bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of a modified Care and Comfort Score and responsiveness to hip surgery in children with cerebral palsy in Gross Motor Function Classification System levels IV and V
Authors: Makaram Navnit S. , Prescott Robin J. , Alexander Phyllida , Robb James E. , Gaston Mark S.
Published: August 2023

Aims

The purpose of this study was to assess the reliability and responsiveness to hip surgery of a four-point modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) scoring tool in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V.

Methods

This was a population-based cohort study in children with CP from a national surveillance programme. Reliability was assessed from 20 caregivers who completed the mCCHQ questionnaire on two occasions three weeks apart. Test-retest reliability of the mCCHQ was calculated, and responsiveness before and after surgery for a displaced hip was evaluated in a cohort of children.

Results

Test-retest reliability for the overall mCCHQ score was good (intraclass correlation coefficient 0.78), and no dimension demonstrated poor reliability. The surgical intervention cohort comprised ten children who had preoperative and postoperative mCCHQ scores at a minimum of six months postoperatively. The mCCHQ tool demonstrated a significant improvement in overall score from preoperative assessment to six-month postoperative follow-up assessment (p < 0.001).

Conclusion

The mCCHQ demonstrated responsiveness to intervention and good test-retest reliability. The mCCHQ is proposed as an outcome tool for use within a national surveillance programme for children with CP.

Cite this article: Bone Jt Open 2023;4(8):580–583.
"That Dreadful Distemper": Smallpox, Quakers, and Inoculation in Enlightenment Britain
Authors: Bouldin Elizabeth
Published: August 2023

abstract: Quakers were early adopters and promoters of inoculation, but the procedure became a contested issue among Friends. This study analyzes eighteenth-century Quaker writings on inoculation, which emphasized both human reason and divine revelation. Highlighting the diversity of ideas about the meaning of smallpox and the value of inoculation, the essay demonstrates how debates over inoculation drew Quakers into broader discourses surrounding religion, disease, and medicine in Enlightenment Britain.
The Annotations in the 1525 Ptolemy in the Huntington Library: The Continuing Influence of Martin Waldseemüller's World Map of 1507
Authors: Van Duzer Chet
Published: August 2023

abstract: This article addresses the annotations in the exemplar of the 1525 edition of Ptolemy's Geography at the Huntington Library. The book has a rich ownership history and a sixteenth-century humanistic program of annotation by multiple hands. These annotations include texts copied from Martin Waldseemüller's 1507 world map. The manuscript enhancements of the book also include an extension eastward of the modern map of Eastern Europe. The book is a powerful testament to the use of Ptolemy as a matrix for the accumulation of geographic knowledge and to the continuing appreciation of Waldseemüller's 1507 world map.
Debate: Why Study Precolonial African Technology and Material Culture?
Authors: Mapunda Bertram
Published: August 2023

abstract: The worthiness (or worthlessness) of Africa's precolonial history has been a much debated theme since the colonial period. Diverse paradigms, historiographies, and schools of thought have emerged. Judging by the conference "Technology and Material Culture in African History: Challenges and Potentials for Research and Teaching" in the context of the above debates, we see indications of acknowledging precolonial Africa's potential to the present world. Accordingly, this article highlights the worthiness of Africa's past in two major areas: first, in reviving Africans' sense of pride and confidence erased by colonialists and colonial historians; second, in demonstrating the potential epistemological and paradigmatic benefits of African history for researching and teaching about technology and material culture within the continent and beyond. Finally, it advocates for historical archaeology as a means of retrieving information on Africa's past technologies and their resultant material culture.
CCS-UNet: a cross-channel spatial attention model for accurate retinal vessel segmentation
Authors: Zhu Yong-fei , Xu Xiang , Zhang Xue-dian , Jiang Min-shan
Published: August 2023

Precise segmentation of retinal vessels plays an important role in computer-assisted diagnosis. Deep learning models have been applied to retinal vessel segmentation, but the efficacy is limited by the significant scale variation of vascular structures and the intricate background of retinal images. This paper supposes a cross-channel spatial attention U-Net (CCS-UNet) for accurate retinal vessel segmentation. In comparison to other models based on U-Net, our model employes a ResNeSt block for the encoder-decoder architecture. The block has a multi-branch structure that enables the model to extract more diverse vascular features. It facilitates weight distribution across channels through the incorporation of soft attention, which effectively aggregates contextual information in vascular images. Furthermore, we suppose an attention mechanism within the skip connection. This mechanism serves to enhance feature integration across various layers, thereby mitigating the degradation of effective information. It helps acquire cross-channel information and enhance the localization of regions of interest, ultimately leading to improved recognition of vascular structures. In addition, the feature fusion module (FFM) module is used to provide semantic information for a more refined vascular segmentation map. We evaluated CCS-UNet based on five benchmark retinal image datasets, DRIVE, CHASEDB1, STARE, IOSTAR and HRF. Our proposed method exhibits superior segmentation efficacy compared to other state-of-the-art techniques with a global accuracy of 0.9617/0.9806/0.9766/0.9786/0.9834 and AUC of 0.9863/0.9894/0.9938/0.9902/0.9855 on DRIVE, CHASEDB1, STARE, IOSTAR and HRF respectively. Ablation studies are also performed to evaluate the the relative contributions of different architectural components. Our proposed model is potential for diagnostic aid of retinal diseases.
Molecular investigation of TSHR gene in Bangladeshi congenital hypothyroid patients
Authors: Begum Mst. Noorjahan , Mahtarin Rumana , Islam Md. Tarikul , Ahmed Sinthyia , Konika Tasnia Kawsar , Mannoor Kaiissar , Akhteruzzaman Sharif , Qadri Firdausi
Published: August 2023

The disorder of thyroid gland development or thyroid dysgenesis accounts for 80–85% of congenital hypothyroidism (CH) cases. Mutations in the TSHR gene are mostly associated with thyroid dysgenesis, and prevent or disrupt normal development of the gland. There is limited data available on the genetic spectrum of congenital hypothyroid children in Bangladesh. Thus, an understanding of the molecular aetiology of thyroid dysgenesis is a prerequisite. The aim of the study was to investigate the effect of mutations in the TSHR gene on the small molecule thyrogenic drug-binding site of the protein. We identified two nonsynonymous mutations (p.Ser508Leu, p.Glu727Asp) in the exon 10 of the TSHR gene in 21 patients with dysgenesis by sequencing-based analysis. Later, the TSHR368-764 protein was modeled by the I-TASSER server for wild-type and mutant structures. The model proteins were targeted by thyrogenic drugs, MS437 and MS438 to perceive the effect of mutations. The damaging effect in drug-protein complexes of mutants was explored by molecular docking and molecular dynamics simulations. The binding affinity of wild-type protein was much higher than the mutant cases for both of the drug ligands (MS437 and MS438). Molecular dynamics simulates the dynamic behavior of wild-type and mutant complexes. MS437-TSHR368-764MT2 and MS438-TSHR368-764MT1 showed stable conformations in biological environments. Finally, Principle Component Analysis revealed structural and energy profile discrepancies. TSHR368-764MT1 exhibited much more variations than TSHR368-764WT and TSHR368-764MT2, emphasizing a more damaging pattern in TSHR368-764MT1. This genetic study might be helpful to explore the mutational impact on drug binding sites of TSHR protein which is important for future drug design and selection for the treatment of congenital hypothyroid children with dysgenesis.
MedTric : A clinically applicable metric for evaluation of multi-label computational diagnostic systems
Authors: Saha Soumadeep , Garain Utpal , Ukil Arijit , Pal Arpan , Khandelwal Sundeep
Published: August 2023

When judging the quality of a computational system for a pathological screening task, several factors seem to be important, like sensitivity, specificity, accuracy, etc. With machine learning based approaches showing promise in the multi-label paradigm, they are being widely adopted to diagnostics and digital therapeutics. Metrics are usually borrowed from machine learning literature, and the current consensus is to report results on a diverse set of metrics. It is infeasible to compare efficacy of computational systems which have been evaluated on different sets of metrics. From a diagnostic utility standpoint, the current metrics themselves are far from perfect, often biased by prevalence of negative samples or other statistical factors and importantly, they are designed to evaluate general purpose machine learning tasks. In this paper we outline the various parameters that are important in constructing a clinical metric aligned with diagnostic practice, and demonstrate their incompatibility with existing metrics. We propose a new metric, MedTric that takes into account several factors that are of clinical importance. MedTric is built from the ground up keeping in mind the unique context of computational diagnostics and the principle of risk minimization, penalizing missed diagnosis more harshly than over-diagnosis. MedTric is a unified metric for medical or pathological screening system evaluation. We compare this metric against other widely used metrics and demonstrate how our system outperforms them in key areas of medical relevance.
Analysis of the key influencing factors of China’s cross-border e-commerce ecosystem based on the DEMATEL-ISM method
Authors: Xi Xiaodan , Wei Mingxia , Teo Brian Sheng-Xian
Published: August 2023

Systematically analysing the relative importance and hierarchical relationships among the influencing factors of the cross-border e-commerce ecosystem holds rich theoretical value and practical significance for the development of this ecosystem. A total of 19 influencing factors covering four aspects affecting the cross-border e-commerce ecosystem are identified by means of the relevant literature, web pages, research, and discussions with relevant experts and scholars, and the decision-making trial and evaluation laboratory (DEMATEL) and interpretative structural modeling (ISM) method is used to analyse the cause-effect correlation of each factor and to obtain a cause-effect diagram and a multi-level recursive structure model. The results show that three factors, i.e., the e-commerce platform development level, cross-border e-commerce competitiveness, and the cross-border e-commerce transaction scale, have a greater degree of influence on the other influencing factors. Additionally, three factors, i.e., the information development level, GDP, and cross-border online shopping demand, are vulnerable to the influence of the other factors. The level of cross-border e-commerce platform development, cross-border e-commerce competitiveness, and inter-firm competition are the root factors and occupy an important position in the cross-border e-commerce ecosystem as influencing factors and influence the stability of the cross-border e-commerce ecosystem by affecting the other factors.
The impact of family support and organization on adolescents during school closure under Covid-19 lockdown regulations in an area of South Africa
Authors: Kvalsvig Jane D. , Taylor Myra , Watt Kathryn G. , Desmond Chris
Published: August 2023

The Covid-19 pandemic and resultant disruptions to schooling presented significant challenges for many families. Well organised families have been shown to have a protective effect on adolescent wellbeing in periods of shock. At the onset of the Covid-19 pandemic, Asenze, a population-based cohort study, was conducting a third wave of data collection in peri-urban South Africa, examining risk and protective factors during adolescence. By March 2020, n = 272 adolescents and their caregivers (n = 241) in the cohort had been assessed when in-person data collection was halted by lockdown measures countrywide. During this cessation we undertook a brief telephonic qualitative sub-study to explore whether families enrolled in the cohort were able to cohabit cohesively and undertake distance learning during lockdown. A purposeful sample of 20 families (caregivers n = 20, adolescents n = 24) recently assessed in the Wave 3 of the main study, participated in semi-structured interviews. Quantitative data from Waves 1–3 of the main study was used to measure family function, adolescent cognitive function, and profile adolescent and caregivers. The quantitative and qualitative data were integrated to illustrate the dynamics of the participants’ lives before and during lockdown. We found that families classified as well-organized before lockdown, were more likely to report co-operation during lockdown. Adolescents who were self-motivated, had access to smartphones or the internet, and were supported by both family and educators, were well-placed to continue their education without much disruption. However, few schools instituted distance learning. Of the adolescents who were not assisted- some studied on their own or with peers, but others did no schoolwork, hindered by a lack of digital connectivity, and poor service delivery. The experience of adolescence and caregivers in the Asenze Cohort during lockdown highlight the importance of family functioning for adolescent wellbeing in crisis, as well as the need for access to health, mental health, and social services, communication upgrades, and enhancements to the education system during peaceful times, to make a difference to young lives in times of crisis.
Study of the parent-of-origin effect in monogenic diseases with variable age of onset. Application on ATTRv
Authors: Alarcon Flora , Planté-Bordeneuve Violaine , Nuel Grégory
Published: August 2023

In genetic diseases with variable age of onset, an accurate estimation of the survival function for the mutation carriers and also modifying factors effects estimations are important for the management of asymptomatic gene carriers across life. Among the modifying factors, the gender of the parent transmitting the mutation (i.e. the parent-of-origin effect) has been shown to have a significant effect on survival curve estimation on transthyretin familial amyloid polyneuropathy (ATTRv) families. However, as most genotypes are unknown, the parent-of-origin must be calculated through a probability estimated from the pedigree. We propose in this article to extend the method providing mutation carrier survival estimates in order to estimate the parent-of-origin effect. The method is both validated on simulated data and applied to familly samples with ATTRv.
High risk of virologic failure among HIV-infected children and adolescents routinely followed-up in Littoral region of Cameroon
Authors: Mbébi Enoné Patient Juste , Penda Calixte Ida , Ngondi Grâce , Fokam Joseph , Ebong Serge Bruno , Mekoulou Ndongo Jerson , Essangui Same Estelle Géraldine , Ndjengue Nson Louis Sides , Mandengue Samuel Honoré , Eboumbou Moukoko Carole Else
Published: August 2023

Virological response to antiretroviral therapy (ART) remains a challenge for HIV-infected children and adolescents due to non-optimization of pediatric ART for resource-limited settings. In this study, we aimed to investigate factors associated with virologic failure (VF) in HIV-infected-children and adolescents on ART in Cameroon. A prospective patient-based cohort study was conducted among HIV-infected children (0–9 years) and adolescents (10–19 years) followed-up between November 2018 and October 2019 in 38 healthcare centers located in the Littoral region of Cameroon. The 1st viral load (VL) was assessed after 6 months of ART initiation and the 2nd VL between 3 and 6 six months later in patients with VL ≥1000 copies/ml in accordance with the national algorithm using Abbott Real-Time HIV-1 Viral Load Assay. Multivariate analyses were performed to identify the determinants of higher risk of VF. Of 1,029 HIV-infected children and adolescents (393 children and 636 adolescents), 801 (77.8%) cumulatively presented with VL <1000 copies/mL within 12 months on ART. Adolescents were more likely to have VF than children (24.5% vs 18.3%, OR: 1.39; 95%CI: 1.00–1.93; p = 0.047). Patients followed-up in decentralized care units were significantly more likely to have VF compared to those attending the accredited treatment centers (26.1% vs 16.6%, OR: 1.88, 95%CI: 1.37–2.58; p<0.001). Our findings show a high rate of VL suppression (VLS, 77.8%) among HIV-infected children and adolescents, albeit lower than the established target of 90%. Being adolescent and patients followed in the decentralized care units are high risk factors for VF, thereby necessitating routine therapeutic education of patients and guardians in resource limited countries to improve VLS.
Time separating spatial memories does not influence their integration in humans
Authors: Fang Xiaoping , Alsbury-Nealy Benjamin , Wang Ying , Frankland Paul W. , Josselyn Sheena A. , Schlichting Margaret L. , Duncan Katherine D.
Published: August 2023

Humans can navigate through similar environments—like grocery stores—by integrating across their memories to extract commonalities or by differentiating between each to find idiosyncratic locations. Here, we investigate one factor that might impact whether two related spatial memories are integrated or differentiated: Namely, the temporal delay between experiences. Rodents have been shown to integrate memories more often when they are formed within 6 hours of each other. To test if this effect influences how humans spontaneously integrate spatial memories, we had 131 participants search for rewards in two similar virtual environments. We separated these learning experiences by either 30 minutes, 3 hours, or 27 hours. Memory integration was assessed three days later. Participants were able to integrate and simultaneously differentiate related memories across experiences. However, neither memory integration nor differentiation was modulated by temporal delay, in contrast to previous work. We further showed that both the levels of initial memory reactivation during the second experience and memory generalization to novel environments were comparable across conditions. Moreover, perseveration toward the initial reward locations during the second experience was related positively to integration and negatively to differentiation—but again, these associations did not vary by delay. Our findings identify important boundary conditions on the translation of rodent memory mechanisms to humans, motivating more research to characterize how even fundamental memory mechanisms are conserved and diverge across species.
Research on the impact and mechanism of financial development on new urbanization: A case study of the Yangtze River Economic Belt
Authors: Liu Yaobin , Guo Yan , Xie Dejin , Xiao Xiaodong , Hu Weihui
Published: August 2023

Based on panel data of 108 cities in China’s Yangtze River Economic Belt from 2003 to 2019, a multiple mediation model is used in this study to assess the impact and mechanism of financial development on new urbanization. The main conclusions are that financial development can directly promote the improvement of new urbanization and indirectly improve the level of new urbanization by increasing infrastructure investment, optimizing industrial structure, and enhancing human capital. Further, the financial development of middle-upstream cities has a stronger promoting effect on new urbanization. Whereas the financial development of downstream cities mainly promotes the construction of new urbanization through both infrastructure investment and industrial structure optimization, middle-upstream cities rely more solely on infrastructure investment.
Mock trial as a simulation strategy allowing undergraduate nursing students to experience evidence-based practice: A scoping-review
Authors: Song Chieun , Jang Aeri
Published: August 2023

Objective

The purpose of this scoping review was to determine the underlying design of simulations that help undergraduate nursing students acquire evidence-based practice (EBP) experiences.

Method

The JBI methodology was used for this review. The inclusion criteria were studies conducted in academic, clinical, or virtual settings that examined simulation programs designed to facilitate the acquisition of EBP by undergraduate nursing students. A comprehensive search was performed on Jan 3, 2022, using the Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), and the Excerpta Medica database (EMBASE). Grey literature was not included. Publication year was limited to 2020 and later. There was no language restriction. Data were extracted using a tool developed by the reviewers and based on the National League for Nursing Jeffries Simulation Theory.

Result

A total of 12,931 articles were found, and after duplicate articles and articles deemed ineligible based on the title and abstract (12,914 articles), 17 published papers were examined. The full texts of these studies were reviewed for eligibility, and one study was selected for the present scoping review. The selected study examined a mock trial designed to allow undergraduate nursing students to experience the ethical decision-making based on a diversity of evidence. The program reported in the study consisted of a prebriefing—simulation (mock)—debriefing structure with verified positive effects on EBP education.

Conclusion

A mock trial is a useful educational strategy for allowing undergraduate nursing students to experience EBP, but a creative method should be found that can modify the mock trial for practical operation as the designing the program demands high levels of human and material resources.

Registration

OSF Registries, https://osf.io/gdtyu, We updated OSF registry data for documenting important protocol amendments.
Effectiveness of repeated mutagenesis of sesame crosses for enhancing polygenic variability in F2M2 generation
Authors: Kar Rajesh Kumar , Mishra Tapash Kumar , Pradhan Banshidhar , Gaber Ahmed , Sahu Dibyabharati , Das Subhashree , Swain Deepak Kumar , Behera Srikrushna , Padhiary Aditya Kiran , Pattanayak Sarthak , Monalisa S. P. , Pandey Ritu Kumari , Pradhan Poonam Preeti , Sarangi Debendra Nath , Mohanty Mihir Ranjan , Lenka Biswajit , Dip Lingaraj , Jena Anannya , Pradhan Uma , Mishra Siba Prasad , Patel Manas Kumar , Mishra Rashmi Prabha , Hossain Akbar
Published: August 2023

The value of combining hybridization and mutagenesis in sesame was examined to determine if treating hybrid sesame plant material with mutagens generated greater genetic variability in four key productivity traits than either the separate hybridization or mutation of plant material. In a randomized block design with three replications, six F2M2 varieties, three F2varieties, and three parental varieties were assessed at Odisha University of Agriculture and Technology, Bhubaneswar, Odisha, India. The plant characteristics height, number of seed capsules per plant, and seed yield per plant had greater variability in the F2M2 generation than their respective controls (F2), however, the number of primary branches per plant varied less than in the control population. The chances for trait selection to be operative were high for all the characteristics examined except the number of primary branches per plant, as indicated by heritability estimates. Increases in the mean and variability of the characteristics examined indicted a greater incidence of beneficial mutations and the breakdown of undesirable linkages with increased recombination. At both phenotypic and genotypic levels strong positive correlations between both primary branch number and capsule number with seed yield suggest that these traits are important for indirect improvement in sesame seed yield. As a result of the association analysis, sesame seed yield and its component traits improved significantly, which may be attributed to the independent polygenic mutations and enlarged recombination of the polygenes controlling the examined characteristics. Compared to the corresponding control treatment or to one cycle of mutagenic treatment, two cycles of mutagenic treatment resulted in increased variability, higher transgressive segregates, PTS mean and average transgression for sesame seed yield. These findings highlight the value of implementing two EMS treatment cycles to generate improved sesame lines. Furthermore, the extra variability created through hybridization may have potential in subsequent breeding research and improved seed yield segregants may be further advanced to develop ever-superior sesame varieties.
Perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence: A qualitative study
Authors: Upamali Sathma , Rathnayake Sarath
Published: August 2023

Background

Better medication adherence among people with diabetes mellitus was found to be associated with improved glycaemic control. However, medication non-adherence is a significant concern in older people with uncontrolled type 2 diabetes mellitus.

Purpose

To explore the perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence.

Design

A qualitative descriptive exploratory study.

Methodology

A purposive sample of older people with uncontrolled type 2 diabetes mellitus living in the community was recruited. Snowball sampling was applied in community recruitment. In‐depth telephone interviews were conducted using a semi‐structured interview guide. Interviews were transcribed verbatim. Thematic analysis was used in data analysis. The consolidated criteria for reporting qualitative research (COREQ) guidelines were followed.

Results

The emerged six themes were: (a) impact of knowledge, attitudes and practices on medication adherence, (b) treatment-related barriers to medication adherence, (c) impact of age-related changes on medication adherence, (d) person-related barriers to medication adherence, (e) impact of COVID-19 on medication adherence and, (f) role of support systems in medication adherence. Knowledge of the disease process and medications, attitudes towards medication adherence, the practice of different treatment approaches, self-medication and dosing, negative experiences related to medications, polypharmacy, changes in lifestyle and roles, the influence of work-life, motivation, negligence, family support, support received from health workers, facilities available and financial capability are the main factors influence medication adherence. Age-related memory impairment, visual disturbances and physical weaknesses affect medication adherence in older people. Additionally, COVID-19-related guidelines imposed by the government and healthcare system-related issues during the COVID-19 pandemic also affected medication adherence.

Conclusion

Adherence to medications among older people is hampered by a variety of factors, including their knowledge, attitudes and practices, person and treatment-related factors and age-related changes. The COVID-19 pandemic has brought additional challenges. Individualised patient care for older people with uncontrolled type 2 diabetes mellitus to improve medication adherence is timely. Strengthening support mechanisms for the above population is essential.
Understanding and optimising support resources to facilitate CALD student and supervisor allied health fieldwork experiences
Authors: Newton Fiona J. , Lee Den-Ching A. , Brito Sara
Published: August 2023

Background

Although fieldwork supervisors and culturally and linguistically diverse (CALD) students can experience challenges during allied health placements, there is little holistic understanding of how they view and use support resources to address these challenges. This study sought to identify, codify, and map the perceived value attached to support resources used or sought by CALD students and fieldwork supervisors and to ascertain areas where they could be optimised and better presented to users.

Methods

We conducted a thematic analysis to examine interview and open-ended survey responses from CALD students (n = 18) and fieldwork supervisors (n = 161) respectively.

Findings

The six generated themes depicted different patterns of perceived value in university and non-university support resources and spanned three levels of specificity: general, discipline-contextualised, and individualised. Fieldwork supervisors valued a staged approach to support resource design and use for CALD students commencing with general level resources to build foundational language skills and socio-cultural familiarisation and moving on to include disciple-contextualised supports, preplacement mechanisms to monitor student readiness, and formalised mechanisms to enable tailoring of placements. CALD students, however, often undervalued institutional general resources relative to discipline-contextualised resources. The commonality of support resources valued and sought by supervisors from different fields suggests they could be optimised for delivery via an inter-professional community of practice.

Conclusion

Identifying and mapping the perceived value attached to support resources provides actionable insights into how to enhance the ‘fit’ between resources and user needs. Drawing the often-fragmented support resources into a cohesive ecosystem focused around perceived value at different levels of specificity allows CALD students and educators to better conceptualise the types of benefits that can accrue from taking a broader and staged approach to fieldwork placement preparations. Knowing this ecosystem encapsulates what prior uses find of value may enhance perceptions of resource relevance in the minds of new users.
Vector autoregression: Useful in rare diseases?—Predicting organ response patterns in a rare case of secondary AA amyloidosis
Authors: Ihne-Schubert Sandra M. , Kircher Malte , Werner Rudolf A. , Lapa Constantin , Einsele Hermann , Geier Andreas , Schubert Torben
Published: August 2023

Background

Statistical analyses of clinical data are a cornerstone in understanding pathomechanisms of disorders. In rare disorders, cross-sectional datasets of sufficient size are usually not available. Taking AA amyloidosis as an example of a life-threatening rare disorder resulting from of uncontrolled chronic inflammation, we propose techniques from time series analysis to predict organ response to treatment. The advantage of time-series analysis is that it solely relies on temporal variation and therefore allows analyzing organ response to treatment even when the cross-sectional dimension is small.

Methods

The joint temporal interdependence of inflammatory activity and organ response was modelled multivariately using vector autoregression (VAR) based on a unique 4.5 year spanning data set of routine laboratory, imaging data (e.g., 18F-Florbetaben-PET/CT) and functional investigations of a 68-year-old patient with multi-organ involvement of AA amyloidosis due to ongoing inflammatory activity of a malignant paraganglioma in stable disease for >20 years and excellent response to tocilizumab).

Results

VAR analysis showed that alterations in inflammatory activity forecasted alkaline phosphatase (AP). AP levels, but not inflammatory activity at the previous measurement time point predicted proteinuria.

Conclusion

We demonstrate the feasibility and value of time series analysis for obtaining clinically reliable information when the rarity of a disease prevents conventional prognostic modelling approaches. We illustrate the comparative utility of blood, functional and imaging markers to monitor the development and regression of AA amyloidosis.
ICU stays that are judged to be non-beneficial: A qualitative study of the perception of nursing staff
Authors: Mathey Lucas , Jacquier Marine , Meunier-Beillard Nicolas , Andreu Pascal , Roudaut Jean-Baptiste , Labruyère Marie , Rigaud Jean-Philippe , Quenot Jean-Pierre , Ecarnot Fiona
Published: August 2023

Introduction

Non-beneficial stays in the intensive care unit (ICU) may have repercussions for patients and their families, but can also cause suffering among the nursing staff. We aimed explore the perceptions of nursing staff in the ICU about patient stays that are deemed to be “non-beneficial” for the patient, to identify areas amenable to intervention, with a view to improving how the nursing staff perceive the patient pathway before, during and after intensive care.

Methods

Multicentre, qualitative study using individual, semi-structured interviews. All qualified nurses and nurses’ aides who were full-time employees in the ICU of three participating centres were invited to participate. Interviews were recorded, transcribed and analyzed using textual content analysis.

Results

A total of 21 interviews were performed from February 2020 to October 2021, at which point saturation was reached in the data. Average age of participants was 38.5±7.5 years, and they had an average of 10.7±7.4 years of experience working in the ICU. Four major themes emerged from the interviews, namely: (1) the work is oriented towards life-threatening emergencies, technical procedures and burdensome care; (2) a range of specific criteria and circumstances influence the decisions to admit patients to ICU; (3) there are significant organisational, physical and psychological repercussions associated with a non-beneficial stay in the ICU; (4) respondents made some proposals for improvements to the patient care pathway.

Conclusion

Nursing staff have a similar perception to physicians regarding admission decisions and non-beneficial ICU stays. The possibility of future ICU admission needs to be anticipated, discussed systematically with patients and integrated into healthcare goals that are consistent with the patient’s wishes and preferences, in multi-professional collaboration including nursing and medical staff.
Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma
Authors: Yeo Yee Hui , Liang Jeff , Lauzon Marie , Luu Michael , Noureddin Mazen , Ayoub Walid , Kuo Alexander , Sankar Kamya , Gong Jun , Hendifar Andrew , Osipov Arsen , Friedman Marc L. , Lipshutz H. Gabriel , Steinberger Jonathan , Kosari Kambiz , Nissen Nicholas , Abou-Alfa Ghassan K. , Singal Amit G. , Yang Ju Dong
Published: August 2023

INTRODUCTION:

The efficacy and safety of combined immunotherapy and transarterial radioembolization (TARE) were suggested in preclinical and early-phase trials, but these were limited by small sample sizes. We sought to compare the efficacy of combined therapy and immunotherapy alone in patients with advanced hepatocellular carcinoma (HCC).

METHODS:

The National Cancer Database was used to identify patients with advanced HCC diagnosed between January 1, 2017, and December 31, 2019. We included patients who received combined therapy or immunotherapy alone as first-line treatment. Multivariable logistic regression was conducted to determine predictors of combined therapy. Kaplan-Meier and Cox regression approaches were used to identify predictors of overall survival and to compare hazards of mortality between the patients who received combined therapy and immunotherapy alone.

RESULTS:

Of 1,664 eligible patients with advanced-stage HCC, 142 received combined TARE/immunotherapy and 1,522 received immunotherapy alone. Receipt of combination therapy was associated with care at an academic center and inversely associated with racial/ethnic minority status (Hispanic and Black individuals). The median overall survival was significantly higher in the combination group than in the immunotherapy alone group (19.8 vs 9.5 months). In multivariable analysis, combined therapy was independently associated with reduced mortality (adjusted hazard ratio 0.50, 95% confidence interval: 0.36–0.68, P < 0.001). Results were consistent across subgroups and in sensitivity analyses using propensity score matching and inverse probability of treatment weighting.

DISCUSSION:

The combination of TARE and immunotherapy was associated with improved survival compared with immunotherapy alone in patients with advanced-stage HCC. Our findings underly the importance of large clinical trials evaluating combination therapy in these patients.
Press release from the Endocrine Society ENDO 2022 Annual Conference
Authors: Editorial Article
Published: August 2023

ENDO 2022 — the key international event dedicated to endocrine diseases — was held in June 2022. This article provides a brief overview of the event and is focused on the thyroid disease.
Prevalence and predictors of tobacco, alcohol and illicit drug experimentation among Tunisian middle and high school-adolescents
Authors: Amara Amel , Omri Nihel , Sahli Jihene , Zedini Chakib , El Ouni Tasnim , Mtiraoui Ali , Mallouli Manel , Ghardalou Mariem
Published: August 2023

Objectives

Psychoactive substance experimentation among Tunisian adolescents remains one of the most threatening public health concerns. In spite of this, little is known about the prevalence and predictors of these behaviors in the Tunisian context. This study aims to assess the prevalence of tobacco, alcohol and illicit drug experimentation and its predictive factors among adolescents in the delegation of Nfidha, Sousse governorate, Tunisia.

Methods

We conducted a cross sectional study in middle and high schools in the delegation of Nfidha, Sousse governorate, Tunisia, during the first trimester of the 2019–2020 school year using an anonymous questionnaire self-administered to a randomly drawn representative sample of 1,352 pupils. Data collected included socio-demographic characteristics, substance experimentation among school-adolescents, academic performance as well as family and peer’ factors.

Results

Tobacco was the most commonly experimented substance with a prevalence rate of 17.5 % (CI 95 %: 14.8–18.8 %). The prevalence of alcohol and illicit drugs use were 3.3 % [CI 95 %: (2.1–3.9 %)] and 2 % [CI 95 %: (1.1–2.6 %)] respectively. Being male (Adjusted (AOR)=4.09, p<0.001), being a high school pupil (AOR=2.81, p<0.001), having experiencing academic failure (AOR=1.60, p=0.007) and having a father and siblings who use tobacco (AOR=1.72, p=0.002; AOR=2.03, p=0.001 respectively) were the predictors of tobacco experimentation in the multivariate logistic regression analysis. Additionally, being male (AOR=8.40, p<0.001), having experienced academic failure (AOR=2.76, p=0.017) as well as having a father and siblings who use alcohol (AOR=5.90, p<0.001; AOR=3.03, p=0.045 respectively) and having experienced tobacco (AOR=4.28, p<0.001) were the determinants of alcohol experimentation. Similarly, having a history of academic failure (AOR=3.44, p=0.041), having peers who use illicit drugs (AOR=3.22, p=0.028), having a history of tobacco and alcohol experimentation (AOR=6.52, p<0.001; AOR=3.49, p=0.046 respectively) were the predictors of illicit drug experimentation among adolescents.

Conclusions

A substantial number of socio-demographic and environmental factors have been identified as being involved in experimentation with psychoactive substance during adolescence. Therefore, further prevention programs targeting not only adolescents, but also all risk factors are needed.
Optimization of total phenolic content, total flavonoid content and anti-gout properties of polyherbal formulation
Authors: Yee Lim Sin , Abu Bakar Mohd Fadzelly , Abdullah Norazlin , Abu Bakar Fazleen Izzany , Fatmawati Sri
Published: August 2023

Objectives

An increase in gout prevalence has drawn attention among society and this situation drives the exploration of more favourable treatment using traditional medicinal plants which are rich in phenolic and flavonoid to avoid the side effects of modern medication. However, there are only few studies regarding the optimization of phytochemicals and anti-gout properties of medicinal plants and their combinations. The objectives of this study were to determine the optimal formulation of Strobilanthes crispus, Orthosiphon stamineus Benth and Stevia rebaudiana with maximum total phenolic and flavonoid contents as well as minimum IC50 of in vitro xanthine oxidase inhibitory activity and to examine their correlations among the formulations.

Methods

Plant extracts from hot water infusion were tested for the total phenolic content, total flavonoid content and enzyme inhibition through Folin-ciocalteu assay, aluminium chloride method and xanthine oxidase inhibition assay, respectively. Simplex-centroid mixture design was applied in this study and 13 polyherbal formulations were generated by Design Expert Software.

Results

Linear, special cubic and quadratic models were selected to describe the interaction effect between polyherbal formulations and their responses. Low IC50 value (13.90 μg/mL) of xanthine oxidase activity was found in the binary combination of O. stamineus and S. rebaudiana and this probably related to its high phenolic and flavonoid contents as xanthine oxidase inhibition and phytochemicals were correlated.

Conclusions

The suggested optimal formulation was comprised of 44.26 % O. stamineus and 55.74 % S. rebaudiana and it could be developed as an alternative treatment for gout.
Zur Methode der Leuenberger Konkordie
Authors: Põder Thomas-Andreas
Published: August 2023

Die Klärung der Signifikanz der Methode der Leuenberger Konkordie verlangt von sich aus nach einer Berücksichtigung des Lebens der Kirchengemeinschaft, das durch diese Methode vermittelt und strukturiert ist. Der Beitrag betrachtet das Ziel, den Grund und das Motiv der Konkordie. Es wird die Erklärung und Verwirklichung der Kirchengemeinschaft kommentiert und ein Blick auf die Methode der Konkordie in den späteren Lehrgesprächsergebnissen geworfen.
Die Gemeinschaft Evangelischer Kirchen in Europa als politischer und gesellschaftlicher Akteur auf europäischer Ebene: gesellschaftsrelevant und zukunftsweisend?
Authors: Parmentier Elisabeth
Published: August 2023

Die Gemeinschaft Evangelischer Kirchen in Europa (GEKE) sah sich durch die Leuenberger Konkordie vor 50 Jahren dazu verpflichtet, als Kirchengemeinschaft einzustehen für eine “möglichst große Gemeinsamkeit in Zeugnis und Dienst an der Welt“ (§ 29). Dieser Beitrag untersucht fünf Profile der GEKE im Hinblick auf ihre schon effektive Versöhnungsarbeit, auf ihre Wandelbarkeit durch die Jahre und ihr Potential in der heutigen bedrohten Zukunft.
Die Leuenberger Konkordie/die GEKE als ökumenisches Modell? Eine katholische Perspektive
Authors: Hallensleben Barbara
Published: August 2023

Der Beitrag zeigt, warum die Kirchengemeinschaft der Leuenberger Konkordie und der GEKE nicht als katholisches Modell übernommen werden kann. Die innerprotestantische, v. a. lutherische Kritik an der Leuenberger Konkordie entspricht wesentlich den katholischen Anfragen. Während die GEKE „Grund“ und „Gestalt“ der Kirche unterscheidet, geht die katholische Sicht von der sakramentalen „Grundgestalt“ der einen und einzigen Kirche Jesu Christi aus, die in das Heilshandeln des dreieinen Gottes einbezogen ist.
Recontextualization of the arguments of ‘innocence’ by a football club on Turkish newsprint media
Authors: Kökpınar Kaya Emel , Yağlı Emre
Published: August 2023

We explore the media representation of the involvement of Fenerbahçe, a football club in Türkiye, in the 2011 Turkish Sports Corruption Scandal. Specifically, the study focuses on the discursive construction of Fenerbahçe’s ‘innocence’ and ‘corruption’ through the central arguments of Fenerbahçe’s self-defense and how the newsprint media represents these arguments of innocence in Türkiye. The data consist of the council board speech of the club’s president after his release, the front-page headlines, and the news reports of Turkish daily newspapers featuring the speech. In the study, adopting the critical discourse analysis framework, we discuss that the newspapers either recontextualize the innocence arguments or set them aside to pursue their ideological stances. Besides, our analysis reveals that the newspapers ultimately ignore Fenerbahçe’s arguments about the existence of a secret criminal organization endeavoring to gain control of Fenerbahçe via match-fixing claims and the state via a civil coup.
MODELAGEM COMPUTACIONAL DA DISPERSÃO DE EFLUENTES URBANOS PARA ANÁLISE DE RISCO NO LITORAL PARANAENSE
Authors: Tramontini Steffen Breno , De Paula Kirinus Eduardo , Gustavo Girardi Schmidt Luiz
Published: August 2023

Emissários submarinos são soluções para o problema de saneamento em regiões costeiras urbanizadas. O município de Matinhos, Paraná, pretende instalar um emissário a 3 km da costa visando comportar seu crescimento populacional e frente aos possíveis impactos desse empreendimento foi realizada uma simulação numérica utilizando um modelo hidrodinâmico acoplado a um módulo de transporte de poluentes urbanos para avaliar os impactos das plumas de poluentes no oceano. A região do emissário é altamente dinâmica com correntes predominante leste e sudeste, e predominância de ventos de nordeste e sudeste, provavelmente devido à passagem de sistemas atmosféricos transientes. Os poluentes estudados neste trabalho foram: coliformes termotolerantes, demanda bioquímica de oxigênio, nitrogênio orgânico, oxigênio dissolvido e fósforo total. As áreas mais afetadas pela pluma de efluentes foram as camadas de fundo e regiões mais próximas ao emissário, sendo que as plumas chegaram a alcançar regiões a 20 km de distância da costa devido à ação das correntes predominantes. Os efeitos do emissário, com as cargas idealizadas neste estudo, não serão nocivos ao ambiente, porém para que tal empreendimento possa ser realizado, um melhor planejamento deve ser efetuado para que novas simulações e cenários possam ser realizados.
VIABILIDADE ECONÔMICA DE ENERGIA SOLAR PARA UM COMÉRCIO NO LITORAL DO PARANÁ
Authors: Bonetto Vinicius , Almansa Malagoli Juliana , Silva Moreira Virnei , Schumanski Danyelle
Published: August 2023

No Brasil, a base energética gira em torno das hidrelétricas, com a escassez dos recursos não renováveis causado pelo alto consumo de energia. Desta maneira, o mundo está voltado para as fontes de energias renováveis, destacando a energia solar. O território brasileiro é uma das regiões com maior incidência de radiação solar do mundo, fato este que comprova a nossa capacidade elevada de geração a partir desta fonte primária natural e inesgotável que é o Sol. O principal objetivo deste trabalho é projetar um sistema fotovoltaico para um comércio no município de Matinhos no Paraná. Além disso, o empreendimento em questão, trata-se de um comércio alimentício, cujo nome é Varanda Panificadora e Confeitaria, no litoral do Paraná. Neste contexto, analisou-se o consumo médio anual do empreendimento, sendo este de 2.702 kWh. Deste modo, o sistema de energia solar foi projetado para compor 72 placas com potência de 30,24 kWp cada, sendo autossuficiente para a produção média anual de 2.800 kWh. Ademais, o sistema é composto por um conversor com potência nominal de 30 KW. Por fim, destaca-se que no final do projeto apresentou-se um estudo de viabilidade econômica, concluindo-se que o sistema é rentável financeiramente.