
Published: October 2021

Purpose

We present the preliminary results of the STRA-MI-VT Study (NCT04066517), a spontaneous, phase Ib/II study, designed to prospectively test the safety and efficacy of stereotactic body radiotherapy (SBRT) in patientswith advanced cardiac disease and intractable ventricular tachycardia (VT).

Methods

Cardiac computed tomography (CT) integrated by electroanatomical mapping was used for substrate identification and merged with dedicated CT scans for treatment plan preparation. A single 25-Gy radioablation dose was delivered by a LINAC-based volumetric modulated arc therapy technique in a non-invasive matter. The primary safety endpoint was treatment-related adverse effects during acute and long-term follow-up (FU), obtained by regular in-hospital controls and implantable cardioverter defibrillator (ICD) remote monitoring. The primary efficacy endpoint was the reduction at 3 and 6 months of VT episodes and ICD shocks.

Results

Seven out of eight patients (men; age, 70 ± 7 years; ejection fraction, 27 ± 11%; 3 ischemic, 4 non-ischemic cardiomyopathies) underwent SBRT. At a median 8-month FU, no treatment-related serious adverse event occurred. Three patients died from non-SBRT-related causes. Four patients completed the 6-month FU: the number of VT decreased from 29 ± 33 to 11 ± 9 (p = .05) and 2 ± 2 (p = .08), at 3 and 6 months, respectively; shocks decreased from 11 to 0 and 2, respectively. At 6 months, all patients. showed a significant reduction of VT episodes and no electrical storm recurrence, with the complete regression of iterative VTs in 2/2 patients.

Conclusion

The STRA-MI-VT Study suggests that SBRT can be considered an alternative option for the treatment of VT in patients with structural heart disease and highlights the need for further clinical investigation addressing safety and efficacy.
Linking Availability Expectations, Bidirectional Boundary Management Behavior and Preferences, and Employee Well-Being: an Integrative Study Approach
Authors: Reinke Kathrin , Gerlach Gisela I.
Published: October 2021

Information and communication technologies enable employees to be available anywhere and anytime, raising availability expectations of work and nonwork contacts. Building on the theory of planned behavior and the person-environment fit theory, the present study examines how others’ availability expectations predict employees’ management of work and nonwork boundaries, and how these bidirectional boundary management behaviors relate to well-being. Results of structural equation modeling with data from 401 employees collected in two waves show that availability expectations of both coworkers and nonwork contacts predict how employees manage the boundaries of work and nonwork domains. Thereby, availability expectations are negatively related to segmentation of the two domains and coworkers' expectations show an indirect effect on employee well-being. Further, our study shows that work-nonwork and nonwork-work segmentation behavior have divergent effects on employee well-being, indicating that asymmetric boundary management behavior with high work-nonwork segmentation and low nonwork-work segmentation may be beneficial. Besides, moderation analyses underline the importance of enabling individuals to align their boundary management preferences with their actual behavior, especially when individuals have high work-nonwork segmentation preferences. By integrating and unveiling distinct antecedents of work-nonwork and nonwork-work segmentation behavior and their divergent effects on well-being, the present study contributes to a comprehensive framework for investigating and understanding bidirectional boundary management in the face of technology-enabled availability.
Hermaphroditism in fish: incidence, distribution and associations with abiotic environmental factors
Authors: Pla Susanna , Maynou Francesc , Piferrer Francesc
Published: October 2021

The distribution of hermaphroditism in fishes has traditionally been mainly explained by its dependence on biotic factors. However, correlates with major abiotic factors have not been investigated on a quantitative basis and at a global scale. Here, we determined the incidence of hermaphroditism in fish at the family and species level, tested the hypothesis that evolutionary relationships account for the poor presence of hermaphroditism in freshwater species, and tested the association of sexual systems with latitude, habitat type and depth. Functional hermaphroditism is reported in 8 orders, 34 families and 370 species of fishes, all teleosts. Sequential hermaphroditism predominates over simultaneous hermaphroditism at a ratio ~ 5:1 and protogyny (female-to-male sex change) predominates ~ 6:1 over protandry (male-to-female). We found 12 hermaphroditic species that can live in freshwater. However, seven of these species are from four primarily marine families while there are only five species from two mostly freshwater families. Protogynous and bi-directional sex changers have a tighter association with reef-associated tropical and subtropical habitats when compared to protandrous species, which tend to be more plastic in terms of distribution requirements. Finally, simultaneous hermaphrodite species live both in the deep sea and shallow waters in similar proportions. This study can be the basis for further research in specific groups for different purposes, including ecological and evolutionary issues as well as conservation and management of exploited species. Understanding the environmental correlates can help to forecast changes in the distribution or phenology of hermaphrodites in a global change scenario.
An Odd Coupling: Nietzsche and W.E.B. Du Bois on 21st Century Philosophy of Education
Authors: Verharen Charles C.
Published: October 2021

This essay contrasts Nietzsche’s remarks on elite education with W.E.B. Du Bois’ demand for democratized education. The essay takes their remarks as springboards for a twenty-first century philosophy of education rather than an historical account of their philosophies. Both thinkers cultivated Kant and Hegel’s dream that the spirit of freedom guided by reason would unite all the world’s peoples. Both held that education was key to realizing the dream. Their judgments about qualifying for education separated them. Nietzsche insisted that only the elite should receive the fullest measure of education. Du Bois believed that in the future virtually every human being would receive a university-level education. The essay’s principal point is to show how contemporary technology can make Du Bois’ dream a reality. An African philosopher’s working model demonstrates a path to universal university education.
Sensitivity of two SARS-CoV-2 variants with spike protein mutations to neutralising antibodies
Authors: Müller Katharina , Girl Philipp , Giebl Andreas , Gruetzner Stefanie , Antwerpen Markus , Khatamzas Elham , Wölfel Roman , von Buttlar Heiner
Published: October 2021

SARS-CoV-2 infections elicit a humoral immune response capable of neutralising the virus. However, multiple variants have emerged with mutations in the spike protein amongst others, the key target of neutralising antibodies. We evaluated the neutralising efficacy of 89 serum samples from patients, infected with SARS-CoV-2 in the beginning of 2020, against two virus variants isolated from acutely infected patients and harbouring spike protein mutations. One isolate was assigned to lineage B.1.351 (MUC-IMB-B.1.351) whilst the other (MUC-484) was isolated from an immunocompromised patient, sharing some but not all mutations with B.1.351 and representing a transitional variant. Both variants showed a significant reduction in neutralisation sensitivity compared to wild-type SARS-CoV-2 with MUC-IMB-B.1.351 being almost completely resistant to neutralisation. The observed reduction in neutralising activity of wild-type-specific antibodies against both variants suggests that individual mutations in the spike protein are sufficient to confer a potent escape from the humoral immune response. In addition, the effect of escape mutations seems to accumulate, so that more heavily mutated variants show a greater loss of sensitivity to neutralisation up to complete insensitivity as observed for MUC-IMB-B.1.351. From a clinical point of view, this might affect the efficacy of (monoclonal) antibody treatment of patients with prolonged infections as well as patients infected with variants other than the donor. At the same, this could also negatively influence the efficacy of current vaccines (as they are based on wild-type spike protein) emphasising the need to thoroughly surveil the emergence and distribution of variants and adapt vaccines and therapeutics accordingly.
Head-to-head comparison of FNA cytology vs. calcitonin measurement in FNA washout fluids (FNA-CT) to diagnose medullary thyroid carcinoma. A systematic review and meta-analysis
Authors: Trimboli Pierpaolo , Giannelli Jacopo , Marques Bernardo , Piccardo Arnoldo , Crescenzi Anna , Deandrea Maurilio
Published: October 2021

Purpose

The sensitivity of cytology after fine needle aspiration (FNA-cytology) in detecting medullary thyroid carcinoma (MTC) is low. To overcome this problem, measuring calcitonin (CT) in washout fluid of FNA (FNA-CT) has been largely diffused and showed good performance. However, no evidence-based study exists comparing systematically the sensitivity of FNA-cytology and FNA-CT. This study aimed to systematically review the literature and collect data allowing a head-to-head comparison meta-analysis between FNA-cytology and FNA-CT in detecting MTC lesions.

Methods

The online databases of PubMed/MEDLINE and Scopus were searched until June 2021. Original articles reporting the use of both FNA-cytology and FNA-CT in the same series of histologically proven MTC lesions were included They were extracted general features of each study, number of MTC lesions (nodule and neck lymph nodes), and true positive and false negatives of both FNA-cytology and FNA-CT.

Results

Six studies were included. The sensitivity of FNA-cytology varied from 20% to 86% with a pooled value of 54% (95% CI 35–73%) and significant heterogeneity. The sensitivity of FNA-CT was higher than 95% in almost all studies with a pooled value of 98% (95% CI 96–100%) without heterogeneity. The sensitivity of FNA-CT was significantly higher than that of FNA-cytology.

Conclusions

FNA-CT is significantly more sensitive than FNA-cytology in detecting MTC. Accordingly, FNA-CT represents the standard method to use in patients with suspicious MTC lesions, combined with cytology.
Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden
Authors: Axfors Cathrine , Iliadis Stavros I. , Rasmusson Lovisa L. , Beckman Ulrika , Fazekas Attila , Frisén Louise , Sandström Lotta , Thelin Nils , Wahlberg Jeanette , Skalkidou Alkistis , Papadopoulos Fotios C.
Published: October 2021

Introduction

Gender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.

Methods

Cross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.

Results

The proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.

Conclusions

In this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.

Policy Implications

The study findings underline the need for individualized care and flexible gender affirming treatment options. The role of somatic comorbidities should be further explored, and support should be offered to transgender people in need. There is an unmet need for facial surgery among aM.
Suicide ideation and psychosocial distress among refugee adolescents in Bidibidi settlement in West Nile, Uganda
Authors: Bukuluki Paul , Kisaakye Peter , Wandiembe Symon Peter , Besigwa Samuel
Published: October 2021

This study investigated the factors associated with suicidal ideation and psychological distress among Sudanese refugees (aged 10–19 years) in Bidibidi refugee settlement, Yumbe district, Uganda. The analysis is based on cross-sectional data collected as part of the implementation of a project on sexual and reproductive health in Bidibidi refugee settlement. Data were collected from 284 South Sudanese adolescents in July 2020. We estimated the prevalence of psychological distress and suicidal ideation, and their associated profiles. Odds ratios and their 95% Confidence Intervals based on a logistic regression model were used to assess the effect of different potential factors on the risk profiles for suicidal ideation and psychological distress. The prevalence of psychological distress (on KS-6 scale) was estimated to be 12.3% (95%CI: 8.7, 16.7%). The risk for psychological distress is low among male adolescents (AOR = 0.51; 95%CI: 0.23, 1.02), older adolescents, (AOR = 0.12; 95%CI: 0.04, 0.40), and adolescents with a friend or family members they can confide in (AOR = 0.33; 95%CI: 0.11, 0.96). Both suicidal ideation and psychological distress are very high among the female adolescents. Familial and individual interventions can be potentially useful for female adolescents who have a high risk of suicide and psychological distress.
A meta-synthesis of the use of activity theory in design for sustainable behaviour
Authors: Chu Wanjun , Glad Wiktoria , Wever Renee
Published: October 2021

Over the past decade, the field of design for sustainable behaviour (DfSB) has gained a growing amount of research interest. However, as the field evolves, new challenges also arise. A suitable unit of analysis is needed to contextualize users’ behaviour issues in a broader socio-cultural and long-term perspective. This paper explores the use of activity theory (AT) as a potential lens for guiding empirical analysis and design exploration in DfSB. By employing a meta-synthesis approach, we systematically search and synthesize existing studies that adopted AT in design for sustainability. Key findings show that AT’s principles and theoretical implications are especially useful for helping design researchers frame and address DfSB challenges. We argue that by taking activity as the unit of analysis, the AT lens can enable researchers to incorporate users’ dynamic, multi-level and complex activity systems into DfSB considerations.
Effect of surfactants on the long-wave stability of two-layer oscillatory film flow
Authors: Wang Cheng-Cheng , Huang Haibo , Gao Peng , Lu Xi-Yun
Published: October 2021

The stability of the two-layer film flow driven by an oscillatory plate under long-wave disturbances is studied. The influence of key factors, such as thickness ratio (

$n$

), viscosity ratio (

$m$

), density ratio (

$r$

), oscillatory frequency (

$\beta$

) and insoluble surfactants on the stability behaviours is studied systematically. Four special Floquet patterns are identified, and the corresponding growth rates are obtained by solving the eigenvalue problem of the fourth-order matrix. A small viscosity ratio (

$m\le 1$

) may stabilize the flow but it depends on the thickness ratio. If the viscosity ratio is not very small (

$m>0.1$

), in the

$(\beta ,n)$

-plane, stable and unstable curved stripes appear alternately. In other words, under the circumstances, if the two-layer film flow is unstable, slightly adjusting the thickness of the upper film may make it stable. In particular, if the upper film is thin enough, even under high-frequency oscillation, the flow is always stable. The influence of density ratio is similar, i.e. there are curved stable and unstable stripes in the

$(\beta ,r)$

-planes. Surface surfactants generally stabilize the flow of the two-layer oscillatory membrane, while interfacial surfactants may stabilize or destabilize the flow but the effect is mild. It is also found that gravity can generally stabilize the flow because it narrows the bandwidth of unstable frequencies.
“A Book One Can with Complete Confidence Call Important”: Albert Erskine, Ralph Ellison, and the Publishing of Invisible Man
Authors: KING DANIEL ROBERT
Published: October 2021

In this article I examine the editing and publishing of Ralph Ellison's Invisible Man by Albert Erskine. Over the course of the piece, I deploy letters, drafts, and other material drawn from both Ellison's archive in the Library of Congress and Erskine's own archive at the University of Virginia to unpack how Erskine, as a white editor at a powerful international publishing house, conceived of his role in shepherding to market and marketing what he saw as a major literary work by an African American author.
Provincialising International Relations through a reading of dharma
Authors: Shani Giorgio , Behera Navnita Chadha
Published: October 2021

This article will attempt to ‘provincialise’ (Chakrabarty, 2000) the ‘secular cosmology’ of International Relations (IR) through an examination of the relational cosmology of dharma. We argue that IR is grounded in ‘secularised’ Judaeo-Christian assumptions concerning time, relations between self and other, order, and the sovereign state that set the epistemic limits of the discipline. These assumptions will be ‘provincialised’ through an engagement with dharma based on a reading of The Mahābharāta, one of the oldest recorded texts in the world. We argue that the concept of dharma offers a mode of understanding the multidimensionality of human existence without negating any of its varied, contradictory expressions. By deconstructing notions of self and other, dharma illustrates how all beings are related to one another in a moral, social, and cosmic order premised on human agency, which flows from ‘inside-out’ rather than ‘outside-in’ and that is governed by a heterogenous understanding of time. This order places limits on the state's exercise of power in a given territory by making the state responsible for creating social conditions that would enable all beings to realise their potential, thus qualifying the principle of state sovereignty that remains the foundation of the ‘secular cosmology of IR’.
From conflict to complementarity: Reconciling international counterterrorism law and international humanitarian law
Authors: Saul Ben
Published: October 2021

This article clarifies the ongoing confusion in doctrine and practice about both the actual and optimal interaction between international counterterrorism law (CTL) and international humanitarian law (IHL) in armed conflict. It discusses the advantages and disadvantages of the co-application of CTL with IHL, before considering a variety of techniques for mutually accommodating the interests of both regimes, particularly through partial exclusion clauses in counterterrorism instruments or laws. It concludes by identifying the optimal approach to the relationship between CTL and IHL, which recognizes the legitimate interests of both fields of law while minimizing the adverse impacts of each on the other.
Inhibition of USP28 overcomes Cisplatin-resistance of squamous tumors by suppression of the Fanconi anemia pathway
Authors: Prieto-Garcia Cristian , Hartmann Oliver , Reissland Michaela , Fischer Thomas , Maier Carina R. , Rosenfeldt Mathias , Schülein-Völk Christina , Klann Kevin , Kalb Reinhard , Dikic Ivan , Münch Christian , Diefenbacher Markus E.
Published: October 2021

Squamous cell carcinomas (SCC) frequently have an exceptionally high mutational burden. As consequence, they rapidly develop resistance to platinum-based chemotherapy and overall survival is limited. Novel therapeutic strategies are therefore urgently required. SCC express ∆Np63, which regulates the Fanconi Anemia (FA) DNA-damage response in cancer cells, thereby contributing to chemotherapy-resistance. Here we report that the deubiquitylase USP28 is recruited to sites of DNA damage in cisplatin-treated cells. ATR phosphorylates USP28 and increases its enzymatic activity. This phosphorylation event is required to positively regulate the DNA damage repair in SCC by stabilizing ∆Np63. Knock-down or inhibition of USP28 by a specific inhibitor weakens the ability of SCC to cope with DNA damage during platin-based chemotherapy. Hence, our study presents a novel mechanism by which ∆Np63 expressing SCC can be targeted to overcome chemotherapy resistance. Limited treatment options and low response rates to chemotherapy are particularly common in patients with squamous cancer. The SCC specific transcription factor ∆Np63 enhances the expression of Fanconi Anemia genes, thereby contributing to recombinational DNA repair and Cisplatin resistance. Targeting the USP28-∆Np63 axis in SCC tones down this DNA damage response pathways, thereby sensitizing SCC cells to cisplatin treatment.
Biological functions and clinical significance of long noncoding RNAs in bladder cancer
Authors: Zhang Yan , Chen Xianwu , Lin Juntao , Jin Xiaodong
Published: October 2021

Bladder cancer (BCa) is one of the 10 most common cancers with high morbidity and mortality worldwide. Long noncoding RNAs (lncRNAs), a large class of noncoding RNA transcripts, consist of more than 200 nucleotides and play a significant role in the regulation of molecular interactions and cellular pathways during the occurrence and development of various cancers. In recent years, with the rapid advancement of high-throughput gene sequencing technology, several differentially expressed lncRNAs have been discovered in BCa, and their functions have been proven to have an impact on BCa development, such as cell growth and proliferation, metastasis, epithelial-mesenchymal transition (EMT), angiogenesis, and drug-resistance. Furthermore, evidence suggests that lncRNAs are significantly associated with BCa patients’ clinicopathological characteristics, especially tumor grade, TNM stage, and clinical progression stage. In addition, lncRNAs have the potential to more accurately predict BCa patient prognosis, suggesting their potential as diagnostic and prognostic biomarkers for BCa patients in the future. In this review, we briefly summarize and discuss recent research progress on BCa-associated lncRNAs, while focusing on their biological functions and mechanisms, clinical significance, and targeted therapy in BCa oncogenesis and malignant progression.
Risks and rewards of increasing patient access to medical records in clinical ophthalmology using OpenNotes
Authors: Radell Jake E. , Tatum Jasmine N. , Lin Chen-Tan , Davidson Richard S. , Pell Jonathan , Sieja Amber , Wu Albert Y.
Published: October 2021

Background

The implementation of OpenNotes and corresponding increase in patient access to medical records requires thorough assessment of the risks and benefits of note-sharing. Ophthalmology notes are unique among medical records in that they extensively utilize non-standardized abbreviations and drawings; they are often indecipherable even to highly-educated clinicians outside of ophthalmology. No studies to date have assessed ophthalmologist perceptions of OpenNotes.

Methods

A cross-sectional study was conducted from 4/28 to 5/12/2016. A survey was distributed to 30 clinicians (25 ophthalmologists, three optometrists, two nurses) in the University of Colorado’s Department of Ophthalmology to evaluate provider attitudes towards granting patients access to online medical records.

Results

Many clinicians felt patients would have difficulty understanding their records and may be unnecessarily alarmed or offended by them. Some clinicians worried their workload would increase and feared having to change the way they document. Perceived benefits of OpenNotes included improving patient understanding of their medical conditions, strengthening patient–physician trust, and enhancing patient care. Many perceived risks and benefits of note-sharing were associated with conceptions of the ideal clinician–patient relationship.

Conclusions

Clinicians in ophthalmology perceived both benefits and consequences of increasing patient access to ophthalmic records, and there were significant correlations between these perceptions and their conceptions of the clinician–patient relationship. This is the first study to assess potential ophthalmology provider attitudes toward sharing ophthalmic records. Although limited in sample size and power, this study demonstrates some ways patient-accessible ophthalmic records can affect the clinical practice of ophthalmology and emphasizes the unique challenges of OpenNotes in ophthalmology.