bluuebunny/crossref_metadata_2025 huggingface dataset:
Information processing likelihood, eHealth literacy, and complexity of seeking strategies as predictors of health decision-making quality
Authors: Connelly Yaron , Lewis Nehama , Talmud Ilan , Kaplan Giora
Published: August 2023

eHEALS is one of the most prevalent scales used to measure eHealth literacy. However, significant criticism toward its conceptualization had raised. This study tests the effects of eHEALS alongside constructs from the elaboration likelihood model and information seeking processes, within a multidimensional model to predict medical decision-making quality. We test this model using a sample of 56 participants who completed a 45-minute online simulation task, requiring them to offer recommendation for a hypothetical medical scenario. Findings revealed that neither eHealth literacy nor elaboration likelihood independently predicted decision quality. However, eHEALS was positively associated with higher decision quality, but only among participants who had greater motivation and ability to process health information, and who used more complex information seeking strategies. Findings suggest that the eHEALS measure can be examined using a multidimensional theoretical approach to illustrate the ways in which patients obtain and utilize health information to make informed decisions.
The retrieval of positive freedom, post-Kantian perfectionism and neo-Roman liberty in contemporary political thought
Authors: Shoikhedbrod Igor
Published: August 2023

In recent years, political theorists have increasingly turned their attention to the past in search of conceptual renovation in the present. While recourse to the past has been a recurring thread throughout the history of political thought, the overlapping concern of recent scholarship has been to revisit seemingly exhausted political concepts with the aim of repurposing them for contemporary political challenges and realities. The three edited collections under review – Positive Freedom, Perfektionismus der Autonomie and Rethinking Liberty Before Liberalism – are distinguished by their thoughtful attempts at retrieving and politicizing the concepts of positive freedom, post-Kantian perfectionism, and neo-Roman liberty in contemporary political thought. These retrievals present promising avenues for theoretical innovation, along with the ever-present risk of diminishing interpretive returns.
Lessons Learned From Remotely Onboarding Undergraduates Into Applied Energy and Entrepreneurship Research
Authors: Kotla Bhavana , Bosman Lisa , Chelberg Kelli , Magana Alejandra J. , Guzey Siddika Selcen
Published: August 2023

Understanding what motivates students to enroll, persist, and complete an undergraduate research experience is crucial in developing strategies for creating well-rounded and inclusive research programs. This paper showcases an approach for a virtual undergraduate research onboarding program to orient engineering students to the National Science Foundation (NSF) Research Experience for Undergraduates (REU). A participatory action research strategy, photovoice, was used to identify factors influencing student motivation, satisfaction, and success for a virtual research onboarding program. Although photovoice has been used as an assessment tool in various educational settings, to our knowledge, it has not been used to evaluate virtual undergraduate research onboarding programs to promote retention of historically underrepresented students in science, technology, engineering, and mathematics (STEM). The exploratory findings of this study reinforce best practices for formal face-to-face onboarding programs, offer new insights for informal virtual programs, and provide an approach to program assessment with recommendations for developing impactful onboarding experiences for student enrollment, persistence, and completion.
Evaluation of the moisture management and air permeability of cotton/antistatic polyester knitted fabrics
Authors: Asfand Norina , Daukantienė Virginija
Published: August 2023

This research fills in the missing knowledge on the moisture management and air permeability of knitted fabrics developed using mixed cotton/antistatic polyester yarns with both antibacterial and antistatic behavior to enhance their functionality. The effect of the knit pattern, technical side, percentage of fiber mixture and treatment on water absorption capacity and time, relative water vapor permeability and resistance, and air permeability of developed fabrics was investigated. The 1x1 rib knit and half-Milano rib knit patterns were applied in each 4 percentages of cotton and antistatic polyester and 3 types of finishing to prepare 24 fabrics. The water absorption capacity for 1x1 rib knit fabrics was in the range of 182–231% and 162–237% for the half-Milano knitted fabric with the ∼20% increase when increasing the percentage of antistatic polyester or applying the treatment. The water absorption time depended on the pattern, the fabric treatment, and the percentage of the fiber mixture. The applied antibacterial treatment significantly prolonged the water absorption time of most of the dyed and softened samples. The 1x1 rib knitted fabrics showed significantly higher water vapor and air permeability than the half-Milano rib knitted fabrics. The relative water vapor and air permeability of the treated samples increased significantly with an increasing percentage of polyester. Research results are of great practical value when designing new textiles and simulating mathematically their comfort behavior when choosing them for a particular garment.
Swallowing Words
Authors: Lockford Lesa
Published: August 2023

In this poetic exploration, I riff off the poem “There Was an Old Lady Who Swallowed a Fly” to capture how negative consequences may ensue despite our best intentions. I consider how language evolves and, as it does so, how it continually requires that we change. I offer too that these dynamics are best engaged through tolerance, generosity, and grace.
Circulating exosomal microRNA-4497 as a potential biomarker for metastasis and prognosis in non-small-cell lung cancer
Authors: Zheng Bokun , Peng Mingcheng , Gong Jun , Li Changsheng , Cheng Hongbing , Li Yirong , Tang Yueting
Published: August 2023

Circulating exosomal microRNAs (miRNAs) have shown great potential for the diagnosis, prognosis, and treatment monitoring of patients with non-small-cell lung cancer (NSCLC). Our main purpose was to determine the clinical value of serum exosomal miR-4497 as a new non-invasive biomarker for NSCLC. The exoRNeasy Kit (QIAGEN, Hilden, Germany) was used to isolate exosomes and exoRNA from the serum of 84 patients with NSCLC (NSCLC group), 30 patients with benign lung lesion (BLL group), and 47 healthy controls. Six serum exosomal miRNAs (Let-7b-5p, miR-122-5p, miR-155-5p, miR-223-3p, miR-320c, and miR-4497) were selected as candidate miRNAs and analyzed using real-time qPCR, among which miR-4497 displayed the most striking differences. Exosomal miR-4497 expressed significantly lower in NSCLC than in BLL patients and healthy controls ( P < 0.001). Further investigation showed that miR-4497 was negatively correlated with the malignant characteristics of tumors (tumor size, tumor–node–metastasis [TNM] stage, and distant metastasis) and was an independent tumor suppressor ( P < 0.05). According to receiver operating characteristic (ROC) analysis, exosomal miR-4497 independently exhibited excellent diagnostic efficacy, which could be improved by combining it with traditional markers (for identifying tumor size, the area under the curve [AUC] = 0.761; TNM stage, AUC = 0.878; distant metastasis, AUC = 0.895; all P < 0.001). Moreover, longitudinal analysis revealed that exosomal miR-4497 levels increased after chemoradiotherapy ( P < 0.001). According to the survival analysis, poor overall survival (OS) and disease-free survival (DFS) were associated with low exosomal miR-4497 levels ( P < 0.05). Moreover, exosomal miR-4497 was an independent protective factor affecting DFS (hazard ratio = 0.190, P = 0.009) in the Cox proportional hazards model. Therefore, serum exosomal miR-4497 can be used as a potential biomarker to identify NSCLC and healthy individuals or BLL patients for early screening or as a biomarker for staging and grading, prognosis, and monitoring recurrence, metastasis, and the therapeutic effects in patients with NSCLC.
A Salt in the Buffer Zone: Potassium Dysregulation Drives Glioma Growth?
Authors: Street James S. , Lignani Gabriele
Published: August 2023

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Analysis of systemic risk factors between diabetic/vascular patients having primary lower limb amputations and re-amputations
Authors: Yammine Kaissar , Otayek Joeffroy , Haikal Emil , Daher Mohammad , El Alam Anthony , Boulos Karl , Assi Chahine
Published: August 2023

Background: Patients with diabetes mellitus (DM) are known to be predisposed to many complications in the lower extremities such as neuropathy, peripheral artery disease (PAD) and infection. Diabetic foot ulcers are complications of diabetes that can lead to lower extremity amputations, re-amputations and high mortality rates.

Purpose: The aim of this study is to evaluate the risk factors associated with higher re-amputation rates in diabetic foot disease.

Research Design: This is a mono-centric retrospective comparative study.

Study Sample: the study included 136 patients, with a total of 193 procedures (111 primary amputations and 82 re-amputations) between 2011 and 2021.

Data Analysis: The t-student test and Spearman correlation were used to look for mean differences and any relevant association, respectively. Multivariate logistic regression analysis was computed to look for independent variables.

Results: Twenty-two (27%) and 60 (50%) of those who had major and minor amputations, respectively, had a re-amputation ( p = 0.006). Besides diabetes (89%), the commonest risk factor associated with amputation was hypertension (86.7%), be it for primary amputation or re-amputation, followed by peripheral (PAD) and coronary artery diseases. Only three risk factors showed independent correlation with re-amputation; chronic kidney disease (r = 15%,  p = 0.03), smoking (r = 15%,  p = 0.03), and simultaneous presence of DM + PAD (r = 13.7%,  p = 0.05).

Conclusions: Factors that were significantly correlated with increased re-amputation rates have a clear pathologic pathway that affects vascularity and wound healing. Further studies should be aimed at developing a clear scoring system that can be used to stratify patient for re-amputation risk, and to better predict the results according to the severity of diabetes.
F4/80+CD206+ M2-like macrophages contribute to bone erosion in collagen-induced arthritis by differentiating into osteoclasts
Authors: Sun HeHe , Wang HongMin , Gao ChenHui , Tai Li , Yang YueYao , Dong HongLiang , Gao XiaoMing
Published: August 2023

Objective

Rheumatoid arthritis is an autoimmune disease characterized by synovial inflammation-driven cartilage and bone destruction, a process mainly mediated by osteoclasts. In recent years M2-like macrophages have been found to play an important role in the pathological process of RA by mediating pro-inflammatory effects, but their roles in the bone destruction of autoimmune arthritis have not been reported.

Methods and Results

In this study we identified that an abundant cell population of CD45+CD11b+Gr-1-F4/80+CD206+ cells, which were normally classified as M2-like macrophages, was present in synovium of collagen-induced arthritis (CIA) mice, and these cells had the potential to differentiate into osteoclasts. These M2-like macrophages sorted from CIA synovium highly expressed RANK and could be activated by RANKL and M-CSF to acquire osteoclast markers and bone resorption function both in vitro and in vivo. Furthermore, in vitro differentiated M2 macrophages from both CIA mouse bone marrow and RA patient peripheral blood mononuclear cells were also able to differentiate into osteoclasts, confirming the general osteoclastogenesis capability of M2 subtype macrophages.

Conclusion

All these results suggest that synovial F4/80+CD206+ M2-like macrophages in RA may be novel osteoclast precursors and contribute significantly to bone erosive changes seen in RA. Our studies provided new directions and targets for the diagnosis and treatment of rheumatoid arthritis.
The ethics of immigration enforcement: How far may states go?
Authors: Niño Arnaiz Borja
Published: August 2023

The ethics of immigration has largely remained on the abstract level, prescribing ideal principles for non-ideal circumstances. One striking example of this tendency is found in the ethics of immigration enforcement. Many authors contend that even though immigration restrictions are legitimate in principle, enforcement renders them illegitimate in practice. In this article I argue, in response to this claim, that if one supports immigration restrictions, one should also support immigration enforcement, even if it entails the use of physical force. Not enforcing immigration restrictions is unjust to law-abiding migrants, undermines the rule of law, and amounts to virtually open borders. In order to illustrate the case, I will draw upon the enforcement of tax law. My argument is that if states are allowed to go to great lengths in the enforcement of tax law, there is no reason why they should not be allowed to go to comparable lengths in the enforcement of immigration law. This analogy will provide us with the moral baseline with which to judge the permissibility of immigration enforcement. The proposal takes the rights of migrants seriously, only the right to immigrate is not one. The article also anticipates some potential objections and responds to them.
Drug switching in axial spondyloarthritis patients in Germany – a social listening analysis
Authors: Kahn Maria , Papukchieva Steffeni , Fehr Axel , Eberl Markus , Rösler Berenice , Veit Justyna , Friedrich Benjamin , Poddubnyy Denis
Published: August 2023

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease which primarily affects the axial skeleton resulting in chronic back pain and stiffness. According to the guideline, the first-line treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and non-pharmacological treatment. Second line treatment involves biological disease-modifying antirheumatic drugs (bDMARDs) such as tumour necrosis factor and interleukin-17 inhibitors.

Objectives:

The aim of this social media listening research project was to analyse switches of medication and the reasons thereof to gain valuable insights into real-life journeys of patients suffering from axSpA.

Methods:

Publicly available posts in German-speaking disease-specific forums were scanned for disease-specific keywords and commonly used drugs by axSpA patients on the Permea platform. Posts containing at least two key words were selected and switches between medications were manually labelled. A total of 287 scraped posts between 01 July 2010 and 04 Feb 2022 were analysed.

Results:

The largest group of described medication switches was initially using bDMARDs. Switches to a different bDMARD, termination of medication and switches to glucocorticoids were most frequently named. Patients on NSAIDs switched to glucocorticoids, a different NSAID or bDMARD, whereas patients on csDMARDs most frequently changed to bDMARDs. In all medication groups the main reason for switching was insufficient efficacy and side effects. Additionally, for the medication groups bDMARDs, csDMARDs and corticosteroids, pregnancy and lactation were given as a reason for switching, whereas patients in the NSAID group never mentioned pregnancy and breastfeeding as a reason for switching treatment.

Conclusion:

Our analysis shows medication switches based on real-life patient experiences shared with peers in a social listening setting. We also show medication switches differing from advised guidelines. Gathering real-life insights into patients’ journey dealing with chronic diseases allows us to understand, and thereby improve patient care and treatment.
Ginsenosides and Ginseng Phenolic Acids Relieve Ionizing Radiation-Induced Pyroptosis and Apoptosis in Intestinal Epithelial Cells
Authors: Shi Kai , Chen Fei , Li Xiang , Liang Chen , Sun Haiming , Yang Tao , Zheng Junnian , Ma Bo , Wei Liang
Published: August 2023

Exposure to ionizing radiation (IR) during procedures such as abdominal and pelvic radiotherapy results in severe intestinal injury. In the current study, we demonstrated that a lethal dose of IR triggered intestinal epithelial cell apoptosis and pyroptosis via Caspase-3 cleavage. The ginseng active ingredients, ginsenosides (GS) and ginseng phenolic acids (GPA), significantly inhibited IR-induced apoptosis in IEC-6 cells. GS and GPA also reduced Caspase-3 and GSDME cleavage and HMGB1 and LDH release, thus inhibiting pyroptosis after IR. Moreover, GS- or GPA-treated IEC-6 cells showed reduced reactive oxygen species and DNA damage accumulation. These results suggest that IR induces apoptosis and GSDME-dependent pyroptosis through Caspase-3 activation, which can be relieved by GS and GPA, thus supporting the potential use of GS and GPA in the prevention and treatment of IR-induced intestinal injury.
Epithelioid haemangioendothelioma—a rare cause of right pleural effusion and multiple primary nodules: Case report & review of the literature
Authors: Bashir Mohamed Ryan , Shehata Monica , Gorman William , AlShammari Abdullah , Buderi Silviu , Jordan Simon
Published: August 2023

Pulmonary epithelioid haemangioendothelioma (PEH) is a rare vascular neoplasm. The thoracic manifestation of this disorder is identified via three major imaging patterns, namely multiple primary nodules, diffuse infiltrative pleural thickening, and multiple pulmonary reticulonodular opacities. The commonest pattern of presentation is bilateral multiple nodules. Diagnosis is based on histopathological findings and verified by positive immunochemistry staining. Patients with PEH are usually asymptomatic. We report the case of a 51-year-old female who presented to our facility with a five-month history of cough, pleural nodularity, and pleural effusion. She underwent surgical washout with right pleural biopsies that showed a malignant epithelioid tumor with features of epithelioid haemangioendothelioma (EH). A CXR after treatment did not demonstrate a residual pleural effusion.
Protein-Losing Enteropathy and Plastic Bronchitis Following the Total Cavopulmonary Connections
Authors: Hammer Veronika , Schaeffer Thibault , Staehler Helena , Heinisch Paul Philipp , Burri Melchior , Piber Nicole , Lemmer Julia , Hager Alfred , Ewert Peter , Hörer Jürgen , Ono Masamichi
Published: August 2023

Background

We aimed to evaluate incidence, outcomes, and predictors of protein-losing enteropathy (PLE) and plastic bronchitis (PB) in a cohort of total cavopulmonary connection (TCPC).

Methods

We included 620 consecutive patients undergoing TCPC between 1994 and 2021. Prevalence and predictors for onset of PLE/PB were evaluated. Death and heart transplantation after onset of PLE/PB were examined.

Results

A total of 41 patients presented with PLE/PB (31 with PLE, 15 with PB, and 5 developed both PLE and PB). Their median age at TCPC was 2.2 (interquartile ranges [IQRs], 1.7-3.7) years, and time period to onset for PLE was 2.6 (IQR: 1.0-6.6) years and for PB was 1.1 (IQR: 0.3-4.1) years after TCPC. Independent factors for developing PLE/PB were dominant right ventricle (RV, hazard ratio [HR], 2.243; 95% confidence interval [CI], 1.129-4.458, P = .021) and prolonged pleural effusion after TCPC (HR, 2.101; 95% CI, 1.090-4.049, P = .027). In PLE/PB population, freedom from death or transplantation after PLE/PB diagnosis at 5 and 10 years were 88.7% and 76.4%, respectively. Eleven surgical interventions were performed in 10 patients, comprising atrioventricular valve repairs (n = 4), Fontan pathway revisions (n = 2), pacemaker implantation (n = 2), secondary fenestration (n = 1), diaphragm plication (n = 1), and ventricular assist device implantation (n = 1). In nine patients, a recovery from PLE with the resolution of PLE symptoms and normal protein levels was achieved. Eight patients died and the remaining continued to have challenging protein loss.

Conclusions

Protein-losing enteropathy and PB remain severe complications in the cohort of TCPC. Patients with dominant RV, and prolonged pleural effusions, were at risk for PLE/PB.
Comparing Apples With Apples: Women Faculty Research Productivity in Vietnamese Higher Education
Authors: Gao Chunhai , Khalid Sabika , Van Thang NGUYEN , Tadesse Endale
Published: August 2023

For decades, abundant studies have illustrated the vast scholarly publication disparity between male and women academics. Exhaustingly, in 21st-century higher education, women’s academic research participation is below the world average, except in a few countries that comprehensively studied their faculties and personal and institutional agencies to restore parity. Higher education is widely discussed in Vietnam as incompetent academics with a shred of scholarly publications and venerable gender disparities. Hence, the current study sought to contribute robust policy and practical implications for stakeholders by inspecting women’s faculties solely to shed light on the root hindrances of their scholarly share. Remarkably, the findings of the study demonstrate that women faculty members have promising scholarly contributions in disciplines where women scientists are marginalized, that having children becomes a notable motivator for mothers in academia, and that there is genuine support from a husband who understands the worth of his wife’s research contribution to the institution and family.
Clinical outcome of dorsal versus lateral plating in proximal phalangeal fracture: A retrospective study
Authors: Tam Cheuk Yin , Koo Jeffrey Justin Siu Cheong , Li Pui Man Carmen , Leung Kam Yiu Adrian , Chau Wai Wang , Ho Pak Cheong
Published: August 2023

Background: Plating of proximal phalangeal fracture is the commonly adopted fixation method. However, whether placing the implant at the dorsal or lateral aspect of the phalanx can yield a better clinical outcome is still under debate. Our study aims to compare the functional outcome of dorsal plating versus lateral plating in patients suffering from a proximal phalangeal fracture. Methods: A retrospective comparative study was performed comparing the clinical outcome of dorsal and lateral plating in proximal phalangeal fracture. Fourteen patients from our center with a total of 17 proximal phalangeal fractures (excluding the thumb) were included in this study. The total range of movement and range of movement of each finger joint together with grip strength were the main focuses of this study. Operative complications and the need for subsequent related operations were also analyzed. Results: Nine cases were treated by dorsal plating and eight cases adopted lateral plating. There was no significant difference in demographic data between the two groups with a mean follow-up period of 20.75 months. Lateral plating provided better total range of movement (dorsal plating (D): 203.9 ± 35.2 vs. lateral plating (L): 248.8 ± 23.7; p-value = 0.01) and percentage change in total range of movement (D: 79.41% ± 10.35, L: 94.47% ± 6.09; p-value < 0.01). There was less extension lag in lateral plating as evidenced by the sum of extension lag of the three finger joints being statistically significantly smaller (D: 32.8 ± 14.2 vs. L: 4.44 ± 6.2, p < 0.01). Less percentage decrease in grip strength compared with the contralateral normal hand was also noted in the lateral plating group (D: 68.17% ± 31.11 vs. L: 98.13% ± 10.88, p = 0.02). Conclusions: Based on this study, lateral plating provides better functional outcomes in terms of range of movement, extension lag, and grip strength than dorsal plating. Level of Evidence: Therapeutic, retrospective comparative study, Level III.
Accuracy and outcome of a handheld accelerometer-based navigation device compared to conventional alignment method in total knee arthroplasty in a Chinese population
Authors: Man Sheryl Lok-Chi , Chau Wai-Wang , Zheng Xieyang , Ong Michael Tim-Yun , Ho Kevin Ki-Wai
Published: August 2023

Background

Total knee arthroplasty (TKA) is a successful procedure in treatment of degenerative disease of the knee, and optimal component placement is essential for long-term implant survival. The purpose of this study was to compare the accuracy of the accelerometer-based KneeAlign 2 (KA2) navigation system against conventional methods for accurate positioning of the femoral and tibial components in TKA in a Chinese population.

Methods

A total of 123 (37 conventional and 86 KA2) cases of elective primary TKA were reviewed. Hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and anatomical lateral distal femoral angle (aLDFA) were measured from hip-to-ankle EOS radiographs. Accuracy of conventional alignment and KA2 navigation system was assessed by measuring the difference between intraoperative goal and postoperative radiographic measurements of the components for each respective case.

Results

There was no significant difference between conventional alignment methods and KA2 navigation in achieving a neutral mechanical alignment of the lower limb. KA2 navigation was significantly more accurate than conventional alignment methods for optimal positioning of the tibial component in both the coronal and sagittal plane, while no significant difference between the two groups was appreciated in the positioning of the femoral component in the coronal plane.

Conclusions

TKA using the accelerometer-based KA2 system was found to offer a high degree of accuracy in component alignment, and in particular, significantly improved tibial component alignment in comparison with conventional alignment methods in a Chinese population. However, no significant improvements were observed in neutral mechanical axis of the lower limb alignment and femoral component placement in the coronal plane.
The Lower Palaeolithic and Microlithic Sites of Dulung River Valley, Eastern India
Authors: Baul Shubhrakanti , Polley Krishnendu
Published: August 2023

Lower Palaeolithic and Microlithic periods are considered two of the most important phases of human’s cultural evolution. The Indian subcontinent is one of the few places where the earliest evidence of both the Lower Palaeolithic and Microlithic periods have been found. In this article, preliminary observations on 28 recently discovered Lower Palaeolithic and Microlithic sites in the Dulung River valley of the eastern part of India are described. The sites have been found by intensive foot surveys conducted in the last two years. The Lower Palaeolithic sites are mostly found in the ferricrete deposits of the uplands of this region, whereas Microlithic sites are found deposited in the latosol/oxisol horizons of the badlands of this region. Among recovered Lower Palaeolithic artefacts, Acheulean Handaxes appear to be dominant. Recovered microliths are fewer in number, but they are fresh in condition. The results of this study give a more clear understanding of the distribution of the earliest human cultures in Eastern India.
Diagnosing Noise-Induced Hearing Loss Sustained During Military Service Using Deep Neural Networks
Authors: Moore Brian C.J. , Schlittenlacher Josef
Published: August 2023

The diagnosis of noise-induced hearing loss (NIHL) is based on three requirements: a history of exposure to noise with the potential to cause hearing loss; the absence of known causes of hearing loss other than noise exposure; and the presence of certain features in the audiogram. All current methods for diagnosing NIHL have involved examination of the typical features of the audiograms of noise-exposed individuals and the formulation of quantitative rules for the identification of those features. This article describes an alternative approach based on the use of multilayer perceptrons (MLPs). The approach was applied to databases containing the ages and audiograms of individuals claiming compensation for NIHL sustained during military service (M-NIHL), who were assumed mostly to have M-NIHL, and control databases with no known exposure to intense sounds. The MLPs were trained so as to classify individuals as belonging to the exposed or control group based on their audiograms and ages, thereby automatically identifying the features of the audiogram that provide optimal classification. Two databases (noise exposed and nonexposed) were used for training and validation of the MLPs and two independent databases were used for evaluation and further analyses. The best-performing MLP was one trained to identify whether or not an individual had M-NIHL based on age and the audiogram for both ears. This achieved a sensitivity of 0.986 and a specificity of 0.902, giving an overall accuracy markedly higher than for previous methods.
Ethno-Racial Stratification in the Refinanced Mortgage Market
Authors: Loya Jose
Published: August 2023

The mortgage industry is a key component of ethno-racial stratification in wealth and homeownership. Previous research demonstrates that unequal treatment of minorities has created inequality in access and exclusion to low-cost mortgage loans in the housing market. While prior studies have documented the disadvantages Black and Latino home seekers face in obtaining a mortgage, these studies have not considered the obstacles that current homeowners face when seeking to refinance their mortgage. This study draws on annual data from the Home Mortgage Disclosure Act (HMDA) from 2018 to 2019 to assess ethno-racial disparities in refinanced mortgage outcomes by loan purpose. I demonstrate that loan rejections and high-cost loans are highest among Black homeowners seeking to refinance their home, especially when trying to make home improvements or cashing-out equity from their home. In general, Asians and Latinos perform in between Whites and Blacks across mortgage outcomes and loan purpose. These trends are particularly true when examining adverse loan outcomes for applicants seeking a cash-out refinance. Implications for ethno-racial stratification and the wealth gap are discussed.
Laugier-Hunziker Syndrome: A Rare Cause of Oral Mucosa Pigmentation
Authors: Iijima Yosuke , Nakayama Nami , Yamada Miki , Hino Shunsuke , Horie Norio , Kaneko Takahiro
Published: August 2023

Introduction: Various diseases cause pigmentation of the oral mucosa. Among them, however, Laugier-Hunziker syndrome is not well known to dentists. Laugier-Hunziker syndrome is a benign pigmentary disorder characterized by the unique expression of pigmentation of the mucosa, nails and skin. In this report, we present a rare case of Laugier-Hunziker syndrome that occurred in an elderly person. Case Presentation: The patient was an 84-year-old female resident of an elderly care facility. The institutional dental hygienist reported that she was concerned about the discoloration of the oral mucosa. On examination, she had pigmentation of her oral mucosa and nails. She had no history of any disease or medication that would cause pigmentation. Although this condition was initially unknown to us, a diagnosis of Laugier-Hunziker syndrome was made. Conclusion: We report a case of Laugier-Hunziker syndrome in an elderly woman, which is not a well-known condition among dental professionals. More knowledge about diseases that cause pigmentation of the oral mucosa would be helpful in dental practice, especially at external facilities.
Health Behaviors, Financial Difficulties, and Depressive Symptoms Among Older Adults Across Gender and Race During the COVID-19 Pandemic
Authors: Liu Yujun , Wang Heng , Hughes M. Courtney
Published: August 2023

Background: COVID-19 deeply affected the health and well-being of older adults. This study examines health behavior change and the interrelationships between health behaviors, financial difficulties, and depressive symptoms among older adults across gender and race during the pandemic. Methods: Using Rounds 1, 5, and 10 of the National Health and Aging Trends Study (NHATS) linked with the NHATS COVID-19 dataset, our sample included Medicare beneficiaries aged 65 or older in the U.S. ( N = 3,118). We modeled the interrelationships between health behaviors, financial difficulties, and depressive symptoms using a structural equation model. Results: Female participants reported less walking, more changes in eating habits, less sleeping, and less alcohol consumption during the pandemic than before the pandemic compared to male participants. Compared to White, Non-White participants showed higher proportions of experiencing financial difficulties, less walking, less vigorous activity, and changes in time spent eating and sleeping during than before the pandemic. Financial difficulties was positively associated with depressive symptoms and sedentary behavior. Active behavior was negatively associated with depressive symptoms, while sedentary behavior was positively associated with more depressive symptoms. Discussion: Health professionals should consider health behaviors and financial difficulties when intervening on depressive symptoms experienced by older adults since the pandemic.
Why U.S. Patients Declined Hospital-at-Home during the COVID-19 Public Health Emergency: An Exploratory Mixed Methods Study
Authors: Paulson Nels , Paulson Margaret P. , Maniaci Michael J. , Rutledge Rachel A. , Inselman Shealeigh , Zawada Stephanie J.
Published: August 2023

To understand why US patients refused participation in hospital-at-home (H@H) during the coronavirus disease 2019 Public Health Emergency, eligible adult patients seen at 2 Mayo Clinic sites, Mayo Clinic Health System—Northwest Wisconsin region (NWWI) and Mayo Clinic Florida (MCF), from August 2021 through March 2022, were invited to participate in a convergent-parallel study. Quantitative associations between H@H participation status and patient baseline data at hospital admission were investigated. H@H patients were more likely to have a Mayo Clinic patient portal at baseline ( P-value: .014), indicating a familiarity with telehealth. Patients who refused were more likely to be from NWWI ( P-value < .001) and have a higher Epic Deterioration Index score ( P-value: .004). The groups also had different quarters (in terms of fiscal calendar) of admission ( P-value: .040). Analyzing qualitative interviews (n = 13) about refusal reasons, 2 themes portraying the quantitative associations emerged: lack of clarity about H@H and perceived domestic challenges. To improve access to H@H and increase patient recruitment, improved education about the dynamics of H@H, for both hospital staff and patients, and inclusive strategies for navigating domestic barriers and diagnostic challenges are needed.
Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study
Authors: Andersson Ulf , Maurin Söderholm Hanna , Andersson Henrik , Wireklint Sundström Birgitta , Andersson Hagiwara Magnus , Puaca Goran
Published: August 2023

Introduction

Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR.

Methods

Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources.

Results

The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates.

Conclusion

The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.
T-cell dysfunction by pseudohypoxia and autocrine purinergic signaling in chronic lymphocytic leukemia
Authors: Montironi Chiara , Jacobs Chaja F. , Cretenet Gaspard , Peters Fleur S. , Schomakers Bauke V. , van Weeghel Michel , Kater Arnon P. , Simon-Molas Helga , Eldering Eric
Published: August 2023

Acquired T-cell dysfunction is common in chronic B-cell malignancies. Given the strong connection between T-cell metabolism and function, we investigated metabolic alterations as the basis of T-cell dysfunction induced by malignant cells. Using B-cell malignant cell lines and human peripheral blood mononuclear cells, we first established a model that recapitulates major aspects of cancer-induced T-cell dysfunction. Cell lines derived from chronic lymphocytic leukemia (CLL) (PGA-1, CII, and Mec-1), but not from other B-cell malignancies, altered the T-cell metabolome by generating a pseudohypoxic state. T cells were retained in aerobic glycolysis and were not able to switch to oxidative phosphorylation (OXPHOS). Moreover, T cells produced immunosuppressive adenosine that negatively affected function by dampening the activation, which could be restored by the blocking of adenosine receptors. Subsequently, we uncovered a similar hypoxic-like signature in autologous T cells from primary CLL samples. Pseudohypoxia was reversible upon depletion of CLL cells ex vivo and, importantly, after the in vivo reduction of the leukemic burden with combination therapy (venetoclax and obinutuzumab), restoring T-cell function. In conclusion, we uncovered a pseudohypoxic program connected with T-cell dysfunction in CLL. Modulation of hypoxia and the purinergic pathway might contribute to therapeutic restoration of T-cell function.
Distribution and clinical impact of molecular subtypes with dark zone signature of DLBCL in a Japanese real-world study
Authors: Urata Tomohiro , Naoi Yusuke , Jiang Aixiang , Boyle Merrill , Sunami Kazutaka , Imai Toshi , Nawa Yuichiro , Hiramatsu Yasushi , Yamamoto Kazuhiko , Fujii Soichiro , Yoshida Isao , Yano Tomofumi , Chijimatsu Ryota , Murakami Hiroyuki , Ikeuchi Kazuhiro , Kobayashi Hiroki , Tani Katsuma , Ujiie Hideki , Inoue Hirofumi , Tomida Shuta , Yamamoto Akira , Kondo Takumi , Fujiwara Hideaki , Asada Noboru , Nishimori Hisakazu , Fujii Keiko , Fujii Nobuharu , Matsuoka Ken-ichi , Sawada Keisuke , Momose Shuji , Tamaru Jun-ichi , Nishikori Asami , Sato Yasuharu , Yoshino Tadashi , Maeda Yoshinobu , Scott David W. , Ennishi Daisuke
Published: August 2023

The distribution and clinical impact of cell-of-origin (COO) subtypes of diffuse large B-cell lymphoma (DLBCL) outside Western countries remain unknown. Recent literature also suggests that there is an additional COO subtype associated with the germinal center dark zone (DZ) that warrants wider validation to generalize clinical relevance. Here, we assembled a cohort of Japanese patients with untreated DLBCL and determined the refined COO subtypes, which include the DZ signature (DZsig), using the NanoString DLBCL90 assay. To compare the distribution and clinical characteristics of the molecular subtypes, we used a data set from the cohort of British Columbia Cancer (BCC) (n = 804). Through the 1050 patient samples on which DLBCL90 assay was successfully performed in our cohort, 35%, 45%, and 6% of patients were identified to have germinal center B-cell–like (GCB) DLBCL, activated B-cell–like (ABC) DLBCL, and DZsig-positive (DZsigpos) DLBCL, respectively, with the highest prevalence of ABC-DLBCL, differing significantly from the BCC result (P < .001). GCB-DLBCL, ABC-DLBCL, and DZsigpos-DLBCL were associated with 2-year overall survival rates of 88%, 75%, and 66%, respectively (P < .0001), with patients with DZsigpos-DLBCL having the poorest prognosis. In contrast, GCB-DLBCL without DZsig showed excellent outcomes after rituximab-containing immunochemotherapy. DZsigpos-DLBCL was associated with the significant enrichment of tumors with CD10 expression, concurrent MYC/BCL2 expression, and depletion of microenvironmental components (all, P < .05). These results provide evidence of the distinct distribution of clinically relevant molecular subtypes in Japanese DLBCL and that refined COO, as measured by the DLBCL90 assay, is a robust prognostic biomarker that is consistent across geographical areas.
Genome-wide analysis of the MADS-box gene family in Lonicera japonica and a proposed floral organ identity model
Authors: Lin Yi , Qi Xiwu , Wan Yan , Chen Zequn , Fang Hailing , Liang Chengyuan
Published: August 2023

Background

Lonicera japonica Thunb. is widely used in traditional Chinese medicine. Medicinal L. japonica mainly consists of dried flower buds and partially opened flowers, thus flowers are an important quality indicator. MADS-box genes encode transcription factors that regulate flower development. However, little is known about these genes in L. japonica.

Results

In this study, 48 MADS-box genes were identified in L. japonica, including 20 Type-I genes (8 Mα, 2 Mβ, and 10 Mγ) and 28 Type-II genes (26 MIKCc and 2 MIKC*). The Type-I and Type-II genes differed significantly in gene structure, conserved domains, protein structure, chromosomal distribution, phylogenesis, and expression pattern. Type-I genes had a simpler gene structure, lacked the K domain, had low protein structure conservation, were tandemly distributed on the chromosomes, had more frequent lineage-specific duplications, and were expressed at low levels. In contrast, Type-II genes had a more complex gene structure; contained conserved M, I, K, and C domains; had highly conserved protein structure; and were expressed at high levels throughout the flowering period. Eleven floral homeotic MADS-box genes that are orthologous to the proposed Arabidopsis ABCDE model of floral organ identity determination, were identified in L. japonica. By integrating expression pattern and protein interaction data for these genes, we developed a possible model for floral organ identity determination.

Conclusion

This study genome-widely identified and characterized the MADS-box gene family in L. japonica. Eleven floral homeotic MADS-box genes were identified and a possible model for floral organ identity determination was also developed. This study contributes to our understanding of the MADS-box gene family and its possible involvement in floral organ development in L. japonica.
ABO, Lewis blood group systems and secretory status with H.pylori infection in yemeni dyspeptic patients: a cross- sectional study
Authors: Almorish Mohammed Abdulwahid , Al-absi Boshra , Elkhalifa Ahmed M. E. , Elamin Elham , Elderdery Abozer Y. , Alhamidi Abdulaziz H.
Published: August 2023

Background

The ABO and Lewis blood group antigens are potential factors in susceptibility to H. pylori infection. This research aimed to examine the prevalence of Helicobater pylori (H.pylori) infection and its association with ABO, Lewis blood group systems, and secretory status in Yemeni symptomatic patients.

Methods

In a cross-sectional study, 103 patients referred for endoscopy due to dyspepsia were included. H pylori infection was assessed using stool antigen and serum antibody rapid tests. ABO and Lewis blood group systems were examined using hemagglutination assay. Saliva samples were investigated for identification of the secretory phenotype using hemagglutination inhibition test.

Results

The prevalence of H. pylori infection was (80.6%), with a higher rate of infection in females than males. The ABO blood groups were found to be significantly different between males and females (p = 0.047). The O blood group was prevalent among H. pylori patients, especially secretors. There was a significant association between ABO blood groups and H. pylori infection (p = 0.001). The Le (a + b+) phenotype was the most common, followed by Le (a + b-), Le (a-b+), and Le (a-b-). Lewis blood group systems and secretory status of symptomatic patients were not associated with H. pylori infection. The results showed that serum Ab test for H. pylori achieved poor sensitivity (68%), specificity of 55%; positive predictive value (PPV) 86%, negative predictive value (NPV) 29% and accuracy 65.1%.

Conclusion

The prevalence of H. pylori infection was high in Yemeni patients. This infection was linked to the O and Le (a + b+) secretor phenotype. The H. pylori stool Ag test is the most reliable noninvasive diagnostic method for detecting H. pylori infection.
Systematic analysis of histone acetylation regulators across human cancers
Authors: Song Congkuan , Liu Xinfei , Lin Weichen , Lai Kai , Pan Shize , Lu Zilong , Li Donghang , Li Ning , Geng Qing
Published: August 2023

Background

Histone acetylation (HA) is an important and common epigenetic pathway, which could be hijacked by tumor cells during carcinogenesis and cancer progression. However, the important role of HA across human cancers remains elusive.

Methods

In this study, we performed a comprehensive analysis at multiple levels, aiming to systematically describe the molecular characteristics and clinical relevance of HA regulators in more than 10000 tumor samples representing 33 cancer types.

Results

We found a highly heterogeneous genetic alteration landscape of HA regulators across different human cancer types. CNV alteration may be one of the major mechanisms leading to the expression perturbations in HA regulators. Furthermore, expression perturbations of HA regulators correlated with the activity of multiple hallmark oncogenic pathways. HA regulators were found to be potentially useful for the prognostic stratification of kidney renal clear cell carcinoma (KIRC). Additionally, we identified HDAC3 as a potential oncogene in lung adenocarcinoma (LUAD).

Conclusion

Overall, our results highlights the importance of HA regulators in cancer development, which may contribute to the development of clinical strategies for cancer treatment.