bluuebunny/crossref_metadata_2025 huggingface dataset:
Who reports insufficient and disturbed sleep? Results from a representative population-based health survey in Hong Kong
Authors: Bedford Laura Elizabeth , Tang Eric Ho Man , Dong Weinan , Wong Carlos King Ho , Tse Emily Tsui Yee , Ng Amy Pui Pui , Cheung Bernard Man Yung , Wu Tingting , Yu Esther Yee Tak , Lam Cindy Lo Kuen
Published: September 2022

Objectives

To highlight the prevalence of sleep problems and identify associated risk factors among a representative sample recruited from the general population of Hong Kong.

Design, setting and participants

Participants included 12 022 individuals (aged 15 or above) who took part in the Population Health Survey 2014/15, a territory-wide survey conducted by the Department of Health of the Government of the Hong Kong Special Administrative Region.

Primary and secondary outcome measures

Outcomes were the prevalence of (1) insufficient sleep (<6 hours sleep per day) and (2) any sleep disturbance (difficulty initiating sleep, intermittent awakenings, early awakening) ≥3 times per week in the past 30 days. Multivariable logistic regression identified associations between sleep problems and sociodemographic, clinical and lifestyle factors.

Results

9.7% of respondents reported insufficient sleep and 10.5% reported sleep disturbances ≥3 times a week. Female gender, monthly household income <$12 250 (Hong Kong dollar), lower education level, mental health condition and physical health condition were significantly associated with both insufficient and disturbed sleep (all p<0.05). Unemployment, homemaker, insufficient physical activity, current/former smoking status and harmful alcohol consumption were associated with sleep disturbances only (all p<0.01).

Conclusions

Sleep problems are highly prevalent in Hong Kong. As such problems are associated with a range of health conditions, it is important to facilitate improvements in sleep. Our results show that harmful alcohol consumption, insufficient physical activity and current smoking are modifiable risk factors for sleep disturbances. Public health campaigns should focus on these risk factors in order to promote a healthy lifestyle and ultimately reduce sleep disturbances. Targeted interventions for high-risk groups may also be warranted, particularly for those with doctor-diagnosed physical and mental health conditions.
Understanding the widespread use of veterinary ivermectin for Chagas disease, underlying factors and implications for the COVID-19 pandemic: a convergent mixed-methods study
Authors: Apodaca Michel Boris , Navarro Miriam , Pritsch Michael , Du Plessis Jeremy Douglas , Shock Jonathan , Schwienhorst-Stich Eva-Maria , Zirkel Janina , Schrader Hanna , Saavedra Irala Claudia , Rubilar Gonzalo , Gunesch Carolin , Kasang Christa , Zoller Thomas , Gagyor Ildiko , Parisi Sandra
Published: September 2022

Objectives

Veterinary ivermectin (vet-IVM) has been used widely in Latin America against COVID-19, despite the lack of scientific evidence and potential risks. Widespread vet-IVM intake was also discovered against Chagas disease during a study in Bolivia prior to the pandemic. All vet-IVM-related data were extracted to understand this phenomenon, its extent and underlying factors and to discuss potential implications for the current pandemic.

Design

A convergent mixed-methods study design including a survey, qualitative in-depth interviews (IDI) and focus group discussions (FGD).

Setting

A cross-sectional study conducted in 2018 covering the geographic area of Monteagudo, an endemic municipality for Chagas disease.

Participants

A total of 669 adult household representatives from 26 communities participated in the survey, supplemented by 14 IDI and 2 FGD among patients, relatives and key informants.

Results

9 IDI and 2 FGD contained narratives on vet-IVM use against Chagas disease. Five main themes emerged: (1) the extent of the vet-IVM phenomenon, (2) the perception of vet-IVM as a treatment for Chagas disease, (3) the vet-IVM market and the controversial role of stakeholders, (4) concerns about potential adverse events and (5) underlying factors of vet-IVM use against Chagas disease.

In quantitative analysis, 28% of participants seropositive for Chagas disease had taken vet-IVM. Factors associated with multivariate analysis were advanced age (OR 17.01, 95 CI 1.24 to 36.55, p=0.027 for age above 60 years), the experience of someone close as information source (OR 3.13, 95 CI 1.62 to 5.02, p<0.001), seropositivity for Chagas disease (OR 3.89, 95 CI 1.39 to 6.20, p=0.005) and citing the unavailability of benznidazole as perceived healthcare barrier (OR 2.3, 95 CI 1.45 to 5.18, p=0.002). Participants with an academic education were less likely to report vet-IVM intake (OR 0.12, 95 CI 0.01 to 0.78, p=0.029).

Conclusions

Social determinants of health, the unavailability of treatment and a wonder drug image might contribute to the phenomenon of vet-IVM.
Prophylactic treatment of breast implants with a solution of gentamicin, vancomycin and cefazolin antibiotics for women undergoing breast reconstructive surgery: protocol for a randomised, double-blind, placebo-controlled trial (The BREAST-AB trial)
Authors: Hemmingsen Mathilde Nejrup , Larsen Andreas , Weltz Tim K , Ørholt Mathias , Wiberg Sebastian , Bennedsen Anne Karen , Bille Camilla , Carstensen Lena Felicia , Jensen Lisa Toft , Bredgaard Rikke , Koudahl Vibeke , Schmidt Volker Jürgen , Vester-Glowinski Peter , Hölmich Lisbet Rosenkrantz , Sørensen Søren J , Bjarnsholt Thomas , Damsgaard Tine , Herly Mikkel
Published: September 2022

Introduction

Periprosthetic infection is one of the most severe complications following implant-based breast reconstruction affecting 5%–10% of the women. Currently, many surgeons apply antibiotics locally on the breast implant to reduce the risk of postoperative infection, but no randomised, placebo-controlled trials have tested the treatment’s efficacy.

Methods and analysis

The BREAST-AB trial (BREAST-AntiBiotics) is an investigator-initiated, multicentre, randomised, placebo-controlled, double-blind trial of local treatment with gentamicin, vancomycin and cefazolin on breast implants in women undergoing implant-based breast reconstruction. The trial drug consists of 80 mg gentamicin, 1 g vancomycin and 1 g cefazolin dissolved in 500 mL of isotonic saline. The placebo solution consists of 500 mL isotonic saline. The trial drug is used to wash the dissected tissue pocket and the breast implant prior to insertion. The primary outcome is all-cause explantation of the breast implant within 180 days after the breast reconstruction surgery. This excludes cases where the implant is replaced with a new permanent implant, for example, for cosmetic reasons. Key long-term outcomes include capsular contracture and quality of life. The trial started on 26 January 2021 and is currently recruiting.

Ethics and dissemination

The trial was approved by the Regional Ethics Committee of the Capital Region (H-20056592) on 1 January 2021 and the Danish Medicines Agency (2020070016) on 2 August 2020. The main paper will include the primary and secondary outcomes and will be submitted to an international peer-reviewed journal.

Trial registration number

NCT04731025.
Development and appropriateness of a scoring method for International Classification of Functioning, Disabilities, and Health assessment in older patients with heart failure: a Delphi survey of expert panel in Japan
Authors: Shiota Shigehito , Kitagawa Toshiro , Goto Naoya , Fujisita Hironori , Tamekuni Yurika , Nakayama Susumu , Mio Naoki , Kanai Kana , Naka Makiko , Yamaguchi Mizuho , Mochizuki Mariko , Ochikubo Hiroyuki , Hidaka Takayuki , Yasunobu Yuji , Nakano Yukiko , Kihara Yasuki , Kimura Hiroaki
Published: September 2022

Objective

The number of older patients with heart failure (HF) is increasing in Japan and has become a social problem. There is an urgent need to develop a comprehensive assessment methodology based on the common language of healthcare; the International Classification of Functioning, Disability and Health (ICF). The purpose of this study was to develop and confirm the appropriateness of a scoring methodology for 43 ICF categories in older people with HF.

Design

Cross-sectional survey. We applied the RAND/University of California at Los Angeles (UCLA) Appropriateness Method with a modified Delphi method.

Setting and participants

We included a panel of 26 multidisciplinary experts on HF care consisting of home physicians, cardiovascular physicians, care managers, nurses, physical therapists, a pharmacist, occupational therapist, nutritionist and a social worker.

Measures

We conducted a literature review of ICF linking rules and developed a questionnaire on scoring methods linked to ICF categories in older people with HF. In the Delphi rounds, we sent the expert panel a questionnaire consisting of three questions for each of the 43 ICF categories. The expert panel responded to the questionnaire items on a 1 (very inappropriate) – 9 (very appropriate) Likert scale and repeated rounds until a consensus of ‘Appropriate’ and ‘Agreement’ was reached on all items.

Results

A total of 21 panel members responded to all the Delphi rounds. In the first Delphi round, six question items in four ICF categories did not reach a consensus of ‘Agreement’, but the result of our modifications based on panel members’ suggestions reached to a consensus of ‘Appropriate’ and ‘Agreement’ on all questions in the second Delphi round.

Conclusion

The ICF-based scoring method for older people with HF developed in this study was found to be appropriate. Future work is needed to clarify whether comprehensive assessment and information sharing based on ICF contributes to preventing readmissions.
What are the mental health changes associated with the COVID-19 pandemic in people with medical conditions? An international survey
Authors: Modarresi Shirin , Seens Hoda , Hussain Uzair , Fraser James , Boudreau Jacob , MacDermid Joy
Published: September 2022

Objectives

The COVID-19 pandemic has negatively impacted mental health worldwide but there is paucity of knowledge regarding the level of change in mental health in people with a medical condition (physical/psychiatric). The objectives of this study were (1) to compare the change in mental health in people with and without medical conditions, (2) to assess the change in various types of medical conditions, (3) to evaluate the association between change in mental health and number of comorbidities, and (4) to investigate the influence of receiving treatment and activity limitation imposed by the medical condition(s).

Design

Cross-sectional.

Setting

Online international survey.

Participant

English-speaking adults (age ≥18) were included in the study, with no exclusions based on sex/gender or location. 1276 participants (mean age 30.4, 77.7% female) were included.

Primary and secondary outcome measures

Pre and during COVID-19 pandemic symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9) were assessed. The Self-Administered Comorbidity Questionnaire was used to collect data regarding medical conditions.

Repeated-measures analysis of covariance (objectives 1, 2 and 4) and Pearson’s correlation coefficient (objective 3).

Results

50.1% of participants had a medical condition. During the COVID-19 pandemic, compared with people with no medical condition, people with both psychiatric and physical conditions experienced significantly higher symptoms of anxiety (12%, p=0.009) and depression (9.4%, p<0.001). Although not statistically significant, the increase in anxiety and depression occurred across seven major categories of conditions. An association was found between having a higher number of medical conditions with higher anxiety and depression symptoms (r=0.16 anxiety, r=0.14 depression, p<0.001). Receiving treatment and being functionally limited by the disease did not have a significant impact on the amount of change (p>0.05).

Conclusions

During the COVID-19 pandemic, people who had a combination of psychiatric and physical conditions experienced greater symptoms of anxiety and depression. Patients with chronic diseases may need extra support to address their mental health as a result of the pandemic.
Feasibility and acceptability of a mobile model of environmental enrichment for patients with mixed medical conditions receiving inpatient rehabilitation: a mixed methods study
Authors: Fulton Sarah , Janssen Heidi , Salih Salih , James Alecia , Elphinston Rachel A
Published: September 2022

Objectives

To investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation.

Design

A mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events.

Setting

A 30-bed mixed medical ward in a public hospital that services Brisbane’s southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards.

Participants

Nursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited.

Interventions

The mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards.

Results

Four themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported.

Conclusions

As interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.
Synergism between the metabolic syndrome components and cancer incidence: results from a prospective nested case–control study based on the China Health and Retirement Longitudinal Study (CHARLS)
Authors: Li Lin , Meng Fang , Xu Dongkui , Xu Lingkai , Qiu Junlan , Shu Xiaochen
Published: September 2022

Objectives

Synergism between the metabolic syndrome (MetSyn) components and cancer incidence still remains inconclusive. We aimed to investigate the unique or joint role of MetSyn components in cancer onset.

Design

We conducted a prospective nested case–control study based on the China Health and Retirement Longitudinal Study.

Setting

An ongoing national representative longitudinal study included follow-up survey of people aged 45 years and older and their partners living in private households in China.

Participants

There were 17 708 individuals included at baseline. A total of 306 incident cancers was identified during the follow-up. For every case, we used incidence-density sampling to match three concurrent cancer-free controls by age, sex, and both duration and calendar time of follow-up. Exposure of interest was any MetSyn diagnosis at baseline.

Results

We observed elevation in cancer risk associated with MetSyn in a significant way when the number of MetSyn components was over three (OR: 1.88; 95% CI: 1.19 to 2.97), or when components contained any of elevated triglycerides (OR: 1.61; 95% CI: 1.05 to 2.48), reduced high-density lipoprotein (HDL) cholesterol (OR: 2.33; 95% CI: 1.40 to 3.86) or elevated blood pressure (OR: 1.65; 95% CI: 1.04 to 2.59) after consistent multiple adjustments in different models. The highest cancer risk was in the female reproductive system and breast cancer (OR: 4.22; 95% CI: 1.62 to 10.95) followed by digestive system (OR: 1.67; 95% CI: 1.11 to 2.53). Sensitivity analyses showed similar results after first follow-up was excluded. However, any unique MetSyn component was not associated with increased cancer risk. Interestingly, the reduced HDL was observed to be widely associated with over twofold increased risk of cancer, only when together with other MetSyn components.

Conclusion

MetSyn components, in a collaborative manner rather than its unique component, were associated with elevated cancer risk. Not only obesity but even subtle metabolic disturbances may give rise to cancer.
Minimal disease activity and remission in patients with psoriatic arthritis with elevated body mass index: an observational cohort study in the Swiss Clinical Quality Management cohort
Authors: Vallejo-Yagüe Enriqueta , Burkard Theresa , Micheroli Raphael , Burden Andrea Michelle
Published: September 2022

Objective

To assess the impact of elevated body mass index (BMI) in the achievement of minimal disease activity (MDA) and several definitions of remission in patients with psoriatic arthritis (PsA) in Switzerland. Secondarily, to assess the overlapping across the study outcomes.

Methods

This observational cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included patients with PsA starting their first biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) from 1997 to 30 June 2018. Exposure was BMI category at b/tsDMARD start: overweight, obese, and normal weight (reference). Logistic regression was used to assess the achievement of MDA and remission at ≤12 months, as well as treatment persistence at 1 year, in overweight patients and patients with obesity compared with the normal weight group. Remission was defined by Disease Activity for Psoriatic Arthritis (DAPSA), clinical DAPSA (cDAPSA) and 28-joint Disease Activity Score (DAS28). Additionally, overlapping across study outcomes was investigated.

Results

The study included 306 (39.5%) normal weight patients, 285 (36.8%) overweight patients and 183 (23.6%) patients with obesity. Compared with the normal weight group, patients with obesity had lower odds of achieving MDA at ≤12 months (adjusted OR (ORadj) 0.45, 95% CI 0.24 to 0.82). This was consistent with the observed reduced odds of achieving DAPSA-remission (ORadj 0.42, 95% CI 0.21 to 0.85), cDAPSA-remission (ORadj 0.51, 95% CI 0.27 to 0.96) and DAS28-remission (ORadj 0.51, 95% CI 0.32 to 0.81) in patients with obesity versus normal weight patients. Among the 125 patients achieving MDA, the majority (81.8% normal weight, 80.0% overweight, 78.9% obese) achieved cDAPSA-remission. No differences were observed in the odds to achieving treatment persistence between the BMI strata.

Conclusions

Obesity halved the likelihood of achieving MDA and remission in patients with PsA with b/tsDMARDs compared with those with normal weight, while it did not impact treatment persistence. High overlapping of patients achieving the outcomes MDA and cDAPSA-remission was observed across every BMI group.
Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)
Authors: Kawakatsu Yoshito , Adolph Christopher , Mosser Jonathan F , Baffoe Peter , Cheshi Fatima , Aiga Hirotsugu , Watkins David , Sherr Kenneth H
Published: September 2022

Objective

This study aims to identify the individual and contextual factors consistently associated with utilisation of essential maternal and child health services in Nigeria across time and household geolocation.

Design, setting and participants

Secondary data from five nationally representative household surveys conducted in Nigeria from 2003 to 2018 were used in this study. The study participants are women and children depending on essential maternal and child health (MCH) services.

Outcome measures

The outcome measures were indicators of whether participants used each of the following essential MCH services: antenatal care, facility-based delivery, modern contraceptive use, childhood immunisations (BCG, diphtheria, tetanus, pertussis/Pentavalent and measles) and treatments of childhood illnesses (fever, cough and diarrhoea).

Methods

We estimated generalised additive models with logit links and smoothing terms for households’ geolocation and survey years.

Results

Higher maternal education and households’ wealth were significantly associated with utilisation of all types of essential MCH services (p<0.05). On the other hand, households with more children under 5 years of age and in poor communities were significantly less likely to use essential MCH services (p<0.05). Except for childhood immunisations, greater access to transport was positively associated with utilisation (p<0.05). Households with longer travel times to the most accessible health facility were less likely to use all types of essential MCH services (p<0.05), except modern contraceptive use and treatment of childhood fever and/or cough.

Conclusion

This study adds to the evidence that maternal education and household wealth status are consistently associated with utilisation of essential MCH services across time and space. To increase utilisation of essential MCH services across different geolocations, interventions targeting poor communities and households with more children under 5 years of age should be appropriately designed. Moreover, additional interventions should prioritise to reduce inequities of essential MCH service utilisation between the wealth quantiles and between education status.
Short-term outcomes and intermediate-term follow-up ofHelicobacter pyloriinfection treatment for naïve patients: a retrospective observational study
Authors: Wang Yujing , Xiang Yu , Liao Oulan , Wu Yaoyi , Li Yan , Du Qin , Ye Jun
Published: September 2022

Objectives

To explore the outcomes ofHelicobacter pyloriinfection treatments for naïve patients in the real-world settings.

Design

A retrospective observational study.

Setting

Single tertiary level academic hospital in China.

Participants

We identified patients initially receiving quadruple therapy forH. pyloriinfection from 2017 to 2020 in whom eradication was confirmed (n=23 470).

Primary outcome

Efficacy of different initialH. pyloriinfection treatments.

Secondary outcome

Results of urea breath test (UBT) afterH. pylorieradication.

Results

Among 23 470 patients who received initialH. pyloritreatment, 21 285 (90.7%) were treated with amoxicillin-based regimens. The median age of the patients decreased from 2017 to 2020 (45.0 vs 39.0, p<0.0001). The main treatments were therapies containing amoxicillin and furazolidone, which had an eradication rate of 87.6% (14 707/16 784); those containing amoxicillin and clarithromycin had an eradication rate of 85.5% (3577/4182). The date of treatment, age, antibiotic regimen and duration of treatment showed correlations with the failure ofH. pylorieradication in a multivariable logistic regression analysis. Finally, positive UBT results after eradication clustered around the cut-off value, in both the13C-UBT and14C-UBT.

Conclusions

The majorH. pyloriinfection treatments for naïve patients were those containing amoxicillin and furazolidone, which offered the highest eradication rate. The date of treatment, age, antibiotic regimen and duration of treatment were risk factors for the failure ofH. pylorieradication. Additionally, positive UBT results after eradication clustered around the cut-off value.
mSep: investigating physiological and immune-metabolic biomarkers in septic and healthy pregnant women to predict feto-maternal immune health – a prospective observational cohort study protocol
Authors: Sharma Simran , Zaher Summia , Rodrigues Patrícia R S , Davies Luke C , Edkins Sarah , Strang Angela , Chakraborty Mallinath , Watkins W John , Andrews Robert , Parkinson Edward , Angelopoulos Nicos , Moet Linda , Shepherd Freya , Davies Kate Megan Megan , White Daniel , Oram Shaun , Siddall Kate , Keeping Vikki , Simpson Kathryn , Faggian Federica , Bray Maryanne , Bertorelli Claire , Bell Sarah , Collis Rachel E , McLaren James E , Labeta Mario , O’Donnell Valerie B , Ghazal Peter
Published: September 2022

Introduction

Maternal sepsis remains a leading cause of death in pregnancy. Physiological adaptations to pregnancy obscure early signs of sepsis and can result in delays in recognition and treatment. Identifying biomarkers that can reliably diagnose sepsis will reduce morbidity and mortality and antibiotic overuse. We have previously identified an immune-metabolic biomarker network comprising three pathways with a >99% accuracy for detecting bacterial neonatal sepsis. In this prospective study, we will describe physiological parameters and novel biomarkers in two cohorts—healthy pregnant women and pregnant women with suspected sepsis—with the aim of mapping pathophysiological drivers and evaluating predictive biomarkers for diagnosing maternal sepsis.

Methods and analysis

Women aged over 18 with an ultrasound-confirmed pregnancy will be recruited to a pilot and two main study cohorts. The pilot will involve blood sample collection from 30 pregnant women undergoing an elective caesarean section. Cohort A will follow 100 healthy pregnant women throughout their pregnancy journey, with collection of blood samples from participants at routine time points in their pregnancy: week 12 ‘booking’, week 28 and during labour. Cohort B will follow 100 pregnant women who present with suspected sepsis in pregnancy or labour and will have at least two blood samples taken during their care pathway. Study blood samples will be collected during routine clinical blood sampling. Detailed medical history and physiological parameters at the time of blood sampling will be recorded, along with the results of routine biochemical tests, including C reactive protein, lactate and white blood cell count. In addition, study blood samples will be processed and analysed for transcriptomic, lipidomic and metabolomic analyses and both qualitative and functional immunophenotyping.

Ethics and dissemination

Ethical approval has been obtained from the Wales Research Ethics Committee 2 (SPON1752-19, 30 October 2019).

Trial registration number

NCT05023954.
Systems approach to enhance Lynch syndrome diagnosis through tumour testing
Authors: Singh Vinit , Mezzacappa Catherine , Gershkovich Peter , Di Giovanna Jessica , Ganzak Amanda , Gibson Joanna , Sinard John , Xicola Rosa M , Llor Xavier
Published: September 2022

Background

Guidelines recommend universal mismatch repair (MMR) tumour testing of colorectal adenocarcinomas (CRCs) to screen for Lynch syndrome (LS). However, its implementation remains disjointed and referral for genetic testing dismal, particularly among minorities. We aimed to increase referral, cancer genetic testing and eventually LS diagnosis by developing the CLEAR LS (Closed Loop Enhanced Assessment and Referral for Lynch Syndrome) intervention, a systems approach which in the second phase was automated.

Methods

This is a cohort study of all patients diagnosed with CRC at an academic centre between 1 January 2012, when implementation of universal CRC testing began, and 31 January 2021. The original cohort spanned through 31 May 2015. Tumour testing included MMR immunohistochemistry, followed byBRAFV600E/MLH1promoter methylation testing when indicated. The intervention included a manual phase (1 June 2015 through 31 July 2018), which systematised pathology screening and cancer genetics (CG) referral mechanisms, and an automated phase (1 August 2018 through 31 January 2021) using computer programming.

Results

A total of 249/1541 CRC (17.38%) had MMR loss of expression and 129 (8.37%) qualified for CG evaluation. Referral was 27.58% in the original cohort and 92.1% in the intervention (p<0.001). Patients seen by CG among referred were 27.58% in the original cohort and 74.3% in the intervention (p two-sided<0.001). The distribution of race/ethnicity among patients qualifying and referred for CG evaluation was not significantly different across cohorts. LS diagnosis increased from 0.56% (original cohort) to 1.43% (intervention). Cost per new diagnosis of LS decreased from US$173 675 to $87 960 from original cohort to intervention.

Conclusion

Implementation of systematic case identification and referral support mechanisms significantly increased the proportion of patients undergoing genetic testing and doubled the percentage of patients diagnosed with LS with no referral differences across racial/ethnic groups.
New wormhole models with stability analysis via thin-shell in teleparallel gravity
Authors: Javed Faisal , Mumtaz Saadia , Mustafa G. , Hussain Ibrar , Liu Wu-Ming
Published: September 2022

This study explores new wormhole solutions in the background of teleparallel gravity. All the energy conditions are investigated for two different new calculated shape functions. The presence of exotic matter is confirmed due to the violation of the energy conditions. Thin-shell around the wormhole geometry is obtained by using the cut and paste approach taking the Schwarzschild black hole as an exterior manifold. The stability of thin-shell is explored by using linearized radial perturbation about equilibrium shell radius for both choices of calculated shape functions. It is concluded that stable regions and the position of the expected event horizon depend on the choice of physical parameters.
Observational constraints on f(T) gravity from model-independent data
Authors: dos Santos F. B. M. , Gonzalez J. E. , Silva R.
Published: September 2022

We establish new constraints on f(T) gravity models by using cosmological data. In particular, we investigate the restrictions given by the gas mass fraction measurements of galaxy clusters and transversal BAO data. Both data sets are regarded as weakly dependent on a fiducial cosmology. In addition, we also include a CMB measurement of the temperature power spectrum first peak, along with H(z) values from cosmic chronometers and supernovae data from the Pantheon data set. We also perform a forecast for future constraints on the deviation of f(T) models from the $$\Lambda $$
Λ
CDM scenario by following the specifications of the J-PAS and Euclid surveys and find significant improvements on the constraints of the b-parameter, when compared to the results of the statistical analysis.
Exosomal miR-452-5p Induce M2 Macrophage Polarization to Accelerate Hepatocellular Carcinoma Progression by Targeting TIMP3
Authors: Zongqiang Hu , Jiapeng Chen , Yingpeng Zhao , Chuntao Yan , Yiting Wang , Jiashun Zhu , Li Li
Published: September 2022

Background. Hepatocellular carcinoma (HCC) cell-derived exosomes have shown effects on inducing M2 macrophage polarization and promoting HCC progression. MiR-452-5p was reported by recent studies to promote malignancy progression as an exosomal microRNA that secreted by HCC cells, of which the underlying mechanism remains unclear. Here, we further explored how miR-452-5p functions in HCC. Methods. MiR-452-5p expressions in HCC cells was examined by in situ hybridization. Next, HCC cell lines were transfected with the mimics or the inhibitor of miR-452-5p. Transfected cells’ biological behavior were analyzed by CCK-8, flow cytometry, and Transwell assay. Then, exosomes were purified from miR-452-5p inhibited or overexpressed HCC cells and cocultured with macrophages to examine the role of miR-452-5p in macrophage polarization. To examine the role of exosomal miR-452-5p on macrophage polarization and tumor growth. We also performed the dual-luciferase assay to explore the targeting relationship between miR-452-5p and TIMP3. Results. The upregulation of miR-452-5p was identified in HCC. The effects of HCC cell-derived exosomes on accelerating HCC migration and invasion and inducing M2 macrophage polarization were confirmed, which were further enhanced after overexpressing miR-452-5p but neutralized after silencing miR-452-5p. In addition, in vivo experiments demonstrated the effect of miR-452-5p on accelerating HCC growth and metastasis. Also, we identified that TIMP3 overexpression inhibited the promoted cell invasion and migration by HCC cell-derived exosomes. Conclusion. Exosomal miR-452-5p secreted from HCC cells could induce polarization of M2 macrophage and therefore stimulating HCC progression by targeting TIMP3. Thus, miR-452-5p might be a potential biomarker for HCC prognosis.
Homeobox B9 Promotes the Progression of Hepatocellular Carcinoma via TGF‐β1/Smad and ERK1/2 Signaling Pathways
Authors: Bai Lizhi , Ge Pan , Zhang Yanni , Song Yi , Xing Rong , Zhou Dangxia
Published: September 2022

Objectives. Homeobox B9 (HOXB9), a homeodomain‐containing transcription factor, may play a role in hepatocellular carcinoma (HCC) progression. However, the exact mechanisms underlying its action remain unclear. Materials and methods. Immunohistochemistry was used to investigate the expression of HOBX9 and its prognostic values in HCC patients. HCC cells were transfected with pBabe‐HOXB9 and shHOXB9 plasmids, and MTT assay, Transwell assays, and xenograft mouse models were employed to determine the effects of HOXB9 on HCC cell proliferation, migration, and invasion in vitro and in vivo. The biological mechanisms involved in the role of HOXB9 were determined with Western blot and RT‐qPCR methods. Results. HOXB9 expression was significantly increased in HCC tissues and cell lines. Patients with higher HOXB9 levels were associated with poor prognosis. Overexpression of HOXB9 in BEL‐7405 cells promoted proliferation, migration, and invasion, whereas knockdown of HOXB9 in HepG2 cells significantly reduced cell proliferation, migration, and invasion abilities. Mechanically, a positive correlation was found between HOXB9 expression and transforming growth factor‐β1 (TGF‐β1) and extracellular signal‐regulated kinase (ERK)1/2 pathway in HCC tissues. HOXB9 overexpression stimulated TGF‐β1/Smads signaling pathway in BEL‐7405 cells. In contrast, HOXB9 knockdown inhibited the TGF‐β1/Smads signaling pathway in HepG2 cells. In addition, the treatment with TGF‐β1 inhibitor, LY364947, significantly reserved HOXB9 overexpression‐induced cell proliferation, migration, and invasion abilities. Conclusions. These findings validated that HOXB9 promoted proliferation, migration, and invasion in HCC cells by stimulating the TGF‐β1/Smads and ERK1/2 signaling pathway. HOXB9 could be a promising prognostic biomarker and a potential therapeutic target in HCC.
Ethical Framework of Social Media Based on Text Analysis of Terms of Service of Six Major Platforms
Authors: Mao Wanxi , Wang Zhaoxin
Published: September 2022

In the present digital world, people rely extensively on social media for networking and socializing. As a consequence, they face numerous ethical challenges which make it necessary to constantly reflect on new media ethics emerging from social media. The terms of service (ToS) of social media provide the opportunities for big tech companies’ guidelines to design the ecology and the ethical environment of social media. The existing studies conducted in this domain emphasize on specific ethical issues pertaining to ToS such as privacy, freedom of speech, and copyright protection. But all of these studies lack the exploration of its general ethical framework. Considering the theoretical framework of the Potter Box Model of Reasoning, Schwartz’s value scale, and Christians and Ess’ ethical principles, this paper examines the ToS of social media run by six major platforms across the globe. The result reveals 15 values, which are summarized into three pairs of ethical principles: egoism and altruism, monism and pluralism, and utilitarianism and deontology. The paper further analyzes the hidden conflicts and reveals the emergence of “relational” ethical principle.
A DOE (Response Surface Methodology) Approach to Predict the Strength Properties of Concrete Incorporated with Jute and Bamboo Fibres and Silica Fumes
Authors: Sridhar Jayaprakash , Jegatheeswaran Dhanapal , Gobinath Ravindran
Published: September 2022

Design of Experiment approach is adopted for deriving progression variables comprising jute fibres, bamboo fibres, and silica fumes. To obtain the optimal combination of progression variables, the effect of progression variable on the strength properties of concrete, Box–Behnken design of Response Surface Methodology was adopted. Totally four responses like compressive strength and split tensile strength at 14 days and 28 days were considered. Regression models for responses were tested using Analysis of Variance (ANOVA) and Pareto chart. The statistical importance of each progression variable was evaluated, and the attained models were articulated in second‐order polynomial equation. The outcomes showed that addition of jute fibres, bamboo fibres, and silica fumes has enhanced the strength properties, but higher level of fibres incorporation exhibited reduction in strength. Surface plot, Pareto chart, and regression analysis outcomes show that the most substantial and influence factor at 14 days and 28 days for compressive strength is Jute fibres and for split tensile strength is both jute and bamboo fibres. The percentage of error of the validation tests is less than 4% for compressive strength and less than 3% for split tensile strength.
Study on the Application of Traditional Chinese Auspicious Images in Environmental Art Design Based on VR Senses
Authors: He Zhou
Published: September 2022

Virtual reality is high-tech involving multiple disciplines developed at the end of the 20th century. Virtual reality technology can be used in many fields, such as remote control, business, education, entertainment, visual simulation, military, art, architecture, and network. Essentially, virtual reality technology has three basic characteristics: immersion, interaction, and imagination. This study analyzes the advantages of VR technology in the specific application of environmental art design based on case studies and considers the impact of VR technology on human beings from multiple dimensions such as sociology and philosophy. First, it analyzes the application and advantages of VR technology in various stages of the environmental art design. Secondly, combined with cases, it explains the advantages of VR technology in four directions: exhibition, interior, landscape, and planning. Then, it finds out the problems in the application and their solutions. In addition, to solve these problems, you need to explore the answers from more fields such as philosophy and sociology. Then, it discusses the development trend of environmental art design under VR technology and how designers should keep up with the time. Finally, as a designer of the new era, we apply VR technology to our own design and creation practice. We also analyzed the many forms of expression of auspicious images. Through the actual research and induction of modern designers, we summed up its main forms and expressions and drew some conclusions that everyone recognized, which can provide a reference for future designers.
Streamline Effect Improvement of Additive Manufactured Airfoil Utilizing Dynamic Stream Control Procedure
Authors: Srinath R. , Mukesh R. , Poojari Manish C. , Hasan Inamul , Amare Alebachew Wubetu
Published: September 2022

In the era of fast transport, to create inventive stream flow management solutions that are capable of diminishing the aerodynamic drag of the vehicles, there is a need to modify the flow characteristics over the vehicle by deferring or expelling the position of the flow partition. The objective of this study involves the parameterized design of an airfoil utilizing the Bezier curve technique with the assistance of the simulation program. For flow regulations, synthetic jet modules are ingrained at different percentages of the chord to manage the stall characteristics. The parametrization system, combined with the stream control method, can give a much better insight into flow re-energization and pave some way for the reduction of the wake. Digital fabrication technique (3d printing or Rapid Prototyping method) is used to fabricate the end product for aerodynamic testing. The comparative outcome showed a reduction in drag at certain angles of attack due to the surface finish obtained. By comparing the results, the aerodynamic efficiency showed a significant rise of 13.05% at lower angles of attack when compressed gas was used in the synthetic jet closer to the frontier edge of the airfoil. Near the stall angle of attack, the coefficient of lift (Cl) and coefficient of drag (Cd) values showed no progress.
Eplerenone Prevents Cardiac Fibrosis by Inhibiting Angiogenesis in Unilateral Urinary Obstruction Rats
Authors: Chang Yi , Ben Ying , Li Hui , Xiong Yunzhao , Chen Gege , Hao Juan , Ma Xuelian , Gao Xiaomeng , Qiang Panpan , Shimosawa Tatsuo , Wang Xiangting , Yang Fan , Xu Qingyou
Published: September 2022

Introduction. Cardiovascular disease constitutes the leading cause of mortality in patients with chronic kidney disease (CKD), which is termed cardiorenal syndrome type 4 (CRS-4). Here, we report the development of pathological cardiac remodeling and fibrosis in unilateral urinary obstruction (UUO) rats. Methods. Hematoxylin and eosin (H&E) staining was performed to observe the pathology of myocardial tissue. The degree of myocardial tissue fibrosis was observed by Masson and Sirius red staining. Immunohistochemical staining was applied to detect the expression of CD34 and CD105 in myocardial tissue, and immunofluorescent staining was performed to examine the expression of CD34, collagen I/collagen III, and alpha smooth muscle actin ( α-SMA). The expression of the signal pathway-related proteins vascular endothelial growth factor A (VEGFA), vascular endothelial growth factor receptor 2 (VEGFR2), nuclear factor κB (NF- κB), and interleukin (IL)-1 β was tested by western blotting. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA levels of serum and glucocorticoid-inducible kinase (SGK)-1, NF- κB, and interleukin-1 β (IL-1 β). Results. The results showed the development of pathological cardiac remodeling and cardiac dysfunction in UUO rats. Moreover, there was more angiogenesis and endothelial-mesenchymal transition (End-MT) in the UUO group, and these effects were inhibited by eplerenone. Conclusions. The results indicated that this cardiac fibrosis was associated with angiogenesis and that End-MT was related to aldosterone and mineralocorticoid receptor (MR) activation. Moreover, in association with the MR/IL-1 β/VEGFA signaling pathway, early treatment with the MR antagonist eplerenone in rats with UUO-induced CKD may significantly attenuate MR activation and cardiac fibrosis.
Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant
Authors: Keeling Stephanie , McDonald Malcolm F. , Anand Adrish , Dunson Jordan , Williams Elizabeth , Zhang Theodore , Hickner Brian , Galván Nhu Thao Nguyen , Mahony Christine O’ , Goss John A , Rana Abbas
Published: September 2022

Introduction. Pediatric liver transplant recipients have demonstrated excellent long-term survival. The purpose of this analysis is to investigate factors associated with 20-year survival to identify areas for improvement in patient care. Methods. Kaplan–Meier with log-rank test as well as univariate and multivariate logistic regression methods were used to retrospectively analyze 4,312 liver transplant recipients under the age of 18 between September 30, 1987 and March 9, 1998. Our primary endpoint was 20-year survival among one-year survival. Results. Logistic regression analysis identified recipient age as a significant risk factor, with recipients below 5 years old having a higher 20-year survival rate (

p
<
0.001

). A preoperative primary diagnosis of a metabolic dysfunction was found to be protective compared to other diagnoses (OR 1.64, CI 1.20–2.25). African-American ethnicity (OR 0.71, CI 0.58–0.87) was also found to be a risk factor for mortality. Technical variant allografts (neither living donor nor cadaveric) were not associated with increased or decreased rates of 20-year survival. Conclusions. Our analysis suggests that long-term survival is inversely correlated with recipient age following pediatric liver transplant. If validated with further studies, this conclusion may have profound implications on the timing of pediatric liver transplantation.
Effect of Rehabilitation Physical Training on PE Teaching Sports Injury under Ultrasonic Examination
Authors: Li Wangda
Published: September 2022

In order to solve the problem of the effect of rehabilitation physical training on physical education teaching injury, a method based on ultrasonic examination of rehabilitation physical training on physical education teaching injury effect observation method is proposed. In this method, the ISOMED isokinetic muscle strength test, the body shape test, the balance ability test, the lower limb explosive power test, and other methods are used to evaluate the knee joint of patients systematically, and the specific rehabilitation physical training plan is formulated to achieve the treatment purpose. The experimental results show that after the targeted training, a series of indicators on the affected side increase significantly: the power increases by 45.6%, the force increases by 8.3%, and the speed increases by 38.7%. It is concluded that the muscle strength, shape, balance ability, and lower limb explosive power of patients are significantly improved, which lays a solid foundation for athletes to recover smoothly and achieve good competition results.
Modeling of Multitask Principal-Agent Based on Accounts Receivable
Authors: Xin Yuhong , Liu Dehui , Li Xiaoli
Published: September 2022

The research work on multi-task principal-agent in supply chain seldom considered other factors. In this paper, basing on accounts receivable mode of supply chain finance, we add the financing factor of bank in multi-task principal-agent to study the incentive mechanism between the manufacturer and the supplier. First we develop an incentive model under the condition of symmetric information and work out the optimal result. Next the circumstance with asymmetric information is also discussed. Last, the effort level of supplier is discussed when the receivables business ran normally.