bluuebunny/crossref_metadata_2025 huggingface dataset:
Synchronization implementation of two eccentric rotors actuated with swung and fixed motors
Authors: Wang Yuanguo , Fang Pan , Hou Yongjun , Chai Guodong , Wang Yanliang
Published: March 2022

In a vibrating screen machinery, two eccentric rotors (ERs) are actuated by swung and fixed motors. When the working efficiency of vibrating screens is the highest, the motion trajectory of the vibrating body is an ellipse. However, to implement elliptical trajectory, the ideal synchronization between the two ERs must be needed. Hence, the self-synchronous theory and synchronous control method for the vibrating screen machinery are explored. First, the mathematic model of the vibration system is deduced based on Lagrange equation; then, the synchronous condition and stability criterion are inferred from averaged small parameter method. In addition, the synchronization controllers, related to speed and phase of the ERs, are designed by with sliding mode control (SMC), and the master–slave control strategy is applied to design the control structure. Meanwhile, the stability performance of the controllers is demonstrated by Lyapunov theory and Hurwitz condition. Finally, computer simulations are implemented to validate the theoretical reliability of self-synchronization and synchronous control. The simulation results show that the system can be self-synchronized, but the ideal synchronization is difficult to achieve when the two ERs are self-synchronously rotated, which leads to non-ideal dynamic characteristics; nevertheless, the ideal synchronization can be implemented by the proposed synchronous control method.
Free vibration analysis of non-uniform Bernoulli beam by using Laplace Adomian decomposition method
Authors: Lin Ming-Xian , Deng Chih-Yi , Chen Cha’o-Kuang
Published: March 2022

This paper discusses an investigation into the influence of the cone ratio and axial force on the vibration problem in a non-uniform cantilever Euler–Bernoulli beam. In the analysis, the governing equation for the non-uniform cantilever Euler–Bernoulli beam is solved using the Laplace Adomian decomposition method (LADM). The LADM is used to convert the governing equation into a characteristic equation of a non-uniform Euler–Bernoulli beam, and a simple calculation is performed to obtain the natural frequencies and corresponding modals. The obtained numerical results are verified using a comparison with the results reported in previous studies. The present study speeds up the convergent rate and the accuracy of calculation by comparing the results using the modified Adomian decomposition method (MADM) and differential transformation method (DTM). The main power and advantage of the LADM are providing an analytical approximation to a nonlinear differential equation without linearization, perturbation, approximation, and discretization, all of which lead to huge numerical computation. The numerical methods demonstrated that the natural frequency increases with increasing the rotating spring modulus and moving spring modulus, and the moving spring modulus has a greater influence on the natural frequency. The effects of the cone ratio and axial force are presented for non-uniform Euler–Bernoulli beams. The numerical results show that the LADM is a suitable technique for analyzing the behavioral characteristics of beams.
Coordinated control of free-floating dual-arm space robots based on hybrid task-priority approach
Authors: Hong Mengqing , Zhou Hui , Liu Liaoxue , Guo Yu
Published: March 2022

This paper addresses the problem of the coordinated control of the free-floating dual-arm space robots, in the case of multiple conflict tasks. Taking the dynamic coupling effect into consideration, a relative Jacobian matrix is presented to establish the kinematic model of the free-floating dual-arm space robot. Then, an adaptive coordinated controller is elaborately developed for three conflict tasks, including position tracking of the master arm, relative motion of dual arms, and obstacle avoidance. Owing to the hybrid task-priority approach, the proposed controller can effectively ensure the execution of the obstacle avoidance task without sacrificing the performance of the first two tasks. In addition, the singularity problem is settled via introducing an adaptive damping factor based damped least-squares inverse. Meanwhile, a novel hyperbolic tangent function is designed to handle the discontinuity in performing the null space task. Finally, numerical simulations were constructed to compare the performance of the proposed coordinated controller based on hybrid task-priority approach with the controller based on task-priority approach. The simulation results show that the proposed controller has an improved tracking performance of the master arm and safety performance, compared with single task-priority approach.
Lower socioeconomic status worsens outcome of patients with systemic lupus erythematosus independently of access to healthcare
Authors: Sagy Iftach , Cohen Yarden , Nahum Yehudit , Pokroy-Shapira Elisheva , Abu-Shakra Mahmoud , Molad Yair
Published: March 2022

Objectives

Socioeconomic status (SES) has been found to be associated with worse outcomes of systemic lupus erythematosus (SLE). The impact of national health insurance on SLE outcomes has not been explored.

Methods

A retrospective inception cohort of patients older than 18 years with SLE diagnosed and followed in lupus clinics of two large tertiary medical centers were included. Patients were stratified into three groups by SES: lower 25th quantile, middle 25th‐75th quantile, and upper 75th quantile. Primary outcomes were all-cause mortality, development of end-stage kidney disease (ESKD), and score ≤ 4 on the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K) at the last visit.

Results

We identified 617 patients (548 females, 88.8%) with a median follow-up of 15 years (range, 8.0–23.0). Compared to the middle and upper SES groups, the lower SES group was characterized by younger age at disease onset (31.5 years vs. 34.3 and 37.4 years, respectively, p = 0.011) and higher rate of lupus nephritis (42.7% vs. 35.7% and 23.8%, respectively, p = 0.002). In multivariate models, patients in the middle and upper SES groups had a significantly lower risk of mortality (HR = 0.45; 95% CI, 0.24–0.82, p = 0.010) and ESKD (HR = 0.24; 95% CI, 0.08–0.73, p = 0.012), with no effect on the rate of SLEDAI 2K ≤ 4 (OR = 1.49; 95% CI, 0.92–2.40, p = 0.09).

Conclusion

Even within a health system that provides high and equal accessibility to medical care, low SES is associated with worse outcomes of SLE. Policymakers should focus on managing possible barriers that prevent patients of lower SES from obtaining optimal care.
Quantifying the role of nanocarbon fillers on dielectric properties of poly(vinylidene fluoride) matrix
Authors: Chougule Shivanand M , Twinkle Anna , Thomas Riya , Balachandran Manoj
Published: March 2022

Development of polymers with excellent dielectric properties is a challenge for advanced electronic devices. Impregnating conducting fillers like carbon nanoparticles can enhance the dielectric constant, retaining low loss due to its compatibility and favorable polarization within the polymer matrix. The multifunctional characteristics of coal-derived nanocarbon can improve permittivity and facilitate large-scale production at a lower cost. The incorporation of coal-based nanocarbon in the polymer matrix and its dielectric response is seldom investigated. In this work, different ratios (10:90, 50:50, 90:10 by weight) of nanocarbon/PVDF composite are prepared via a simple solution casting technique. The dielectric measurements show that nanofillers’ addition significantly augments the dielectric constant value, which is ∼3 times (50:50 composite) higher than pure PVDF. The uniform distribution of 50% filler within the polymer matrix impeded the seepage of charge at the interface and enhanced the permittivity via polarization of accumulated charges. The composite also exhibited balanced dielectric loss that is essential for energy storage applications.
Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis
Authors: Mescouto Karime , Olson Rebecca E , Hodges Paul W , Costa Nathalia , Patton Mary Anne , Evans Kerrie , Walsh Kelly , Lonergan Kathryn , Setchell Jenny
Published: March 2022

Despite recommendations to incorporate physical and psychosocial factors when providing care for people with back pain, research suggests that physiotherapists continue to focus on biological aspects. This study investigated how interpersonal and institutional norms influence this continued enactment of the biological aspects of management. We used theoretically-driven analysis, drawing from Foucauldian notions of power, to analyse 28 ethnographic observations of consultations and seven group discussions with physiotherapists. Analysis suggested that physiotherapy training established expectations of what a physiotherapist ‘should’ focus on, and institutional circumstances strongly drew the attention of physiotherapists towards biological aspects. Resistance to these forces was possible when, for example, physiotherapists reflected upon their practice, used silences and pauses during consultations, and actively collaborated with patients. These circumstances facilitated use of non-biomedical management approaches. Findings may assist physiotherapists to rework the enduring normative focus on biomedical aspects of care when providing care for patients with back pain.
Treatment of diabetic macular edema with intravitreal DEX Implant in Germany: Efficacy and safety in naïve and pre-treated patients in clinical practice
Authors: Augustin Albert Joseph
Published: March 2022

Purpose

To investigate the efficacy and safety of dexamethasone (DEX) implant in eyes with diabetic macular edema (DME) over 12-months.

Methods

In this retrospective study charts from a single center were analysed, including naïve and pre-treated patients. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated at baseline, months 1–2, 3–4, 5–6 and 7–12.

Results

Data of 77 eyes were analysed (58.4% were pre-treated with anti-VEGF inhibitors). Mean baseline BCVA values for the whole sample, pre-treated and naïve patients, were 60.94 (SD 13.74), 60.85 (SD 13.80) and 61.01 (SD 13.86) letters, respectively. In the whole sample BCVA changes against baseline were significant (p < 0.05) at months 1–2, 3–4 and 7–12. In the pre-treated group changes were statistically significant at months 1–2 and 7–12. No statistically significant differences were found in the naïve group and between subgroups. In the whole group and the pre-treated group, CRT changes against baseline were significant (p < 0.05) at all time points, while in the naïve group changes were only significant at time point months 3–4. No statistically significant differences were found between subgroups. IOP increases were moderate and successfully managed with topical medication.

Conclusion

After treatment with DEX implant, BCVA increased and CRT decreased significantly in the whole population at all time points. No significant differences were found between naïve and pre-treated patients. Changes in BCVA and CRT in the naïve group were not statistically significant. This was most likely attributable to the small sample size. The data underlines the importance of DEX implant as an efficacious and safe alternative to VEGF- inhibitors in real world practice.
“Failing in spite of wonderfulness”: High-stakes ensemble adjudication in low-income schools
Authors: Nussbaum Kelsey
Published: March 2022

The culture of competition in music education is pervasive, reflecting the overall growth in standardization and accountability measures in education. With this study, I addressed the intersection of two underexamined topics in music education: teachers’ experience with competitive ensemble events and the structural challenges of working in a low-income, student of color (SOC) majority campus. In this basic qualitative study, I examined how instrumental music teachers navigate the high-stakes policy of an adjudicated large-ensemble contest within and beyond their classrooms. Research questions include the following: (a) What do teachers perceive to be the unique challenges they face in preparing for and participating in ensemble adjudication as a result of their context in a low-income, SOC-majority campus? (b) How does preparation and participation ensemble adjudication influence teaching and learning in instrumental music classrooms? (c) What do teachers perceive to be the function and justification for compulsory ensemble adjudication? Findings suggest that teachers working in these contexts experience unique challenges in preparing for and succeeding in adjudication events due to the intersection of campus-based challenges and policy. In addition, music teachers experience similar narrowing of content and heightened stress as their general education counterparts within accountability structures.
Long Covid at the crossroads: Comparisons and lessons from the treatment of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Authors: Hunt Joanne , Blease Charlotte , Geraghty Keith J
Published: March 2022

Whilst parallels have been drawn between Long Covid and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), there is a well-documented history of negative stereotyping and marginalisation of patients with ME/CFS. A socio-politically oriented comparison of scientific, clinical and societal responses to Long Covid and ME/CFS is thus important to prevent similar harms arising among Long Covid patients. We identify four reasons for injustices in the treatment of ME/CFS patients, and discuss the risk of Long Covid following a similar trajectory. We conclude with policy and practice recommendations to help prevent such injustices arising again, including consideration of critical reflexivity in medical education.
Exploring young children’s argumentation as a heuristic intertextual practice
Authors: Hong Huili , Cai Qijie , Wang Min
Published: March 2022

Argumentation is a fundamental communicative ability that children develop over time through formal schooling and daily practice with peers and family members. Literature on children's argumentation appears to have focused on their social interactions out of school, clinical environment, or informal pedagogic contexts. Even though there are research inquiries into children’s argumentation in formal academic learning, many have been focused on argumentative writing in math or science classes. Much less is known about teacher-led argumentation and the youngest children's emerging argumentation in language art classes, where argumentation is formally and systematically introduced and learned. This paper reports a year-long ethnographic study on argumentation in a first-grade English language art classroom in the United States. Ethnographic discourse analysis was conducted to analyze two key literacy events from the daily reader's and writer's workshop. It is supplemented with qualitative analysis of the researchers' field notes and the students' artifacts. Our findings highlight the inherent intertextual nature of children’s argumentation and a critical role the teacher played in eliciting and steering the children’s argumentation construction through strategic instructional conversations (especially accountable talk). Our findings also revealed teacher-led children’s intertextual argumentation as a powerful heuristic process and tool to enrich students’ learning. The paper concludes some classroom argumentation teaching practices based on the research findings.
Normalized Power Variance: A new Field Orthogonal to Power in EEG Analysis
Authors: Aoki Yasunori , Kazui Hiroaki , Pascual-Marqui Roberto D. , Bruña Ricardo , Yoshiyama Kenji , Wada Tamiki , Kanemoto Hideki , Suzuki Yukiko , Suehiro Takashi , Satake Yuto , Yamakawa Maki , Hata Masahiro , Canuet Leonides , Ishii Ryouhei , Iwase Masao , Ikeda Manabu
Published: March 2022

To date, electroencephalogram (EEG) has been used in the diagnosis of epilepsy, dementia, and disturbance of consciousness via the inspection of EEG waves and identification of abnormal electrical discharges and slowing of basic waves. In addition, EEG power analysis combined with a source estimation method like exact-low-resolution-brain-electromagnetic-tomography (eLORETA), which calculates the power of cortical electrical activity from EEG data, has been widely used to investigate cortical electrical activity in neuropsychiatric diseases. However, the recently developed field of mathematics “information geometry” indicates that EEG has another dimension orthogonal to power dimension — that of normalized power variance (NPV). In addition, by introducing the idea of information geometry, a significantly faster convergent estimator of NPV was obtained. Research into this NPV coordinate has been limited thus far. In this study, we applied this NPV analysis of eLORETA to idiopathic normal pressure hydrocephalus (iNPH) patients prior to a cerebrospinal fluid (CSF) shunt operation, where traditional power analysis could not detect any difference associated with CSF shunt operation outcome. Our NPV analysis of eLORETA detected significantly higher NPV values at the high convexity area in the beta frequency band between 17 shunt responders and 19 non-responders. Considering our present and past research findings about NPV, we also discuss the advantage of this application of NPV representing a sensitive early warning signal of cortical impairment. Overall, our findings demonstrated that EEG has another dimension — that of NPV, which contains a lot of information about cortical electrical activity that can be useful in clinical practice.
An Investigation of the Mechanisms of Radiation-Induced Muscle Injury in a Tree Shrew (Tupaia belangeri) Model
Authors: Zhao Pengcheng , Xia Wei , Wei Jianglian , Feng Yiwei , Xie Mao , Niu Zhijie , Liu Heng , Ke Shenghui , Liu Huayu , Tang Anzhou , He Guangyao
Published: March 2022

Background

Animal models suitable for investigating mechanisms behind radiation-induced muscle injury are lacking. We developed a tree shrew model of such injury and investigated pathological changes and mechanisms.

Methods

Animals were divided into control (n = 5), radiation-induced acute injury (n = 5), and radiation-induced chronic injury (n = 5) groups. Tensor veli palatini (TVP) muscles of acute injury and chronic injury groups were dissected under a microscope at 1 and 24 weeks after radiation therapy, respectively. TVP muscles were stained with HE and Masson to visualize pathological changes. ELISA was performed to measure oxidative injury. RT-qPCR and immunohistochemical staining was performed to measure expression levels of miR-206 and histone deacetylase 4 (HDAC4).

Results

Compared to the control group, acute injury group showed a significant decrease in miR-206 expression (.061 ± .38, P < .05) and a significant increase in HDAC4 expression (37.05 ± 20.68, P < .05). Chronic injury group showed a significant decrease in miR-206 expression (.23 ± .19, P < .05) and a significant increase in HDAC4 expression (9.66 ± 6.12, P < .05).

Discussion

A tree shrew model of radiation-induced muscle injury was established by exposing TVP muscle region to radiation of 20-Gy. Experimental results indicated that injury caused by radiation persisted despite gradual healing of the TVP muscle and miR-206 regulatory pathway plays a key role in regulating radiation-induced muscle injury.
Physiotherapy management of atraumatic anterior sternoclavicular joint instability: A prospective case series
Authors: Tunnicliffe Helen , Athanatos Lambros , Singh Harvinder , Armstrong Alison
Published: March 2022

Background

Atraumatic sternoclavicular joint (SCJ) instability is rare. Long-term outcomes are presented for patients managed with physiotherapy. A standardised method of assessment and treatment with a structured physiotherapy programme is also presented.

Methods

Long-term outcome was analysed in this prospectively collected series (2011-2019) of patients who were assigned to a structured physiotherapy programme for atraumatic SCJ instability. Outcome-measures (subjective SCJ grading of joint stability (SSGS score), Oxford shoulder instability score (OSIS adapted for SCJ) and visual analogue scale (VAS) for pain) were collected at discharge and long-term follow up.

Results

26 patients (29 SCJ's) responded (return rate 81%). Mean follow-up was 5.1 years (range 0.9-8.3 years). 17/26 patients were hyperlax. 93% (27/29) of SCJs achieved a stable joint on SSGS score. Mean OSIS score at long-term follow up was 33.4 (range 3-48) and VAS 2.7 (range 0-9). 95% who were compliant with physiotherapy had a stable SCJ (mean OSIS 37.8 (SD 7.3) and VAS 1.6 (SD 2.1)). Those non-compliant, 90% were stable but had lower function (mean OSIS 25 (SD 14, p = 0.02) and more pain, VAS 4.9 (SD 2.9, p = 0.006).

Conclusion

The structured physiotherapy programme is highly effective in treating patients with atraumatic SCJ instability. Compliance was essential in ensuring better outcomes.
Feasibility of telesurgery in the modern era
Authors: Malik Muhammad Hammad , Brinjikji Waleed
Published: March 2022

Telesurgery is not a foreign concept and dates to as early as the 1920s. The use of robots in medicine has had a very positive effect and improved outcomes with little to no adverse effects. Having global access to telemedicine and telesurgery during the COVID-19 pandemic and being able to provide top medical care to gravely ill and contagious patients without compromising the safety of the medical team would be a very big achievement. We explore the hurdles needed to make it a realistic goal and give recommendations to achieve it utilizing the major advancements that have occurred over the past few years in the fields of engineering, communication etc. The biggest issues needed to be addressed are of financial investment, legal concerns, and availability of high-speed uninterrupted data connections.
Examining Experiences of Poor Sleep During Pregnancy: A Qualitative Study to Inform the Development of a Prenatal Sleep Intervention
Authors: Felder Jennifer N. , Mirchandaney Riya , Harrison Jessica , Manber Rachel , Cuneo Judith , Krystal Andrew , Epel Elissa , Hecht Frederick
Published: March 2022

Background

Poor sleep is common during pregnancy and is associated with increased risk of negative health outcomes. Research indicates that physical discomfort and having an active mind are primary factors for prenatal sleep disturbances. Mindfulness-based interventions have the potential for addressing these factors, but have yet to be optimized for this purpose in this population.

Objective

The objective of this study was to gather input from pregnant and postpartum individuals about the value of a mindfulness-based program for improving prenatal sleep and their preferred content and delivery format.

Methods

We conducted 2 focus groups with 12 pregnant people experiencing poor sleep quality and 3 individual interviews with postpartum people. Interviews were thematically analyzed.

Results

The majority of participants expressed strong interest in a mindfulness program for improving prenatal sleep. Participants reported that pregnancy-specific physical discomfort and worry (both general and pregnancy-specific) affected their sleep. Participants wanted sleep education, and strategies for calming the mind, reducing physical discomfort, reducing impact of bedtime partners on sleep, and tips for improving sleep schedule and quality. Participants recognized the convenience of an online intervention and the social benefits of an in-person intervention and favored a hybrid delivery model.

Conclusion

Addressing prenatal sleep problems is an unmet need. Given the challenges and discomfort women face during pregnancy, and the importance of adequate sleep for promoting mental and physical health during pregnancy, sleep difficulties are critical to address. A mindfulness-based intervention for improving prenatal sleep was deemed of high interest to this perinatal population.
Lessons Learned From the COVID-19 Pandemic as Experienced by Older Adults Treated for COVID-19
Authors: Pel-Littel Ruth E. , Stekelenburg Diny E. , Willems Hanna C. , Jansen Steffy W.M. , Festen Jan , van der Linden Carolien M.J.
Published: March 2022

Background

In order to provide the best care, the perspective of older COVID-19 patients must be involved in the development of treatment protocols. This study describes the experiences of older adults affected by COVID-19 who recovered in the hospital or at home.

Methods

Qualitative semi-structured interviews were conducted with 23 older adults affected by COVID-19. A content-based thematic analysis was conducted.

Results

Nine categories were identified as recurring topics, which were grouped into three major themes. The first theme describes experiences in the first phase of the disease when older adults fell ill. The second theme includes experiences during the illness, ranging from illness severity to participation in decision-making, communication barriers and isolation effects. The final theme covers the recovery course, residual symptoms and social aspects.

Conclusion

Older adults treated for COVID-19 experienced a feeling of being in a fast-paced whirlwind and lost total control over the situation. Extra attention should be paid to shared decision making, coordinated information provision and the instalment of a primary contract to the patient. The uncertainty of their situation, isolation measures and fears could result in psychological consequences and hinder rehabilitation in older adults.
Rekhiyo Jugajug Aage: A Reading of Caste and Gender in the Aaradhivani of Kachchh
Authors: Marvada Keshabhai
Published: March 2022

This article attempts to read and analyse the aaradhivani of Kachchh in terms of caste and gender. The first section explores the genre and looks into the narrative style of Rekhiyo Jugajug Aage Aarth, a performance text that is deeply tied to Dalit spirituality in Kachchh. The second section looks at this narrative ethnographically, and it further studies its historical development and circulation in different media: oral, written and digital. It intends to understand the functionality of the performance. It will examine the question of authorship as it emerges through the circulation of such texts. In the third section, with the close reading of the text, I will examine the problematized ideas of caste and gender. Chamars or Shudras are at the bottom of the Hindu caste hierarchy. I argue that this Dalit narrative challenges this social structure and older ideas though radical perspectives so as to subvert caste hierarchy by means of narrating the great deeds of Meghwar (Dalit) sants. It also seeks to study the transactionality of caste and region across a pan-Indian imaginary.
Impact of Socket Preservation Technique Using Autogenous Dentin Graft and Hydroxyapatite Crystals on Primary Stability of Dental Implants in Same Individuals: A Pilot Study
Authors: Hashmi Ghulam Sarwar , Rahman Tabishur , Varshney Anurag , Khan Shahla
Published: March 2022

A pilot study was conducted to analyze and compare the stability of dental implants using 2 different graft materials (autologous dentin graft and an alloplastic hydroxyapatite [HA] crystal) in the same patient. As far as we know, this study is first of its kind where socket preservation has been done using 2 different grafts in the same patient. Ten patients undergoing extraction of at least 2 teeth were selected. Atraumatic extractions were performed. Out of the 2 extraction sockets, 1 was grafted with autogenous tooth graft and other with HA crystals. Computed tomography scan was performed 3 months after grafting to evaluate bone mineral density. Primary implant stability was measured using resonance frequency analysis. It was observed that among both sites, autogenous tooth grafted sites showed better results.
Pirfenidone exacerbates Th2-driven vasculopathy in a mouse model of systemic sclerosis-associated interstitial lung disease
Authors: Birnhuber Anna , Jandl Katharina , Biasin Valentina , Fließer Elisabeth , Valzano Francesco , Marsh Leigh M. , Krolczik Christina , Olschewski Andrea , Wilhelm Jochen , Toller Wolfgang , Heinemann Akos , Olschewski Horst , Wygrecka Malgorzata , Kwapiszewska Grazyna
Published: March 2022

Background

Systemic sclerosis (SSc) is an autoimmune disease characterised by severe vasculopathy and fibrosis of various organs including the lung. Targeted treatment options for SSc-associated interstitial lung disease (SSc-ILD) are scarce. We assessed the effects of pirfenidone in a mouse model of SSc-ILD.

Methods

Pulmonary function, inflammation and collagen deposition in response to pirfenidone were assessed in Fra-2-overexpressing transgenic (Fra-2 TG) and bleomycin-treated mice. In Fra-2 TG mice, lung transcriptome was analysed after pirfenidone treatment.In vitro, pirfenidone effects on human eosinophil and endothelial cell function were analysed using flow cytometry-based assays and electric cell-substrate impedance measurements, respectively.

Results

Pirfenidone treatment attenuated pulmonary remodelling in the bleomycin model, but aggravated pulmonary inflammation, fibrosis and vascular remodelling in Fra-2 TG mice. Pirfenidone increased interleukin (IL)-4 levels and eosinophil numbers in lung tissue of Fra-2 TG mice without directly affecting eosinophil activation and migrationin vitro. A pronounced immune response with high levels of cytokines/chemokines and disturbed endothelial integrity with low vascular endothelial (VE)-cadherin levels was observed in pirfenidone-treated Fra-2 TG mice. In contrast, eosinophil and VE-cadherin levels were unchanged in bleomycin-treated mice and not influenced by pirfenidone.In vitro, pirfenidone exacerbated the IL-4 induced reduction of endothelial barrier resistance, leading to higher leukocyte transmigration.

Conclusion

This study shows that antifibrotic properties of pirfenidone may be overruled by unwanted interactions with pre-injured endothelium in a setting of high T-helper type 2 inflammation in a model of SSc-ILD. Careful ILD patient phenotyping may be required to exploit benefits of pirfenidone while avoiding therapy failure and additional lung damage in some patients.
Diagnostic, prognostic and differential-diagnostic relevance of pulmonary haemodynamic parameters during exercise: a systematic review
Authors: Zeder Katarina , Banfi Chiara , Steinrisser-Allex Gregor , Maron Bradley A. , Humbert Marc , Lewis Gregory D. , Berghold Andrea , Olschewski Horst , Kovacs Gabor
Published: March 2022

Background

The cardiopulmonary haemodynamic profile observed during exercise may identify patients with early-stage pulmonary vascular and primary cardiac diseases, and is used clinically to inform prognosis. However, a standardised approach to interpreting haemodynamic parameters is lacking.

Methods

We performed a systematic literature search according to PRISMA guidelines to identify parameters that may be diagnostic for an abnormal haemodynamic response to exercise and offer optimal prognostic and differential-diagnostic value. We performed random-effects meta-analyses of the normal values and report effect sizes as weighted mean±sd. Results of diagnostic and prognostic studies are reported descriptively.

Results

We identified 45 eligible studies with a total of 5598 subjects. The mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope, pulmonary arterial wedge pressure (PAWP)/CO slope and peak cardiac index (or CO) provided the most consistent prognostic haemodynamic parameters during exercise. The best cut-offs for survival and cardiovascular events were a mPAP/CO slope >3 Wood units (WU) and PAWP/CO slope >2 WU. A PAWP/CO slope cut-off >2 WU best differentiated pre- from post-capillary causes of PAP elevation during exercise. Upper limits of normal (defined as mean+2sd) for the mPAP/CO and PAWP/CO slopes were strongly age-dependent and ranged in 30–70-year-old healthy subjects from 1.6 to 3.3 WU and 0.6 to 1.8 WU, respectively.

Conclusion

An increased mPAP/CO slope during exercise is associated with impaired survival and an independent, prognostically relevant cut-off >3 WU has been validated. A PAWP/CO slope >2 WU may be suitable for the differentiation between pre- and post-capillary causes of PAP increase during exercise.
Multi-modal locomotor costs favor smaller males in a sexually dimorphic leaf-mimicking insect
Authors: Boisseau Romain P. , Büscher Thies H. , Klawitter Lexi J. , Gorb Stanislav N. , Emlen Douglas J. , Tobalske Bret W.
Published: March 2022

Background

In most arthropods, adult females are larger than males, and male competition is a race to quickly locate and mate with scattered females (scramble competition polygyny). Variation in body size among males may confer advantages that depend on context. Smaller males may be favored due to more efficient locomotion leading to higher mobility during mate searching. Alternatively, larger males may benefit from increased speed and higher survivorship. While the relationship between male body size and mobility has been investigated in several systems, how different aspects of male body morphology specifically affect their locomotor performance in different contexts is often unclear.

Results

Using a combination of empirical measures of flight performance and modelling of body aerodynamics, we show that large body size impairs flight performance in male leaf insects (Phyllium philippinicum), a species where relatively small and skinny males fly through the canopy in search of large sedentary females. Smaller males were more agile in the air and ascended more rapidly during flight. Our models further predicted that variation in body shape would affect body lift and drag but suggested that flight costs may not explain the evolution of strong sexual dimorphism in body shape in this species. Finally, empirical measurements of substrate adhesion and subsequent modelling of landing impact forces suggested that smaller males had a lower risk of detaching from the substrates on which they walk and land.

Conclusions

By showing that male body size impairs their flight and substrate adhesion performance, we provide support to the hypothesis that smaller scrambling males benefit from an increased locomotor performance and shed light on the evolution of sexual dimorphism in scramble competition mating systems.
Impute the missing data using retrieved dropouts
Authors: Wang Shuai , Hu Haoyan
Published: March 2022

Background

In the past few decades various methods have been proposed to handle missing data of clinical studies, so as to assess the robustness of primary results. Some of the methods are based on the assumption of missing at random (MAR) which assumes subjects who discontinue the treatment will maintain the treatment effect after discontinuation. The agency, however, has expressed concern over methods based on this overly optimistic assumption, because it hardly holds for subjects discontinuing the investigational drug. Although in recent years a good number of sensitivity analyses based on missing not at random (MNAR) assumptions have been proposed, some use very conservative assumption on which it might be hard for sponsors and regulators to reach common ground.

Methods

Here we propose a multiple imputation method targeting at “treatment policy” estimand based on the MNAR assumption. This method can be used as the primary analysis, in addition to serving as a sensitivity analysis. It imputes missing data using information from retrieved dropouts defined as subjects who remain in the study despite occurrence of intercurrent events. Then imputed data long with completers and retrieved dropouts are analyzed altogether and finally multiple results are summarized into a single estimate. According to definition in ICH E9 (R1), this proposed approach fully aligns with the treatment policy estimand but its assumption is much more realistic and reasonable.

Results

Our approach has well controlled type I error rate with no loss of power. As expected, the effect size estimates take into account any dilution effect contributed by retrieved dropouts, conforming to the MNAR assumption.

Conclusions

Although multiple imputation approaches are always used as sensitivity analyses, this multiple imputation approach can be used as primary analysis for trials with sufficient retrieved dropouts or trials designed to collect retrieved dropouts.
The role of pregnancy acceptability in maternal mental health and bonding during pregnancy
Authors: McNamara Josephine , Risi Alixandra , Bird Amy L. , Townsend Michelle L. , Herbert Jane S.
Published: March 2022

Background

Pregnancy is an important time for women’s mental health and marks the foundations of the emerging bond between mother and baby. This study aimed to investigate the role of pregnancy acceptability and intendedness in maternal mental health and bonding during pregnancy.

Methods

Data were collected from a community sample of 116 Australian pregnant women (M = 29.54, SD = 5.31) through a series of self-report questionnaires pertaining to mental health and antenatal bonding.

Results

Lower pregnancy acceptability was correlated with higher depression, anxiety and total distress, lower physical and environmental quality of life and lower antenatal bonding. Women who reported their pregnancy was intended reported higher physical quality of life than those who reported their pregnancy was unintended. The relationship between total distress and antenatal bonding was moderated by women’s degree of pregnancy acceptability (low versus high). For women with low acceptability, higher distress was associated with lower bonding, but there was no such association for women with high pregnancy acceptability. The moderation model examining associations between distress and pregnancy acceptability explained 15% of the variance in antenatal bonding scores.

Conclusion

Consideration of women’s appraisal of their pregnancy acceptability may provide a valuable framework for identifying individuals who may be at risk for mental health and bonding difficulties.
Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households
Authors: Kilale Andrew Martin , Pantoja Andrea , Jani Bhavin , Range Nyagosya , Ngowi Bernard James , Makasi Charles , Majaha Melkisedeck , Manga Chacha Dionis , Haule Sylvia , Wilfred Amani , Hilary Pudensiana , Mahamba Vishnu , Nkiligi Emmanuel , Muhandiki Wilbard , Matechi Emmanuel , Mutayoba Beatrice , Nishkiori Nobuyuki , Ershova Julia
Published: March 2022

Background

Although tuberculosis (TB) care is free in Tanzania, TB-associated costs may compromise access to services and treatment adherence resulting in poor outcomes and increased risk of transmission in the community. TB can impact economically patients and their households. We assessed the economic burden of TB on patients and their households in Tanzania and identified cost drivers to inform policies and programs for potential interventions to mitigate costs.

Methods

We conducted a nationally representative cross-sectional survey using a standard methodology recommended by World Health Organization. TB patients of all ages and with all types of TB from 30 clusters across Tanzania were interviewed during July – September 2019. We used the human capital approach to assess the indirect costs and a threshold of 20% of the household annual expenditure to determine the proportion of TB-affected households experiencing catastrophic cost. We descriptively analyzed the cost data and fitted multivariable logistic regression models to identify potential predictors of catastrophic costs.

Results

Of the 777 TB-affected households, 44.9% faced catastrophic costs due to TB. This proportion was higher (80.0%) among households of patients with multi-drug resistant TB (MDR-TB). Overall, cost was driven by income loss while accessing TB services (33.7%), nutritional supplements (32.6%), and medical costs (15.1%). Most income loss was associated with hospitalization and time for picking up TB drugs. Most TB patients (85.9%) reported worsening financial situations due to TB, and over fifty percent (53.0%) borrowed money or sold assets to finance TB treatment. In multivariable analysis, the factors associated with catastrophic costs included hospitalization (adjusted odds ratio [aOR] = 34.9; 95% confidence interval (CI):12.5–146.17), living in semi-urban (aOR = 1.6; 95% CI:1.0–2.5) or rural areas (aOR = 2.6; 95% CI:1.8–3.7), having MDR-TB (aOR = 3.4; 95% CI:1.2–10.9), and facility-based directly-observed treatment (DOT) (aOR = 7.2; 95% CI:2.4–26.6).

Conclusion

We found that the cost of TB care is catastrophic for almost half of the TB-affected households in Tanzania; our findings support the results from other surveys recently conducted in sub-Saharan Africa. Collaborative efforts across health, employment and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence and outcomes.
Clinical study on flipped classroom and mind map in newly recruited nurses’ pre-job training
Authors: Liu Yingmin , Li Yuyuan , Cui Xueran , Zhou Haikun , Wang Jingjing , Zhang Yan
Published: March 2022

Background

Traditional pre-job training mainly provides theoretical lectures and operational skill training for new nurses. However, it has a single teaching method, lacks in comprehensiveness and flexibility, and has unsatisfactory teaching effects. The purpose of this article is to evaluate the influence of the flipped classroom and mind map in the pre-job training of newly recruited nurses.

Method

A total of 92 nurses newly recruited in 2019 were included in the present study and randomly divided into two groups: the intervention group and the control group (n = 46, each). An ordinary training program was applied in the control group, and the flipped classroom + mind map training method was applied in the intervention group. All the new nurses were evaluated using the autonomous learning ability scale before and after pre-job training.

Results

The results of the present study showed that before the pre-job training, the total scores of independent learning ability, learning motivation, self-management ability, learning cooperation ability and information quality of nursing staff were similar in the control group and the intervention group; the differences were not statistically significant (P > 0.05). After the application of different training methods, the total score of independent learning ability (84.95 ± 5.146 vs. 66.73 ± 11.213), learning motivation (28.65 ± 3.198 vs. 22.78 ± 5.995), self-management ability (24.97 ± 3.586 vs. 17.89 ± 4.153), learning and cooperation ability (14.391 ± 1.584 vs. 12.17 ± 2.584) and information quality score (16.93 ± 1.306 vs. 13.89 ± 2.651) in the intervention group were significantly higher than in the control group; the differences were statistically significant (P < 0.05).

Conclusion

The flipped classroom + mind map training method can effectively improve the autonomous learning ability of newly recruited nurses.
The experience of anxiety among Chinese undergraduate nursing students in the later period of their internships: findings from a qualitative study
Authors: Yi Qi-Feng , Yan Jin , Zhang Cui-Jiao , Yang Guo-Li , Huang Hui , Yang Yan
Published: March 2022

Background

Clinical internships are a critical transition period for nursing students to develop into nursing professionals and are essential for the solidification of their professional attitudes. Undergraduate nursing students face multiple sources of severe anxiety that affect their nursing career development during this period. This study aimed to understand the anxiety experienced by undergraduate nursing students in the later period of their internship periods in a Chinese educational context.

Methods

A descriptive qualitative study was conducted. A purposive sample of 17 undergraduate nursing interns with experiences of anxiety was selected from three teaching hospitals in Hunan Province, China. Data were collected through semi-structured interviews and analyzed using the Colaizzi seven-step method for data analysis.

Results

Three themes emerged: the sources of perceived anxiety, the psychological journey of coping with anxiety, and suggestions for nursing management and education. The sub-themes for the first theme included career decision dilemmas, competitive pressures for employment, worries about progress of the graduation projects, challenges of the nursing licensure examination, and low self-confidence in clinical competence. The second theme consisted of two sub-themes: negative avoidance and retreat, and positive preparation and response. The third theme consisted of policy support to create more employment opportunities, comprehensive guidance from nursing schools and hospitals, and psychological assistance and counseling.

Conclusions

This study revealed that undergraduate nursing students were prone to anxiety during the later period of their clinical internships. Specific sources of anxiety encompassed career decision-making, job pursuit, graduation, and licensure examination. Undergraduate nursing students adopted both positive and negative approaches in coping with anxiety during the later period of their clinical internships. Nursing educators and administrators should develop appropriate instructions and support systems to reduce anxiety among undergraduate nursing students.
The impact of the Covid-19 pandemic on primary health care utilization: an experience from Iran
Authors: Rezapour Ramin , Dorosti Abbas Ali , Farahbakhsh Mostafa , Azami-aghdash Saber , Iranzad Ilnaz
Published: March 2022

Background

The Covid-19 pandemic affected the performance of Primary Health Care (PHC) worldwide. This study was performed to investigate the impact of the Covid-19 pandemic on the utilization of PHC in Iran.

Method

A before and after study conducted between 2019 and 2021. 56 medical science universities across the country were studied. The data extracted from Electronic Health Record (EHR) is entitled “SIB”. Three major indicators included a weighted average of essential services provided by (physician, dentist, mental health expert, midwife, nutritionist), percentage of actual delivered service, and percentage of customer satisfaction was selected as a criterion for assessing the PHC. Descriptive statistics and analytical statistics (Wilcoxon test) using SPSS 16 software were used for the data analyzing and reporting.

Results

There was a significant difference among the examined dimensions before and after Covid-19 separation in all studied indicators except the level of percentage of customer satisfaction (P < 0.05). So that the percentage of actually delivered services decreased about 1% and the weighted average of essential services provided by a physician, dentist, midwife, mental health experts, and nutritionist decreased 627.95, 718.81, 460.85, 2914.66, 2410.65 numbers, respectively.

Conclusion

Covid-19 Pandemic has affected the performance of Iranian PHC at the beginning and overall, has a negative consequence on utilization of services. Preparedness to respond to pandemics and develop programs and interventions is necessary to cover the weaknesses of the PHC.