bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Capital and Formal Volunteering Among Family and Unpaid Caregivers of Older Adults
Authors: Baik Sol , Crittenden Jennifer , Coleman Rachel
Published: September 2023

Using data from 1745 caregivers in the National Study of Caregiving (2017), this study explores the connection between caregiving and formal volunteering by identifying the relationship between social capital and formal volunteering among family and other unpaid caregivers of older adults. In addition, this study examines the representative prevalence of formal volunteering in caregivers. We conducted logistic regression models along with established volunteerism correlates from the prior research literature. Approximately a quarter of caregivers participated in volunteering (25.4%). Being male, having higher educational attainment, being a spouse, living separately from the care recipient, caregiving for multiple care recipients, having a better quality of relationship with the care recipient, having better psychological well-being, receiving more social support, attending religious services, and participating in group activity were positively associated with formal volunteer participation. Findings underscore the role of both human and social capital, including the caregiving context, in formal volunteering among caregivers.
Progress in central retinal artery occlusion: a narrative review
Authors: Liu Weishai , Bai Dan , Kou Lieling
Published: September 2023

Central retinal artery occlusion (CRAO) is a catastrophic ophthalmic emergency that severely impairs a patient’s visual function, often reducing visual acuity to counting fingers or worse. Progress in CRAO research has provided new information regarding its epidemiological characteristics and led to useful assessments through various ophthalmic examinations. Additional insights about CRAO have been gained through studies of its pathophysiological mechanisms, improving intervention timing and enhancing patient prognosis. Treatment for CRAO has evolved, particularly with assistance from surgical instruments and surgical robots. Although surgical treatment is now possible, this option is not widely recognized by ophthalmologists. Conservative therapies have limited benefits compared with the natural course of disease. Recently, pars plana vitrectomy plus endovascular surgery has received considerable interest among ophthalmologists because of its potential efficacy in the treatment of CRAO. Considering the inconsistencies in rationale and efficacy of CRAO treatment modalities, it is important to distinguish between treatment effects and the natural courses of various CRAO subclasses. This narrative review explores progress in CRAO epidemiology, pathophysiology, ophthalmic examination, and treatment.
Feline Oral Melanoma—A Retrospective Study in 20 Cats and Case Report
Authors: Briggs Angela , Bell Cindy , Greenfield Barden
Published: September 2023

This retrospective study reported the clinical presentation, histopathologic findings, treatment, results of clinical staging, necropsy findings, and survival times for 20 cats with oral melanoma. The median survival time was 102 days, with a one-year survival rate of 15% ( n = 3). Metastatic disease was documented in 5 cases. Cats with metastatic disease, tumors within the oral cavity (in contrast to labial tumors), and those treated only palliatively after diagnosis had shorter survival times. One case was monitored from the time of presentation until euthanasia.
The Development of Human Cortical Scene Processing
Authors: Dilks Daniel D. , Jung Yaelan , Kamps Frederik S.
Published: September 2023

Decades of research have uncovered the neural basis of place (or “scene”) processing in adulthood, revealing a set of three regions that respond selectively to visual scene information, each hypothesized to support distinct functions within scene processing (e.g., recognizing a particular kind of place versus navigating through it). Despite this considerable progress, surprisingly little is known about how these cortical regions develop. Here we review the limited evidence to date, highlighting the first few studies exploring the origins of cortical scene processing in infancy and the several studies addressing when the scene regions reach full maturity, unfortunately with inconsistent findings. This inconsistency likely stems from common pitfalls in pediatric functional magnetic resonance imaging, and accordingly, we discuss how these pitfalls may be avoided. Furthermore, we point out that almost all studies to date have focused only on general scene selectivity and argue that greater insight could be gleaned by instead exploring the more distinct functions of each region as well as their connectivity. Finally, with this last point in mind, we offer a novel hypothesis that scene regions supporting navigation (including the occipital place area and retrosplenial complex) mature later than those supporting scene categorization (including the parahippocampal place area).
Are peripheral regions in troubled waters for sustainability transitions? A systematic analysis of the literature
Authors: Vale Mário , Peponi Angeliki , Carvalho Luís , Veloso Ana Patrícia , Queirós Margarida , Morgado Paulo
Published: September 2023

While the role of cities and regions is increasingly acknowledged for climate action and discussed in the literature on sustainability transitions, the specific condition of peripheral regions has received less attention. This article develops a bibliometric review to shed light and discuss how the (multi-dimensional) notion of periphery has been conceived and implicitly declinate in different literature streams studying low-carbon sustainability transitions at the sub-national level. While the studies explicitly addressing the issues of peripherality are still scarce, the article identifies four critical dimensions that contribute to frame structural bottlenecks and opportunities: socio-spatial unevenness, asset fragility, network positionality and agency and the multi-scalar embeddedness of transition policies. At the interface of urban and regional studies and sustainability transitions’ research, these dimensions open up new research challenges and trading zones ahead for peripheral regions on navigating troubled waters of sustainability transitions.
Factors Influencing Parental Satisfaction in Children with Cleft Lip and Palate Repair Based on Comprehensive Plastic Surgery Procedures at the Senyum Bali Foundation
Authors: Padmasari Tiesya , Ardi Ardi
Published: September 2023

Analyze contributing factors toward satisfaction after cleft lip and palate treatments in Senyum Bali Foundation. Qualitative case study, an interview with a semi-structured question from February to April 2023 by purposive sampling informants including parents, foundation staff, and plastic surgeon. Unsatisfying nose and teeth appearance due imperfect effects after surgery and requirement of more procedures. Mini model theory study that includes the appearance of the face and lips; speech and hearing; the functions of feeding, masticatory, breathing; psychosocial, quality of life, treatment cost-effectiveness, funding, health services, physician, implementing cultural contexts, surgical outcomes, and parents’ feedback.
Measurement Invariance of the Neurobehavioral Symptom Inventory in Male and Female Million Veteran Program Enrollees Completing the Comprehensive Traumatic Brain Injury Evaluation
Authors: Ozturk Erin D. , Zhang Yichi , Lai Mark H. C. , Sakamoto McKenna S. , Chanfreau-Coffinier Catherine , Merritt Victoria C.
Published: September 2023

This study evaluated measurement invariance across males and females on the Neurobehavioral Symptom Inventory (NSI) in U.S. military veterans enrolled in the VA Million Veteran Program. Participants ( N = 17,059; males: n = 15,450; females: n = 1,609) included Veterans who took part in the VA Traumatic Brain Injury (TBI) Screening and Evaluation Program and completed the NSI. Multiple-group confirmatory factor analyses investigated measurement invariance of the NSI 4-factor model. The configural (comparative fit index [CFI] = 0.948, root mean square error of approximation [RMSEA] = 0.060) and metric (CFI = 0.948, RMSEA = 0.058) invariance models showed acceptable fit. There was a minor violation of scalar invariance (Δχ2 = 232.50, p < .001); however, the degree of noninvariance was mild (ΔCFI = −0.002, [Formula: see text]). Our results demonstrate measurement invariance across sex, suggesting that the NSI 4-factor model can be used to accurately assess symptoms in males and females following TBI. Findings highlight the importance of considering validity of measurement across study groups to increase confidence that a measure is interpreted similarly by respondents from different subgroups.
End-of-Life Narratives of Patients who Request Medical Assistance in Dying: A Qualitative Study Protocol
Authors: Vallès-Poch Mar , Parra Jounou Iris , Ortega-Lozano Ramón , Delgado Janet , Martínez-López María Victoria , Sánchez Garrido Silvia M. , Tamayo-Velázquez Maria Isabel , Triviño-Caballero Rosana , Rodríguez-Arias David
Published: September 2023

Many groups (healthcare professionals, lawyers, philosophers, non-governmental organisations, bioethics committees, journalists, religious groups, etc.) participate in the bioethical debate about medical assistance in dying (MAiD). Bioethics literature on the topic involve different approaches (analytic, empirical, policy oriented, activist) and various normative perspectives (discourses based on deontological premises as the sanctity of life and human dignity, or on utilitarianism, libertarianism, etc.), some of which are at times irreconcilable. Regarding empirical studies, some voices (e.g., healthcare professionals) have been widely considered but the voice of people who request MAiD has been neglected. Understanding the personal and medical circumstances that lead to MAiD, which can only be achieved by listening to the phenomenological discourse of those involved, is key. This study aims to provide knowledge from the testimonies and experiences of patients who have initiated a MAiD request. We believe this research protocol can increase our understanding of a social and academic controversy that lacks important information to be complete. By doing so, this type of research could inform and improve end-of-life public policies, and particularly the health care of individuals who request a MAiD. We propose a qualitative phenomenological study using semi-structured interviews of people in the process of requesting MAiD, as outlined in the Ley Orgánica 3/2021, de regulación de la eutanasia (LORE), the Spanish Law on the Regulation of Euthanasia. The study is conducted nationally using a convenience sampling. The number of interviews is determined sequentially and cumulatively, depending on the richness of the narratives and the saturation of the information that has been collected. For the purposes of analysis, the interviews are transcribed verbatim and pseudonymised afterwards. Data analysis is conducted at the same time as data collection. The proposed study has received a favourable report from the Coordinating Committee on Biomedical Research Ethics of Andalusia (CCEIBA).
Regulatory framework and disparities of complex generics in United States, European Union & Latin America
Authors: Bhatt Mayank , Tank Sampann , Shah Jignesh , Maheshwari Dilip
Published: September 2023

The regulatory agencies all over the world have defined the pathway and the regulations for approval of simple small-molecule generics. In addition, the agencies are striving to form perspicuous regulatory frameworks for approval of biosimilar. According to this viewpoint, the approval of complex generics, also known as non-biological complex pharmaceuticals, is not subject to any clearly defined regulations (NBCDs). Although they differ from biologic products, complex medicines are constructed of huge, extremely complex, and synthetic components. The regulatory frameworks that are currently being used for complicated generics are opaque and uncertain. The market for complex generics is huge and there are fewer generic competitors in this area. In addition, the cost of bringing such generics into the market is high. Thus, there is a need for a well-defined pathway and guidance documents for the authorization of generic versions of complex drug products. The paper focus on the regulatory frameworks that the USA, EU, and Latin America have developed at this time to allow for the introduction of complicated generics to the market. In order to analyse regulatory policies in the USA, Europe, and Latin America for the marketing of NBCD copies, a case study of a product with an approved generic version is used. It also describes on the regulatory disparities existing among the three agencies in the light of complex generics.
Representational level matters for tone-word recognition: Evidence from form priming
Authors: Yue Jinxing , Bastiaanse Roelien , Howard David , Alter Kai
Published: September 2023

In a form priming experiment with a lexical decision task, we investigated whether the representational structure of lexical tone in lexical memory impacts spoken-word recognition in Mandarin. Target monosyllabic words were preceded by five types of primes: (1) the same real words (/lun4/-/lun4/), (2) real words with only tone contrasts (/lun2/-/lun4/), (3) unrelated real words (/pie3/-/lun4/), (4) pseudowords with only tone contrasts (*/lun3/-/lun4/), and (5) unrelated pseudowords (*/tai3/-/lun4/). We found a facilitation effect in target words with pseudoword primes that share the segmental syllable but contrast in tones (*/lun3/-/lun4/). Moreover, no evident form priming effect was observed in target words primed by real words with only tone contrasts (/lun2/-/lun4/). These results suggest that the recognition of a tone word is influenced by the representational level of tone accessed by the prime word. The distinctive priming patterns between real-word and pseudoword primes are best explained by the connectionist models of tone-word recognition, which assume a hierarchical representation of lexical tone.
Face perception and facial emotional expression recognition ability: Both unique predictors of the broader autism phenotype
Authors: Gignac Gilles E , Palermo Romina , Bothe Ellen , Walker Dana L , Wilmer Jeremy B
Published: September 2023

Autism spectrum disorder (ASD) and the broader autistic phenotype (BAP) have been suggested to be associated with perceptual–cognitive difficulties processing human faces. However, the empirical results are mixed, arguably, in part due to inadequate samples and analyses. Consequently, we administered the Cambridge Face Perception Test (CFPT), the Reading the Mind in the Eyes Test (RMET), a vocabulary test, and the Autism Quotient (AQ) to a sample of 318 adults in the general community. Based on a disattenuated path analytic modelling strategy, we found that both face perception ability (β = –.21) and facial emotional expression recognition ability (β = –.27) predicted uniquely and significantly the Communication dimension of AQ. Vocabulary failed to yield a significant, direct effect onto the Communication dimension of the AQ. We conclude that difficulties perceiving information from the faces of others may contribute to difficulties in nonverbal communication, as conceptualised and measured within the context of BAP.
Evidence-based interventions for reducing sickle cell disease-associated morbidity and mortality in sub-Saharan Africa: A scoping review
Authors: Arji Emmanuel Emenike , Eze Ujunwa Justina , Ezenwaka Gloria Oluchukwu , Kennedy Neil
Published: September 2023

Objective:

Sickle cell disease is a lifelong illness affecting millions of people globally, but predominantly burdensome in sub-Saharan Africa, where most affected children do not live to adulthood, despite available evidence-based interventions that reduce the disease burden in high-income countries.

Method:

We reviewed studies evaluating evidence-based interventions that decrease sickle cell disease-related morbidity and mortality among children living in sub-Saharan Africa. We used the Joanna Briggs scoping review methodological framework and grouped identified evidence-based interventions into preventative pharmacotherapeutic agents, newborn screening and comprehensive healthcare, disease-modifying agents, nutritional supplementation, systemic treatment, supportive agents and patient/carer/population education.

Results:

We included 36 studies: 18 randomized controlled trials, 11 observational studies, 5 before-and-after studies and 2 economic evaluation studies, with most of the studies performed in West African countries. Included studies suggest evidence-based interventions effectively to reduce the common morbidities associated with sickle cell disease such as stroke, vaso-occlusive crisis, acute chest syndrome, severe anaemia and malaria infection. Evidence-based interventions also improve survival among study participants. Specifically, our review shows hydroxyurea increases haemoglobin and foetal haemoglobin levels, a finding with practical implications given the challenges with blood transfusion in this setting. The feasibility of implementing individual interventions is hampered by challenges such as affordability, accessibility and the availability of financial and human resources.

Conclusion:

Our review suggests that regular use of low-dose hydroxyurea therapy, sulphadoxine–pyrimethamine chemoprophylaxis, L-arginine and Omega-3 fatty acid supplementation and establishment of specialist stand-alone sickle cell clinics could reduce the sickle cell disease-associated morbidity and mortality in sub-Saharan Africa countries.
Reliability and validity of the Amharic version of immune thrombocytopenia life quality index tool for assessment of the health-related quality of life in Ethiopian patients of immune thrombocytopenia: Cross-sectional study
Authors: Beyene Dessale Abate , Sisay Eskinder Ayalew , Fentie Atalay Mulu , Gebremedhin Amha
Published: September 2023

Background:

Platelet count and bleeding risk are frequently used in clinical assessments of the severity of immune thrombocytopenia. On the other hand, immune thrombocytopenia also influences patients’ health-related quality of life. The immune thrombocytopenia life quality index is a new tool for evaluating health-related quality of life in immune thrombocytopenia patients.

Objective:

To assess the psychometric properties of the Amharic version of the immune thrombocytopenia life quality index tool for immune thrombocytopenia patients in Ethiopia.

Methods:

The facility-based cross-sectional study was carried out from 15 September to 30 October 2022. The school of pharmacy institutional ethics review board provided ethical clearance and approval of the study protocol (approval number: ERB/SOP/487/14/2022). Both written informed consent and family or legal guardian consent were obtained for participants aged 14–18 years and informed consent for participants aged >18 years. The tool was forward-backward translated before being pretested on five immune thrombocytopenia patients. Descriptive statistics were used to report sociodemographic and clinical data. The psychometric properties of the immune thrombocytopenia life quality index in Amharic were evaluated for acceptability, reliability, and construct validity.

Results:

This study included 100 participants, at the age of diagnosis of immune thrombocytopenia, the median with inter-quartile range of platelet count (×109/L) was 15.00 (18.00). The majority of study participants (79, 79%) received prednisolone alone as first-line therapy. The tool psychometric test was reliable; the correlation coefficient between items ranged from 0.147 to 0.956, and the overall Cronbach’s alpha coefficient was 0.956. Furthermore, the tool was construct-valid, with factor analysis between components revealing that Item-1 had an eigenvalue greater than one and explained 72.532% of the total variance among all 10 immune thrombocytopenia life quality index domains. The immune thrombocytopenia life quality index total (alternative score) had a strong ( r = 0.9) correlation with Item-8 and a moderate ( r = 0.317) correlation with Item-5.

Conclusion:

The Amharic version of the immune thrombocytopenia life quality index tool is a valid and reliable tool that can be used to assess the health-related quality of life of immune thrombocytopenia patients in Ethiopia.
Public sentiments and the influence of information-seeking preferences on knowledge, attitudes, death conversation, and receptiveness toward palliative care: results from a nationwide survey in Singapore
Authors: Yeo Su Lin , Ng Raymond Han Lip , Peh Tan-Ying , Lwin May O. , Chong Poh-Heng , Neo Patricia Soek Hui , Zhou Jamie Xuelian , Lee Angel
Published: September 2023

Background:

Low awareness about palliative care among the global public and healthcare communities has been frequently cited as a persistent barrier to palliative care acceptance. Given that knowledge shapes attitudes and encourages receptiveness, it is critical to examine factors that influence the motivation to increase knowledge. Health information-seeking from individuals and media has been identified as a key factor, as the process of accessing and interpreting information to enhance knowledge has been shown to positively impact health behaviours.

Objective:

Our study aimed to uncover public sentiments toward palliative care in Singapore. A conceptual framework was additionally developed to investigate the relationship between information-seeking preferences and knowledge, attitudes, receptiveness of palliative care, and comfort in death discussion.

Design and Methods:

A nationwide survey was conducted in Singapore with 1226 respondents aged 21 years and above. The data were analysed through a series of hierarchical multiple regression to examine the hypothesised role of information-seeking sources as predictors.

Results:

Our findings revealed that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. It further showed that while information-seeking from individuals and media increases knowledge, attitudes and receptiveness to palliative care, the comfort level in death conversations was found to be positively associated only with individuals, especially healthcare professionals.

Conclusion:

Our findings highlight the need for public health authorities to recognize people’s deep-seated beliefs and superstitions surrounding the concept of mortality. As Asians view death as a taboo topic that is to be avoided at all costs, it is necessary to adopt multipronged communication programs to address those fears. It is only when the larger communicative environment is driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore.
Post Varicella Neurological Complication: A Case of Transverse Myelitis
Authors: Vysakha Kavadisseril Vivekanandan , Reshmi C. P. , Cyriac Mathews , Pillai Raina Thankappan
Published: September 2023

Longitudinal extensive transverse myelitis is defined as a spinal cord lesion that extends over three or more spinal segments. Varicella zoster virus is an exclusively human neurotropic virus that reactivates following the weaning of cell-mediated immunity as age advances, resulting in herpes zoster. We report the case of a 61-year lady presenting with dorsal cord longitudinally extending transverse myelitis following herpes zoster infection that resolved with immunomodulation and antivirals.
Multi-variate seismic fragility assessment of CLT coupled wall systems
Authors: Teweldebrhan Biniam Tekle , Goda Katsuichiro , De Risi Raffaele , Tesfamariam Solomon
Published: September 2023

The cross-laminated timber coupled wall (CLT-CW) system, a recently proposed timber-based structural system, has limited understanding of its seismic performance. The existing research in probabilistic seismic fragility assessment (PSFA) of CLT buildings reveals gap, particularly regarding comprehensive evaluation of CLT-CW systems and the impact of its various design parameters. To fully describe the state of the post-earthquake performance of structures, state-of-the-art studies recommend using multi-variate fragility analysis. Accordingly, this article presents a bi-variate PSFA of CLT-CW systems using two engineering demand parameters: the maximum and residual inter-story drift ratios. For the seismicity of Vancouver, British Columbia, Canada, 11 prototype buildings are evaluated considering different design parameters: coupling ratio, coupling beam shear force profile, CLT wall configuration, building story height, and ductility-related seismic force modification factor. Bi-dimensional numerical models of the systems are developed in OpenSees, and incremental dynamic analyses are performed using 30 ground motion records. Three limit state capacities and three limit state function combinations are utilized to develop probabilistic seismic fragility curves. The fragility curves under the different limit state function combinations are compared, and the effect of the different design parameters is investigated. This study contributes to a deeper understanding of the seismic performance of CLT-CW systems, assisting engineers and researchers in assessing seismic risk and developing seismic-resilient structures.
Identification of Candidate Genes that Affect the Contents of 17 Amino Acids in the Rice Grain Using a Genome-Wide Haplotype Association Study
Authors: Wang Xiaoqian , Xie Lihong , Fang Jiachuang , Pang Yunlong , Xu Jianlong , Li Zhikang
Published: September 2023

Background

The amino acid content (AAC) of the rice grain is one of the most important determinants of nutritional quality in rice. Understanding the genetic basis of grain AAC and mining favorable alleles of target genes for AAC are important for developing new cultivars with improved nutritional quality.

Results

Using a diverse panel of 164 accessions genotyped by 32 M SNPs derived from 3 K Rice Genome Project, we extracted 1,123,603 high quality SNPs in 44,248 genes and used them to construct haplotypes. We measured the contents of the 17 amino acids that included seven essential amino acids and 10 dispensable amino acids. Through a genome-wide haplotype association study, 261 gene-trait associations containing 174 genes for the 17 components of AAC were detected, and 34 of these genes were associated with at least two components. Furthermore, the associated SNPs in genes were also identified by a traditional genome-wide association study to identify the key natural variations in the specific genes.

Conclusions

The genome-wide haplotype association study allowed us to detected candidate genes directly and to identify key natural genetic variation as well. In the present study, twelve genes have been cloned, and 34 genes were associated with at least two components, suggesting that the genome-wide haplotype association study approach used in the current study is an efficient way to identify candidate genes for target traits. The identified candidate genes, favorable haplotypes, and key natural variations affecting AAC provide valuable resources for further functional characterization and genetic improvement of rice nutritional quality.
The pear genomics database (PGDB): a comprehensive multi-omics research platform for Pyrus spp.
Authors: Chen Shulin , Sun Manyi , Xu Shaozhuo , Xue Cheng , Wei Shuwei , Zheng Pengfei , Gu Kaidi , Qiao Zhiwen , Liu Zhiying , Zhang Mingyue , Wu Jun
Published: September 2023

Background

Pears are among the most important temperate fruit trees in the world, with significant research efforts increasing over the last years. However, available omics data for pear cannot be easily and quickly retrieved to enable further studies using these biological data.

Description

Here, we present a publicly accessible multi-omics pear resource platform, the Pear Genomics Database (PGDB). We collected and collated data on genomic sequences, genome structure, functional annotation, transcription factor predictions, comparative genomics, and transcriptomics. We provide user-friendly functional modules to facilitate querying, browsing and usage of these data. The platform also includes basic and useful tools, including JBrowse, BLAST, phylogenetic tree building, and additional resources providing the possibility for bulk data download and quick usage guide services.

Conclusions

The Pear Genomics Database (PGDB, http://pyrusgdb.sdau.edu.cn) is an online data analysis and query resource that integrates comprehensive multi-omics data for pear. This database is equipped with user-friendly interactive functional modules and data visualization tools, and constitutes a convenient platform for integrated research on pear.
Analysis of bZIP gene family in lotus (Nelumbo) and functional study of NnbZIP36 in regulating anthocyanin synthesis
Authors: Zhou Ping , Li Jingwen , Jiang Huiyan , Jin Qijiang , Wang Yanjie , Xu Yingchun
Published: September 2023

Background

The basic leucine zipper (bZIP) family is a predominant group of transcription factors in plants, involved in regulating plant growth, development, and response to stressors. Additionally, the bZIP gene family has a key role in anthocyanin production. Despite the significant role of bZIP genes in plants, their potential contribution in lotus remains understudied.

Results

A total of 124 bZIP genes (59 NnbZIPs and 65 NlbZIPs) were identified from genomes of two lotus species. These genes were classified into 13 groups according to the grouping principle of the Arabidopsis bZIP gene family. Analysis of promoter cis-acting elements indicated that most bZIP gene family members in lotus are associated with response to abiotic stresses. The promoters of some bZIP genes contain MYB binding sites that regulate anthocyanin synthesis. We examined the anthocyanin content of the petals from three different colored lotus, combined with transcriptome data analysis and qRT-PCR results, showing that the expression trends of NnbZIP36 and the homologous gene NlbZIP38 were significantly correlated with the anthocyanin content in lotus petals. Furthermore, we found that overexpression of NnbZIP36 in Arabidopsis promoted anthocyanin accumulation by upregulating the expression of genes (4CL, CHI, CHS, F3H, F3'H, DFR, ANS and UF3GT) related to anthocyanin synthesis.

Conclusions

Our study enhances the understanding of the bZIP gene family in lotus and provides evidence for the role of NnbZIP36 in regulating anthocyanin synthesis. This study also sets the stage for future investigations into the mechanism by which the bZIP gene family regulates anthocyanin biosynthesis in lotus.
Predictive models for short-term mortality and length of hospital stay among adults with community-onset bacteraemia before and during the COVID-19 pandemic: application of early data dynamics
Authors: Lee Ching-Chi , Hung Yuan-Pin , Hsieh Chih-Chia , Ho Ching-Yu , Hsu Chiao-Ya , Li Cheng-Te , Ko Wen-Chien
Published: September 2023

Background

The development of scoring systems to predict the short-term mortality and the length of hospital stay (LOS) in patients with bacteraemia is essential to improve the quality of care and reduce the occupancy variance in the hospital bed.

Methods

Adults hospitalised with community-onset bacteraemia in the coronavirus disease 2019 (COVID-19) and pre-COVID-19 eras were captured as the validation and derivation cohorts in the multicentre study, respectively. Model I incorporated all variables available on day 0, Model II incorporated all variables available on day 3, and Models III, IV, and V incorporated the variables that changed from day 0 to day 3. This study adopted the statistical and machine learning (ML) methods to jointly determine the prediction performance of these models in two study cohorts.

Results

A total of 3,639 (81.4%) and 834 (18.6%) patients were included in the derivation and validation cohorts, respectively. Model IV achieved the best performance in predicting 30-day mortality in both cohorts. The most frequently identified variables incorporated into Model IV were deteriorated consciousness from day 0 to day 3 and deteriorated respiration from day 0 to day 3. Model V achieved the best performance in predicting LOS in both cohorts. The most frequently identified variables in Model V were deteriorated consciousness from day 0 to day 3, a body temperature ≤ 36.0 °C or ≥ 39.0 °C on day 3, and a diagnosis of complicated bacteraemia.

Conclusions

For hospitalised adults with community-onset bacteraemia, clinical variables that dynamically changed from day 0 to day 3 were crucial in predicting the short-term mortality and LOS.
A CT-based nomogram established for differentiating gastrointestinal heterotopic pancreas from gastrointestinal stromal tumor: compared with a machine-learning model
Authors: Feng Na , Chen Hai-Yan , Wang Xiao-Jie , Lu Yuan-Fei , Zhou Jia-Ping , Zhou Qiao-Mei , Wang Xin-Bin , Yu Jie-Ni , Yu Ri-Sheng , Xu Jian-Xia
Published: September 2023

Objective

To identify CT features and establish a nomogram, compared with a machine learning-based model for distinguishing gastrointestinal heterotopic pancreas (HP) from gastrointestinal stromal tumor (GIST).

Materials and methods

This retrospective study included 148 patients with pathologically confirmed HP (n = 48) and GIST (n = 100) in the stomach or small intestine that were less than 3 cm in size. Clinical information and CT characteristics were collected. A nomogram on account of lasso regression and multivariate logistic regression, and a RandomForest (RF) model based on significant variables in univariate analyses were established. Receiver operating characteristic (ROC) curve, mean area under the curve (AUC), calibration curve and decision curve analysis (DCA) were carried out to evaluate and compare the diagnostic ability of models.

Results

The nomogram identified five CT features as independent predictors of HP diagnosis: age, location, LD/SD ratio, duct-like structure, and HU lesion/pancreas A. Five features were included in RF model and ranked according to their relevance to the differential diagnosis: LD/SD ratio, HU lesion/pancreas A, location, peritumoral hypodensity line and age. The nomogram and RF model yielded AUC of 0.951 (95% CI: 0.842–0.993) and 0.894 (95% CI: 0.766–0.966), respectively. The DeLong test found no statistically significant difference in diagnostic performance (p > 0.05), but DCA revealed that the nomogram surpassed the RF model in clinical usefulness.

Conclusion

Two diagnostic prediction models based on a nomogram as well as RF method were reliable and easy-to-use for distinguishing between HP and GIST, which might also assist treatment planning.
Clinical impact of myosteatosis measured by magnetic resonance imaging on long-term outcomes of hepatocellular carcinoma after radical hepatectomy
Authors: Yoshikawa Kozo , Shimada Mitsuo , Morine Yuji , Ikemoto Tetsuya , Saito Yu , Yamada Shinichiro , Teraoku Hiroki , Takao Shoichiro
Published: September 2023

Aims

A variety of factors have been reported to affect long-term outcomes after radical resection of hepatocellular carcinoma (HCC). However, the indicators remain controversial. The purpose of this study was to evaluate the relationship between myosteatosis of the multifidus muscle and long-term outcomes after radical surgery for HCC.

Methods

We retrospectively analyzed clinicopathological data for 187 patients with HCC who underwent radical surgery at Tokushima University between January 2009 and December 2020 and measured the density of fat in the multifidus muscle at L3 on their preoperative magnetic resonance images (MRI). Associations of myosteatosis and clinicopathological factors with long-term outcomes were evaluated.

Results

The patients were divided into a myosteatosis-negative group (n = 122) and a myosteatosis-positive group (n = 65). The cancer-specific survival rate after hepatectomy was significantly worse in the myosteatosis-positive group than in the myosteatosis-negative group (p = 0.03). Univariate analysis identified multiple tumors, stage III/IV disease, an alfa-fetoprotein level ≥ 10 ng/ml, PIVKA-II ≥ 400 AU/ml, vp(+) status, and myosteatosis to be prognostic factors for cancer-specific survival. Multivariate analysis revealed multiple tumors, an alfa-fetoprotein level ≥ 10 ng/ml, and myosteatosis to be independent prognostic factors.

Conclusions

Myosteatosis measured by MRI is a simple and useful predictor of the long-term outcome after radical surgery for HCC.
Endophytic fungal species Nigrospora oryzae and Alternaria alternata exhibit antimicrobial activity against gram-positive and gram-negative multi-drug resistant clinical bacterial isolates
Authors: Fanele Asiphe , Ndlovu Sizwe I.
Published: September 2023

Background

The emergence of multidrug-resistant pathogens and the lack of new antimicrobial drugs is a major public health concern that needs urgent and innovative solutions. Endophytic fungi living in unique niches such as in endosymbiosis with plants are increasingly drawing attention as alternative sources of novel and chemically diverse compounds with unique mechanisms of action.

Methods

In the present study, ten endophytic fungi isolated from the medicinal plant, Sclerocarya birrea were screened for bioactivity against a panel of indicator bacteria. Three bioactive endophytic fungi (strains P02PL2, P02MS1, and P02MS2A) were selected and identified through ITS-rDNA sequencing. The whole broth extracts of the three selected isolates were further screened against contemporary drug-resistant bacterial pathogens. This was followed by partial purification by solid phase extraction and GC–MS analysis of bioactive fractions.

Results

The bioactive endophytic fungi were identified as Alternaria alternata species (strains P02PL2 and P02MS1) and Nigrospora oryzae (strain P02MS2A). The whole broth extracts from N. oryzae P02MS2A exhibited a MIC of one μg/mL and 16 μg/mL against gram-negative, MDR Pseudomonas 5625574 and gram-positive MRSA 25775 clinical isolates, respectively. After partial purification and GC–MS analysis of whole broth extract from A. alternaria PO2MS1, 2-fluorobenzoic acid heptadecyl was putatively identified as the active compound in fraction C of this extract. This compound was also putatively identified in fraction E of A. alternata P02PL2, fraction B of A. alternata P02MS1 and fraction B of N. oryzae P02MS2A, and interestingly, all these fractions retained activity against the two MDR clinical isolates.

Conclusion

The putative identification of 2-fluorobenzoic acid heptadecyl compound showing a broad-spectrum of activity, more especially against gram-negative MDR contemporary pathogens is highly encouraging in the initiative at developing novel drugs to combat multi-drug resistance.
A generalizable and interpretable model for mortality risk stratification of sepsis patients in intensive care unit
Authors: Zhuang Jinhu , Huang Haofan , Jiang Song , Liang Jianwen , Liu Yong , Yu Xiaxia
Published: September 2023

Purpose

This study aimed to construct a mortality model for the risk stratification of intensive care unit (ICU) patients with sepsis by applying a machine learning algorithm.

Methods

Adult patients who were diagnosed with sepsis during admission to ICU were extracted from MIMIC-III, MIMIC-IV, eICU, and Zigong databases. MIMIC-III was used for model development and internal validation. The other three databases were used for external validation. Our proposed model was developed based on the Extreme Gradient Boosting (XGBoost) algorithm. The generalizability, discrimination, and validation of our model were evaluated. The Shapley Additive Explanation values were used to interpret our model and analyze the contribution of individual features.

Results

A total of 16,741, 15,532, 22,617, and 1,198 sepsis patients were extracted from the MIMIC-III, MIMIC-IV, eICU, and Zigong databases, respectively. The proposed model had an area under the receiver operating characteristic curve (AUROC) of 0.84 in the internal validation, which outperformed all the traditional scoring systems. In the external validations, the AUROC was 0.87 in the MIMIC-IV database, better than all the traditional scoring systems; the AUROC was 0.83 in the eICU database, higher than the Simplified Acute Physiology Score III and Sequential Organ Failure Assessment (SOFA),equal to 0.83 of the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV), and the AUROC was 0.68 in the Zigong database, higher than those from the systemic inflammatory response syndrome and SOFA. Furthermore, the proposed model showed the best discriminatory and calibrated capabilities and had the best net benefit in each validation.

Conclusions

The proposed algorithm based on XGBoost and SHAP-value feature selection had high performance in predicting the mortality of sepsis patients within 24 h of ICU admission.
Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare
Authors: Gustavsson Catharina , Nordqvist Maria , Bruhn Åsa Bergman , Bröms Kristina , Jerdén Lars , Kallings Lena V. , Wallin Lars
Published: September 2023

Background

The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions).

Methods

This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions.

Results

During the implementation intervention, the workplaces’ readiness-to-change and the healthcare staff’s confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method.

Conclusion

The implementation intervention was not sufficient to produce sustained change of the healthcare staff’s behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs’ sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws.

Trial registration

Registered in the ISRCTN registry with study registration number: ISRCTN15551042 (Registration date: 12/01/2016).
Development of a brief, generic, modular resource-use measure (ModRUM): piloting with patients
Authors: Garfield Kirsty , Thorn Joanna C. , Noble Sian , Husbands Samantha , Hollingworth Will
Published: September 2023

Background

Bespoke self-report resource-use measures (RUMs) are commonly developed or adapted for each new randomised controlled trial. Consequently, RUMs lack standardisation and validation is rarely conducted. A new generic RUM, ModRUM, has been developed using a rigorous process, including consultation with health economists and patients. ModRUM includes a concise core healthcare module, designed to be included in all trials, and depth-adding questions, which can replace or be added to core questions as needed. Modules covering other sectors are under development. The aim of this study was to test the acceptability, feasibility, and criterion and construct validity of the healthcare module of ModRUM.

Methods

Patients who had a recent appointment at their GP practice were invited to complete ModRUM (core module or core module with depth questions), a characteristics form and the EQ-5D-5L. Acceptability was assessed via response rates and questionnaire completion time. Feasibility was assessed by reviewing issues observed in participants’ responses and question completion rates. Construct validity was tested via hypothesis testing and known-group analyses, using Wilcoxon rank-sum and Kruskal–Wallis tests, and a generalised linear model. Criterion validity was tested by comparing ModRUM results with primary care medical records. Sensitivity, specificity, and agreement using Lin’s concordance correlation coefficient (pc) were estimated.

Results

One hundred patients participated from five GP practices in the South-West of England. Acceptability was higher for the core module (20% versus 10% response rate). Question completion rates were high across both versions (> 90%). Some support was observed for construct validity, with results suggesting that healthcare costs differ dependent on the number of long-term conditions (p < 0.05) and are negatively associated with health-related quality of life (p < 0.01). Sensitivity was high for all questions (> 0.83), while specificity varied (0.33–0.88). There was a good level of agreement for GP contacts and costs, and prescribed medication costs (pc > 0.6).

Conclusion

This study provided preliminary evidence of the acceptability, feasibility, and criterion and construct validity of ModRUM. Further testing is required within trials and with groups that were less well represented in this study.