bluuebunny/crossref_metadata_2025 huggingface dataset:
Statistics for undergraduate medical students in Sudan: associated factors for using statistical analysis software and attitude toward statistics among undergraduate medical students in Sudan
Authors: Hasabo Elfatih A. , Ahmed Ghassan E. Mustafa , Alkhalifa Raed M. , Mahmoud Mai D. , Emad Sara , Albashir Roaa B. , Mansour Mohamed E. , Hsabo Elmuiz A.
Published: December 2022

Introduction

Statistics helps medical students understand research. Without understanding statistics, students can’t choose the proper analysis in their research. We aimed to assess the attitude toward statistics, usage of statical software and associated factors for using statistical analysis software in Sudan.

Method

A cross-sectional online survey was distributed among undergraduate medical students across ten Sudanese universities. The study aimed to measure their attitude towards statistics using Survey of Attitudes Toward Statistics (SATS-36) scale.

Results

In total, 489 students were participated with a mean age of 21.94 ± 1.61 and a slight female preponderance (52%, n = 256). The overall attitude towards statistics was 4.64 ± 0.91. The mean attitude scores for the components of SATS-36 scale was higher for students who were using statistical analysis software demonstrating significant difference in affect (p = 0.002), cognitive competence (p = 0.002), value (p = 0.002), Interest (p = 0.004) and Effort (p = 0.029). Almost half of the students (47%) had attended a biostatistics workshop with only 26% of them reported using statistical analysis software. Of the latter group, 72% (n = 91) used SPSS while 50% (n = 64) used excel. Univariate logistic regression showed students who had previously used an statistical software were more likely to be studying in their sixth year compared with second year (OR: 12.652, CI 95% 4.803– 33.332; p < 0.001), older age (OR: 1.224, CI 95% 1.079– 1.388; p = 0.002), attended a course in research methodology (OR: 3.383, CI 95% 2.120– 5.398; p < 0.001) or biostatistics (OR: 1.886, CI 95% 1.252– 2.841; p = 0.002), initiated or participated in a research project (OR:4.349, CI 95% 2.839 – 6.661;p < 0.001) or published a paper (OR: 8.271, CI 95% 3.542 – 19.312; p < 0.001).

Conclusions

The study showed an average attitude towards statistics among medical students. Being at higher years, participating or publishing research and attending research workshop are associated with the usage of statistical software. Also, few students were using statistical software.
Measurement of provider fidelity to immunization guidelines: a mixed-methods study on the feasibility of documenting patient refusals of the human papillomavirus vaccine
Authors: Chang Rachel S. , Shing Jaimie Z. , Erves Jennifer C. , Du Liping , Koyama Tatsuki , Deppen Stephen , Rentuza Alyssa B. , McAfee Caree , Stroebel Christine , Cates Janet , Harnack Lora , Andrews David , Bramblett Robert , Hull Pamela C.
Published: December 2022

Background

Assessment and feedback is a common implementation strategy to improve healthcare provider fidelity to clinical guidelines. For immunization guidelines, fidelity is often measured with doses administered during eligible visits. Adding a patient refusal measure captures provider fidelity more completely (i.e., all instances of a provider recommending a vaccine, resulting in vaccination or refusal) and enables providers to track patient vaccine hesitancy patterns. However, many electronic health record (EHR) systems have no structured field to document multiple instances of refusals for specific vaccines, and existing billing codes for refusal are not vaccine specific. This study assessed the feasibility of a novel method for refusal documentation used in a study focused on human papillomavirus (HPV) vaccine.

Methods

An observational, descriptive-comparative, mixed-methods study design was used to conduct secondary data analysis from an implementation-effectiveness trial. The parent trial compared coach-based versus web-based practice facilitation, including assessment and feedback, to increase HPV vaccination in 21 community-based private pediatric practices. Providers were instructed to document initial HPV vaccine refusals in the EHR's immunization forms and subsequent refusals using dummy procedure codes, for use in assessment and feedback reports. This analysis examined adoption and maintenance of the refusal documentation method during eligible well visits, identified barriers and facilitators to documentation and described demographic patterns in patient refusals.

Results

Seven practices adopted the refusal documentation method. Among adopter practices, documented refusals started at 2.4% of eligible well visits at baseline, increased to 14.2% at the start of implementation, peaked at 24.0%, then declined to 18.8%. Barriers to refusal documentation included low prioritization, workflow integration and complication of the billing process. Facilitators included high motivation, documentation instructions and coach support. Among adopter practices, odds of refusing HPV vaccine were 25% higher for patients aged 15–17 years versus 11–12 years, and 18% lower for males versus females.

Conclusions

We demonstrated the value of patient refusal documentation for measuring HPV vaccination guideline fidelity and ways that it can be improved in future research. Creation of vaccine-specific refusal billing codes or EHR adaptations to enable documenting multiple instances of specific vaccine refusals would facilitate consistent refusal documentation.

Trial Registration NCT03399396 Registered in ClinicalTrials.gov on 1/16/2018.
Assessment of maternal services in China based on WHO’s comprehensive evaluation model
Authors: Liu Yalan , Yan Li , Xia Yulin
Published: December 2022

Background

To understand the trend of equalization in maternal services and to guide policy-makers regarding resource allocation and public health policy in China.

Methods

Twelve indicators, including maternal services needs, utilization, and resource allocation, were collected from China Health Statistical Year Book 2010 and 2020. WHO’s comprehensive evaluation model and the non-integral Rank Sum Ratio (RSR) method were used to analyze, rank, and categorize maternal services of 31 provinces (cities, autonomous regions) in China.

Results

All provinces (cities, autonomous regions) are grouped into relative balance areas, low input areas, resource shortage areas, overutilization areas, and resource waste areas. In 2019, there were 18 provinces (cities, autonomous regions) in the relative balanced area, and more than one-half had achieved equal development. Compared to 2009, the resource shortage area decreased from three to zero, and the resource waste area increased from four to six. Among the provinces (cities, autonomous regions) with a type change compared with 2009, eight changed to a relative balance areas, and four showed an improvement.

Conclusion

Under the policy guidance of promoting the equalization of public health services, maternal services are gradually realized. However, several provinces (cities, autonomous regions) still have problems such as the mismatch between resource input and health needs, resource waste, over-utilization, etc. Therefore, specific policies should be formulated according to the actual types to promote the transformation into equalization regions.
Canadian dental hygienists’ experiences and perceptions of regulatory guidelines during the COVID-19 pandemic: a qualitative descriptive analysis
Authors: Macdonald Lindsay K. , Glogauer Michael , Allison Paul , Quiñonez Carlos , Madathil Sreenath , Rock Leigha D.
Published: December 2022

Background

In Spring of 2020, due to the COVID-19 pandemic, Canadian provincial dental hygiene regulatory bodies implemented new practice guidelines. Reports of stress, anxiety and conflict experienced by dental hygienists have been linked to miscommunication between oral health regulators at this time. Limited data exists on the perceptions and experiences of dental hygienists navigating new guidelines for dental hygiene care during the pandemic. Therefore, the objective of our study was to explore via descriptive thematic analysis how dental hygienists experienced and perceived: i) dental hygiene practice during the COVID-19 pandemic, and ii) their regulatory body’s COVID-19 guidelines.

Methods

Participants were identified through provincial dental hygiene licensing bodies. Online bi-monthly questionnaires were administered to participants (n = 876) from December 2021 to January 2022. Two open-ended questions were asked in the questionnaire. A qualitative descriptive thematic analysis was applied to these two questions.

Results

Major themes at baseline relayed challenges related to workplace compliance, patient treatment and communication of practice protocols. Across responses, hygienists confirmed conflicting messaging from regulators and guideline interpretations as stressors impacting their professional practice and satisfaction within the profession. Participant responses at endpoint cited increased satisfaction with regulatory guidelines as the pandemic evolved, yet inconsistencies in regulators’ messaging was noted as a prevailing issue.

Conclusion

Inconsistent guideline messaging reflects an increased need for collaboration amongst oral health care regulators to streamline protocols for practice and reduce interprofessional conflict in pandemic circumstances. A national unified approach is warranted in establishing guidelines for dental hygiene practice in Canada.
Associations between urinary concentrations of bisphenols and serum concentrations of sex hormones among US. Males
Authors: Zhang Chichen , Luo Yuehong , Qiu Shi , Huang Xinyi , Jin Kun , Li Jiakun , Yang Mi , Hu Dan , Zheng Xiaonan , Jiang Zhongyuan , Wang Mingda , Zou Xiaoli , Wei Qiang
Published: December 2022

Background

Bisphenol A (BPA) exposure and its structural analogs (BPS and BPF) might cause endocrine alterations and adverse physiological effects. Few studies to date have directly explored the association between its structural analogs (BPS, BPF) and sex hormones in adult male participants. Therefore, we aimed to assess the associations between BPA, BPS, BPF, and sex hormones in American adult men.

Methods

We used data from the U.S. National Health and Nutrition Examination Survey 2011–2016. We excluded participants without data available on sex hormones and urinary bisphenols. Furthermore, participants consuming sex hormone medications were excluded. Multivariable regression models were performed to assess the association between bisphenols and sex hormones.

Results

In this study, 2367 participants were included. Of 2367, in 1575 participants, the data on BPS and BPF were available. We found that a per unit increase in BPF was associated with 0.575 ng/dL higher total testosterone (TT) (Model 2: 95% CI: 0.047, 1.103, P = 0.033). However, there was no significant association between BPA or BPS and TT. Furthermore, increased BPA and BPS levels were associated with higher levels of sex hormone-binding globulin (SHBG) (Model 2: β = 0.364, 95% CI: 0.158, 0.571; β = 0.25, 95% CI: 0.071, 0.429, respectively). Additionally, participants in the highest BPA exposure quartile (quartile 4) had 4.072 nmol/L higher levels of SHBG than those in quartile 1 (Model 2: 95% CI: 0.746, 7.397, P = 0.017; P for trend =0.005). Both BPA and BPS were negatively associated with free testosterone (FT, nmol/L) after full adjustment (Model 2, β = − 0.01%, P = 0.0211, P = 0.0211; Model 2, β = − 0.01%, P = 0.0258, respectively). However, BPF was positively associated with FT (Model 2, β = 0.0029%, P = 0.0028).

Conclusion

Our study indicated that exposure to both BPA and its substitutions could alter sex hormone levels. This finding supports the possibility that human exposure to bisphenols at environmental levels might affect the endogenous hormone balance.
Dynamics of COVID-19 progression and the long-term influences of measures on pandemic outcomes
Authors: Lan Yihong , Yin Li , Wang Xiaoqin
Published: December 2022

The pandemic progression is a dynamic process, in which measures yield outcomes, and outcomes in turn influence subsequent measures and outcomes. Due to the dynamics of pandemic progression, it is challenging to analyse the long-term influence of an individual measure in the sequence on pandemic outcomes. To demonstrate the problem and find solutions, in this article, we study the first wave of the pandemic—probably the most dynamic period—in the Nordic countries and analyse the influences of the Swedish measures relative to the measures adopted by its neighbouring countries on COVID-19 mortality, general mortality, COVID-19 incidence, and unemployment. The design is a longitudinal observational study. The linear regressions based on the Poisson distribution or the binomial distribution are employed for the analysis. To show that analysis can be timely conducted, we use table data available during the first wave. We found that the early Swedish measure had a long-term and significant causal effect on public health outcomes and a certain degree of long-term mitigating causal effect on unemployment during the first wave, where the effect was measured by an increase of these outcomes under the Swedish measures relative to the measures adopted by the other Nordic countries. This information from the first wave has not been provided by available analyses but could have played an important role in combating the second wave. In conclusion, analysis based on table data may provide timely information about the dynamic progression of a pandemic and the long-term influence of an individual measure in the sequence on pandemic outcomes.
Feasibility and effectiveness of WhatsApp online group on breastfeeding by peer counsellors: a single-blinded, open-label pilot randomized controlled study
Authors: Fan Heidi S. L. , Ho M. Y. , Ko Rachel W. T. , Kwok Jojo Y. Y. , Chau P. H. , Wong Janet Y. H. , Wang M. P. , Lok Kris Y. W.
Published: December 2022

Introduction

With mobile technologies becoming more advanced and accessible, mobile health (mHealth) has been incorporated in delivering timely and convenient breastfeeding support. However, its feasibility and potential efficacy remain to be examined. Therefore, the primary objective of this study is to assess the feasibility and acceptability of an online instant messaging peer support group for breastfeeding. The secondary objective is to evaluate the effect of the intervention on breastfeeding outcomes.

Methods

A pilot randomized controlled trial was conducted. A total of 33 primiparous women were recruited in the antenatal clinic at a public hospital in Hong Kong between March and April 2021. They were randomized to receive either standard care (n = 18) or standard care and receive peer-group support in an online instant messaging app (n = 15). Participants received telephone follow-up for up to six months postpartum or until they stopped breastfeeding. After completing the study, six participants in the intervention group were interviewed to understand their perceptions of the intervention.

Results

This pilot study shows that online messaging peer support group is feasible and acceptable to women. In total, 54.4% of the eligible women agreed to participate, and 97.0% completed the follow-up. Participants perceived that providing peer support through instant messaging app is appropriate. It serves as a channel for the participants to ask questions and obtain information. Furthermore, meetings of the peer supporters and group members can be held to enhance the effectiveness of the intervention. In addition, no significant differences were found in any and exclusive breastfeeding rates, breastfeeding attitude, and breastfeeding self-efficacy between the two groups.

Conclusions

This study shows that online messaging peer support group is feasible and acceptable. A full-scale study should be conducted to understand the effect of the online instant messaging peer support group on breastfeeding outcomes.

Trial Registration:

The study protocol is registered onClinicaltrial.gov(NCT04826796) on 1 April 2021
Clinical and imaging characteristics of cardiac magnetic resonance presenting with myocardial infarction with non-obstructive coronary arteries in China
Authors: Zhao Xinxiang , Zeng Daobing , He Liping , Sun Wenjing
Published: December 2022

Background

The characteristics are still unclear due to lack of systematic research on patients with myocardial infarction non-obstructive coronary arteries (MINOCA) in China. This study aimed to explore the clinical and imaging features of MINOCA patients.

Methods

The patients who were diagnosed as suspected MI were studied. Cardiac magnetic resonance (CMR) was performed after coronary angiography or coronary computed tomographic angiography examination within one week. Myocardial infarction (MI) was determined by late gadolinium enhancement CMR.The patients with MI were divided into MINOCA and MICAD group according to whether the degree of coronary stenosis was greater than 50%. Cardiac function and imaging characteristics between the two groups were analyzed.

Results

21 patients with MINOCA and 30 patients with myocardial infarction with obstructive coronary artery disease (MICAD) were analyzed. MINOCA patients were younger, and the electrocardiogram was commonly featured by non-ST-elevation. The parameters of left ventricular function were significantly different between the two groups including left ventricular ejection fraction, stroke volume, cardiac output, myocardial mass, and peak ejection rate (P < 0.05). Besides, MINOCA patients had smaller area of MI, less score of transmural extent, fewer involved segments. Furthermore, the transmural extent of MI in MINOCA patients was mainly grade I, that is, most of them were subendocardial MI, which was significantly negatively correlated with the amount of first-pass perfusion.

Conclusions

The clinical characteristics combined with imaging features of CMR may be effective to evaluate the cardiac function in order to make clinical decision for MINOCA patients in China.
Trends in the prevalence, prenatal diagnosis, and outcomes of births with chromosomal abnormalities: a hospital-based study in Zhejiang Province, China during 2014–2020
Authors: Chen Xinning , Lin Dan , Ye Yinghui , Zhang Xiaohui , Chen Danqing
Published: December 2022

Background

To investigate the prevalence and prenatal diagnosis rate of chromosomal abnormalities (CA) in Zhejiang Province, China.

Methods

We estimated the annual changes in the detected prevalence of CA and prenatal diagnosis rate among 681,590 births in Zhejiang Province, China, between 2014 and 2020. Data were derived from the provincial birth defects surveillance system, which represents 30% of annual births in Zhejiang Province. The effect of maternal age was also evaluated.

Results

The detected prevalence of sex chromosomal abnormalities (1.70–7.30 per 10,000 births, Ptrend < 0.001) and microdeletion and microduplication (0.30–6.81 per 10,000 births, Ptrend < 0.001) gradually increased, contributing to an upward trend in overall CA (12.09–39.22 per 10,000 births). The diagnosis rate before 22 gestational weeks constantly increased from 20.8 to 70.1% for trisomy 21 (Ptrend = 0.003). The prevalence rate ratio for maternal age of ≥ 35 years was higher than that for maternal age of 25–29 years for trisomy 21 (5.40, 95% confidence interval [CI] 4.59–6.35) and sex chromosomal abnormalities (3.28, 95% CI 2.48–4.33).

Conclusions

The rising prevalence of CA in China may be attributable to the elevated maternal age and the innovation of prenatal diagnosis tools, Thus, studies should pay attention to the rare CA that were previously ignored, and select rational screening tools.
Clinical and genetic characterization of pediatric patients with progressive familial intrahepatic cholestasis type 3 (PFIC3): identification of 14 novel ABCB4 variants and review of the literatures
Authors: Chen Rong , Yang Feng-Xia , Tan Yan-Fang , Deng Mei , Li Hua , Xu Yi , Ouyang Wen-Xian , Song Yuan-Zong
Published: December 2022

Background

Progressive familial intrahepatic cholestasis type 3 (PFIC3) is an autosomal recessive disease caused by pathogenic variants of the gene ABCB4. This study aimed to investigate the ABCB4 genotypic and the clinical phenotypic features of PFIC3 patients.

Methods

The clinical and molecular genetic data of 13 new pediatric patients with PFIC3 as well as 82 reported ones in the PubMed and CNKI databases were collected and analyzed.

Results

The 13 new PFIC3 patients included six females and seven males, and the main presentations were hepatomegaly, splenomegaly, jaundice, and pruritus, as well as increased levels of gamma-glutamyl transpeptidase (GGT). Fourteen new ABCB4 variants were detected, including eight diagnosed to be likely-pathogenic and six, pathogenic. Among all the 95 PFIC3 cases, hepatomegaly was observed in 85.3% (81/95), pruritus in 67.4% (64/95), splenomegaly in 52.6% (50/95), jaundice in 48.4% (46/95), portal hypertension in 34.7% (33/95) and GGT elevation in 100% (88/88) of the patients. Positive responses at varied degrees to oral ursodeoxycholic acid (UDCA) treatment were observed in 66.1% (39/59) of the patients, among whom 38.5% (15/39) fully recovered in terms of the laboratory changes. Although the condition remained stable in 53 patients (58.9%, 53/90), the clinical outcomes were not promising in the rest 37 cases (41.1%, 37/90), including 7 died, 27 having undergone while another 3 waiting for liver transplantation. A total of 96 ABCB4 variants were detected in the 95 patients. PFIC3 patients with biallelic null variants exhibited earlier onset ages [10.5 (2, 18) vs. 19 (8, 60) months, p = 0.007], lower UDCA response rate [18.2% (2/11) vs. 77.1% (37/48), p = 0.001], and more unpromising clinical outcomes [80% (12/15) vs. 33.3% (25/75), p = 0.001], compared with those with non-biallelic null variants.

Conclusions

PFIC3 presented with hepatomegaly, pruritus, splenomegaly and jaundice with increased serum GGT level as a biochemistry hallmark. Although varying degrees of improvement in response to UDCA therapy were observed, 41.1% of PFIC3 patients exhibited unfavorable prognosis. ABCB4 genotypes of biallelic null variants were associated with severer PFIC3 phenotypes. Moreover, the 14 novel variants in this study expanded the ABCB4 mutation spectrum, and provided novel molecular biomarkers for diagnosis of PFIC3 patients.
Large-scale genomic and transcriptomic profiles of rice hybrids reveal a core mechanism underlying heterosis
Authors: Xie Jianyin , Wang Weiping , Yang Tao , Zhang Quan , Zhang Zhifang , Zhu Xiaoyang , Li Ni , Zhi Linran , Ma Xiaoqian , Zhang Shuyang , Liu Yan , Wang Xueqiang , Li Fengmei , Zhao Yan , Jia Xuewei , Zhou Jieyu , Jiang Ningjia , Li Gangling , Liu Miaosong , Liu Shijin , Li Lin , Zeng An , Du Mengke , Zhang Zhanying , Li Jinjie , Zhang Ziding , Li Zichao , Zhang Hongliang
Published: December 2022

Background

Heterosis is widely used in agriculture. However, its molecular mechanisms are still unclear in plants. Here, we develop, sequence, and record the phenotypes of 418 hybrids from crosses between two testers and 265 rice varieties from a mini-core collection.

Results

Phenotypic analysis shows that heterosis is dependent on genetic backgrounds and environments. By genome-wide association study of 418 hybrids and their parents, we find that nonadditive QTLs are the main genetic contributors to heterosis. We show that nonadditive QTLs are more sensitive to the genetic background and environment than additive ones. Further simulations and experimental analysis support a novel mechanism, homo-insufficiency under insufficient background (HoIIB), underlying heterosis. We propose heterosis in most cases is not due to heterozygote advantage but homozygote disadvantage under the insufficient genetic background.

Conclusion

The HoIIB model elucidates that genetic background insufficiency is the intrinsic mechanism of background dependence, and also the core mechanism of nonadditive effects and heterosis. This model can explain most known hypotheses and phenomena about heterosis, and thus provides a novel theory for hybrid rice breeding in future.
Clazakizumab for the treatment of chronic active antibody-mediated rejection (AMR) in kidney transplant recipients: Phase 3 IMAGINE study rationale and design
Authors: Nickerson Peter W. , Böhmig Georg A. , Chadban Steve , Kumar Deepali , Mannon Roslyn B. , van Gelder Teun , Lee James C. , Adler Scott , Chong Edward , Djamali Arjang
Published: December 2022

Background

Chronic active antibody-mediated rejection (AMR) is a major cause of graft loss with no approved drugs for its treatment. Currently, off-label regimens are used, reflecting the high unmet need for effective therapies based on well-controlled trials. Clazakizumab is a high-affinity, humanized monoclonal antibody that binds interleukin-6 and decreases donor-specific antibody (DSA) production and inflammation. Phase 2 pilot studies of clazakizumab in kidney transplant recipients with chronic active AMR suggest modulation of DSA, stabilization of glomerular filtration rate (GFR), and a manageable safety profile. We report the design of the Phase 3 IMAGINE study (NCT03744910) to evaluate the safety and efficacy of clazakizumab for the treatment of chronic active AMR.

Methods

IMAGINE is a multicenter, double-blind trial of approximately 350 kidney transplant recipients with chronic active AMR (Banff chronic glomerulopathy [cg] >0 with concurrent positive human leukocyte antigen DSA) randomized 1:1 to receive clazakizumab or placebo (12.5 mg subcutaneous once every 4 weeks). The event-driven trial design will follow patients until 221 occurrences of all-cause graft loss are observed, defined as return to dialysis, graft nephrectomy, re-transplantation, estimated GFR (eGFR) <15 mL/min/1.73m2, or death from any cause. A surrogate for graft loss (eGFR slope) will be assessed at 1 year based on prior modeling validation. Secondary endpoints will include measures of pharmacokinetics/pharmacodynamics. Recruitment is ongoing across North America, Europe, Asia, and Australia.

Discussion

IMAGINE represents the first Phase 3 clinical trial investigating the safety and efficacy of clazakizumab in kidney transplant recipients with chronic active AMR, and the largest placebo-controlled trial in this patient population. This trial includes prognostic biomarker enrichment and uniquely utilizes the eGFR slope at 1 year as a surrogate endpoint for graft loss, which may accelerate the approval of a novel therapy for patients at risk of graft loss. The findings of this study will be fundamental in helping to address the unmet need for novel therapies for chronic active AMR.

Trial registration

ClinicalTrials.govNCT03744910. Registered on November 19, 2018.
A comparative study of patient satisfaction about anesthesia with dexmedetomidine for ambulatory dental surgery
Authors: Garip Levin , Verbist Jasmin , Stragier Hendrik , Meyns Joeri , Mesotten Dieter , Vundelinckx Joris
Published: December 2022

Objective

Intranasal administration of dexmedetomidine for monitored anesthesia care (MAC) appears to be an effective, safe, and appropriate alternative to general anesthesia (GA) for ambulatory dental surgery. Based on the available evidence we evaluated a new MAC protocol with intranasal dexmedetomidine as the primary choice.

To assess a difference in patient satisfaction and anesthesia-related discomfort between GA and MAC in ambulatory dental surgery, a study was conducted among patients undergoing various dental procedures. Patient satisfaction and anesthesia-related discomfort were assessed on the first postoperative day using the Bauer patient satisfaction questionnaire.

Results

Although the differences were small, patients in the MAC group were overall more satisfied with the general care compared to the GA group (p < 0.02). Patients in the MAC group reported more postoperative drowsiness compared to the GA group (p < 0.05), but less postoperative hoarseness and sore throat (p = 0.005 and p < 0.001, respectively). Moreover, postoperative thirst was more common in the GA group (p = 0.002).

In conclusion, the differences in patient satisfaction and anesthesia-related discomfort between GA and MAC in this implementation study were small but appeared to favor MAC with intranasal dexmedetomidine over GA as anesthesia method during dental ambulatory surgery.
The rare thoracic complication: perforation of gastric fundus ulcer: a case report
Authors: Polyakov I. S. , Kovalenko A. L. , Petrovsky A. N. , Akobyan A. V. , Porhanov V. A.
Published: December 2022

Background

Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012, https://doi.org/10.2169/internalmedicine.51.6823, Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136, Kathayanatt et al. in Lung India 37(2):174–175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy.

Case presentation

A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report.

Conclusions

Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.
Some inequalities for cr-log-h-convex functions
Authors: Liu Wei , Shi Fangfang , Ye Guoju , Zhao Dafang
Published: December 2022

The main purpose of this paper is to study certain inequalities forcr-log-h-convex functions with an interval value. To this end, we first give a definition ofcr-log-h-convexity of interval-valued functions under thecr-order and study some properties of such functions. On this basis, we establish the Jensen-, Hermite–Hadamard-, and Fejér-type inequalities forcr-log-h-convex functions, and discuss some special cases. In addition, we give some numerical examples to illustrate the accuracy of the results obtained.
Balancing wind power deployment and sustainability objectives in Swedish planning and permitting
Authors: Wretling Vincent , Balfors Berit , Mörtberg Ulla
Published: December 2022

Background

Wind power is a critical renewable energy technology in efforts to achieve the global climate targets. However, local impacts do occur, which demands careful consideration in planning and permitting. Sweden has set an ambition to triple land-based wind power by 2040, and municipalities play a key role in both the planning and permitting process, due to a planning monopoly and veto power in the permitting process. This calls for an investigation of Swedish wind power governance, with a particular focus on recent trends in municipal wind power planning, how wind power is balanced in relation to sustainability objectives in planning and permitting, and insights from practitioners regarding their capacities and drivers.

Results

The results show that about two-thirds of Swedish municipalities have conducted wind power planning in some form, but this basis for decision-making has become outdated due to a lack of institutional capacity at the municipal level. Secondly, the study finds that many municipalities perceive that there are insufficient incentives for a continued wind power expansion. Lastly, the study sheds light on a large heterogeneity within wind power planning practice concerning how trade-offs between wind power deployment and other sustainability aspects are handled, as well as a lack of coherence between planning and permitting.

Conclusions

It is concluded that the current state of municipal wind power planning raises questions regarding the legitimacy of municipal decision-making in terms of perceived justice among local inhabitants and highlights the need for updated wind power plans. Moreover, to promote local acceptance in the future, formalised financial compensation and strategic initiatives that enable the localisation of electricity-intensive industry within municipalities with large-scale wind power production can be two key components. The results also highlight the need for additional support at the municipal level, including access to critical competence and relevant knowledge to enable trade-offs between the different sustainability considerations in an informed and balanced manner. Finally, regional dialogue with key actors, such as the military, Sami representatives and grid operators, would facilitate the handling of inter-municipal issues, in particular by fostering co-operation regarding inter-municipal wind sites.
A tree-ring record of historical fire activity in a piedmont longleaf pine (Pinus palustris Mill.) woodland in North Carolina, USA
Authors: Rother Monica T. , Patterson Thomas W. , Knapp Paul A. , Mitchell Tyler J. , Allen Nell
Published: December 2022

Background

Longleaf pine (Pinus palustris Mill.) ecosystems were historically widespread in the North American Coastal Plain and in some southeastern piedmont and montane settings. The naval stores industry, deforestation, and other human activities resulted in an extensive loss (c. 97% loss) of the original woodlands and savannas. Longleaf pine ecosystems are maintained by frequent surface fire which promotes successful regeneration and maintains open canopy conditions and a largely herbaceous understory. Fire regimes (including the frequency and seasonality of fire) likely varied across the entire range of longleaf pine and through time; further research is needed to elucidate this variability.

Results

We used fire scars in stumps and snags to reconstruct fire history in a piedmont longleaf pine ecosystem in North Carolina. For each tree sampled, we examined multiple cross sections to avoid omission of fire events recorded by smaller fire scars. Our samples revealed evidence of frequent fire (c. 3–4-year fire interval) beginning in the early eighteenth century and extending to the mid-nineteenth century. Fires occurred in the dormant and early earlywood positions of annual rings and were likely human ignited.

Conclusions

To our knowledge, this is the first tree-ring-based fire history in longleaf pine of the piedmont. As such, it offers a rare glimpse into historical fire activity in a now scarce but important ecological setting. More research is needed to develop additional fire chronologies in the piedmont region, including for longer periods of time and for larger spatial areas.
Epcoritamab, a Novel, Subcutaneous CD3xCD20 Bispecific T-Cell–Engaging Antibody, in Relapsed or Refractory Large B-Cell Lymphoma: Dose Expansion in a Phase I/II Trial
Authors: Thieblemont Catherine , Phillips Tycel , Ghesquieres Herve , Cheah Chan Y. , Clausen Michael Roost , Cunningham David , Do Young Rok , Feldman Tatyana , Gasiorowski Robin , Jurczak Wojciech , Kim Tae Min , Lewis David John , van der Poel Marjolein , Poon Michelle Limei , Cota Stirner Mariana , Kilavuz Nurgul , Chiu Christopher , Chen Menghui , Sacchi Mariana , Elliott Brian , Ahmadi Tahamtan , Hutchings Martin , Lugtenburg Pieternella J.
Published: December 2022

PURPOSE

Epcoritamab is a subcutaneously administered CD3xCD20 T-cell–engaging, bispecific antibody that activates T cells, directing them to kill malignant CD20+ B cells. Single-agent epcoritamab previously demonstrated potent antitumor activity in dose escalation across B-cell non-Hodgkin lymphoma subtypes.

PATIENTS AND METHODS

In the dose-expansion cohort of a phase I/II study (ClinicalTrials.gov identifier: NCT03625037 ), adults with relapsed or refractory CD20+ large B-cell lymphoma and at least two prior therapy lines (including anti-CD20 therapies) received subcutaneous epcoritamab in 28-day cycles (once weekly step-up doses in weeks 1-3 of cycle 1, then full doses once weekly through cycle 3, once every 2 weeks in cycles 4-9, and once every 4 weeks in cycle 10 and thereafter) until disease progression or unacceptable toxicity. The primary end point was overall response rate by the independent review committee.

RESULTS

As of January 31, 2022, 157 patients were treated (median age, 64 years [range, 20‐83]; median of three [range, 2-11] prior therapy lines; primary refractory disease: 61.1%; prior chimeric antigen receptor (CAR) T-cell exposure: 38.9%). At a median follow-up of 10.7 months, the overall response rate was 63.1% (95% CI, 55.0 to 70.6) and the complete response rate was 38.9% (95% CI, 31.2 to 46.9). The median duration of response was 12.0 months (among complete responders: not reached). Overall and complete response rates were similar across key prespecified subgroups. The most common treatment-emergent adverse events were cytokine release syndrome (49.7%; grade 1 or 2: 47.1%; grade 3: 2.5%), pyrexia (23.6%), and fatigue (22.9%). Immune effector cell–associated neurotoxicity syndrome occurred in 6.4% of patients with one fatal event.

CONCLUSION

Subcutaneous epcoritamab resulted in deep and durable responses and manageable safety in highly refractory patients with large B-cell lymphoma, including those with prior CAR T-cell exposure.
Neoadjuvant Treatment Versus Upfront Surgery in Resectable Pancreatic Cancer: A Cost-Effectiveness Analysis
Authors: Arjani Simran , Prasath Vishnu , Suri Nipun , Li Sharon , Ahlawat Sushil , Chokshi Ravi J.
Published: December 2022

PURPOSE:

Pancreatic cancer (PC) has an overall 5-year survival rate of 10%. The use of neoadjuvant chemoradiation is debated in resectable disease. The purpose of this study is to evaluate the cost-effectiveness of neoadjuvant chemoradiation followed by pancreaticoduodenectomy (NACRT) versus upfront pancreaticoduodenectomy and adjuvant chemotherapy (USR) in resectable PC.

METHODS:

A decision tree model was used to estimate the cost-effectiveness of NACRT versus USR. Values from the published literature populate the tree: costs from Medicare (FY2021) reimbursements, and morbidity and survival data for quality-adjusted life-years (QALYs). Patients with resectable pancreatic adenocarcinoma who qualified for resection were included. The ICER was the primary outcome. The model was validated using one-way and two‐way deterministic, as well as probabilistic sensitivity analyses.

RESULTS:

The base case was modeled using a 65-year-old male. NACRT yielded 1.61 QALYs at $45,483.52 USD. USR yielded 1.47 QALYs at a discount of $6,840.96 USD. The ICER was $48,130 USD, which favors NACRT. One-way sensitivity analyses upheld these results except when ≤ 21.0% of NACRT patients proceeded to surgery and when ≤ 85.4% of NACRT patients were resectable at surgery. Two-way sensitivity analyses also favored NACRT except in cases when the proportion of resected disease after NACRT decreased. NACRT was favored in 94.3% of 100,000 random-sampling simulations.

CONCLUSION:

It is more cost-effective to administer NACRT before surgery for patients with resectable PC. On the basis of sensitivity analyses, USR with adjuvant therapy is only favored if rates of resection and eligibility for resection after NACRT decrease. NACRT should be considered in all patients unless there is an absolute contraindication.
Introduction: Peter Weiss and The Aesthetics of Resistance
Authors: Evers Kai , Hell Julia , Howes Seth
Published: December 2022

In this introduction the editors first trace the reception of Peter Weiss’s Aesthetics of Resistance in (West) Germany and the United States. Focusing on the relation between politics and aesthetics, some critics characterized this relation as fraught, arguing that the novel’s supposedly outdated politics ultimately rendered it obsolete. Others approached the novel as a writing experiment articulating politics and aesthetics in tense but productive ways. Proceeding and departing from these established views of Weiss’s text, the editors then propose a reading that understands the novel as deliberately opening itself up to future readings, a text conceived and structured to engage readers of not-yet-determined futures.
Looking Away: On Théodore Géricault’s The Raft of the Medusa and the Narration of Political Pedagogy in The Aesthetics of Resistance
Authors: Evers Kai
Published: December 2022

Starting from Hannah Arendt’s reflections on the openness of the future and the function of promises for political action, this essay offers a new understanding of the political pedagogy at work in The Aesthetics of Resistance. Rather than being narrated by the author’s proxy, as much of the novel’s reception assumes, Weiss plays subversively with mask narration. The narrator’s selective reading of Théodore Géricault’s The Raft of the Medusa guides readers to a complex assessment of the costs and deformations necessitated by the narrator’s promise to remain part of the antifascist resistance. Via its poetics of looking away, the novel discloses a probing of history, politics, and collective action that contrasts sharply with the narrator’s stated poetics and teleological expectations. The Aesthetics of Resistance prepares its future readings as an open, not-yet-determined pursuit of aesthetic and political education.
We Can Come Very Close to Them: Solidarity and the Struggle for Liberation inThe Aesthetics of Resistance
Authors: Howes Seth
Published: December 2022

This essay explores how Peter Weiss’s anticolonial, anti-imperialist analysis, developed in the 1960s in response to the advent of decolonization and the emergence of neocolonialism, is woven into Die Ästhetik des Widerstands’ story of political self-education. Two central features of this analysis were Weiss’s concern with how solidarity can be forged between groups separated by geographic distance or cultural difference, and with the difference between national liberation and the more thoroughgoing emancipation Weiss described in 1965 as the “abolition of the reigning injustices in the world.” Examining key scenes in the novel, including the narrator’s recurrent engagements with the problem of solidarity and his historical inquiry into the deeds of the folk hero Engelbrekt Engelbrektsson, this essay suggests that Die Ästhetik’s analysis of German fascism also incorporated Weiss’s long-standing concern with colonialism and imperialism and with how they were encountered and resisted.
Σώμα και φυσική αγωγή
Authors: Λιοπύρη Αμαλία
Published: December 2022

Αντικείμενο της παρούσας εργασίας είναι η παρακολούθηση της κοινωνικής δυναμικής της εξέλιξης της Φυσικής Αγωγής στο σχολικό περιβάλλον της Ελλάδας. Η Φυσική Αγωγή δεν είναι ένα απλό, μεμονωμένο μάθημα στα κατά καιρούς αναλυτικά προγράμματα, αλλά εκφράζει ένα κοινωνικό κεφάλαιο, το οποίο πρέπει να αναλυθεί. Το βασικό ερώτημα είναι εάν η Φυσική Αγωγή ως σχολικό μάθημα (παρακολουθεί τις κοινωνικο- οικονομικές εξελίξεις της κάθε εποχής και τι αυτό μπορεί να σημαίνει για το μέλλον της Φυσικής αυτής Αγωγής στην σημερινή εποχή). Το επίσης βασικό ερώτημα είναι η θέση αυτού του μαθήματος στη γενικότερη δομή και λειτουργία του ολοήμερου σχολείου, το οποίο έρχεται να ανταποκριθεί στις ανάγκες μίας σύγχρονης εκπαιδευτικής διαδικασίας. Ιστορική ανάλυση, κοινωνιολογία και παιδαγωγική συνυφαίνονται άρρηκτα σε αυτή τη μελέτη
The development of nascent entrepreneurial ventures in the context of innovation ecosystems
Authors: Μπαλούτσος Ευστράτιος
Published: December 2022

Τα τελευταία χρόνια έχει υπάρξει πληθώρα δημοσιεύσεων γύρω από το ζήτημα των Οικοσυστημάτων Καινοτομίας. Παρόλα αυτά η ευρεία υιοθέτηση της έννοιας έχει οδηγήσει σε εννοιολογική ασάφεια. Επιπλέον, καθώς η ακριβής φύση των Οικοσυστημάτων Καινοτομίας παραμένει διφορούμενη, είναι δύσκολο να εντοπιστούν παράγοντες που μπορούν να καταστήσουν ένα τέτοιο οικοσύστημα επιτυχημένο, βιώσιμο ή ελκυστικό για τους συμμετέχοντες. Ανεξάρτητα από τη θεωρητική τους πλαισίωση, τα οικοσυστήματα καινοτομίας είναι ζωτικής σημασίας για την επιτάχυνση της ανάπτυξης των επιχειρηματικών εγχειρημάτων, διευκολύνοντας τη διαδικασία καινοτομίας και είναι ιδιαίτερα σημαντικά για τις νεοσύστατες επιχειρήσεις. Σε αυτό το πλαίσιο, η παρούσα διδακτορική διατριβή στοχεύει να προσθέσει στο παρόν σώμα της βιβλιογραφίας παρέχοντας ένα θεωρητικό πλαίσιο που επιτρέπει την εννοιολόγηση των Οικοσυστημάτων Καινοτομίας προκειμένου να κατανοήσουμε πώς η ύπαρξη Οικοσυστημάτων Καινοτομίας επηρεάζει τα εκκολαπτόμενα επιχειρηματικά εγχειρήματα. Για το σκοπό αυτό, η παρούσα εργασία χρησιμοποιεί το θεωρητικό πλαίσιο που παρέχει η Θεωρία Δραστηριοτήτων για την εννοιολόγηση τα Οικοσυστήματα Καινοτομίας ως διασυνδεδεμένα συστήματα δραστηριοτήτων και προτείνει τη χρήση αντιφάσεων και συμμορφώσεων για να εξηγήσει τους μηχανισμούς που εμποδίζουν ή επιτρέπουν την καινοτομία σε ένα οικοσύστημα. Ως εκ τούτου, αυτή η εργασία στοχεύει να απαντήσει ποιες είναι οι κύριες αντιφάσεις και συμμορφώσεις που αναπτύσσονται στα Οικοσυστήματα Καινοτομίας, τα οποία αποτελούνται από νεοσύστατες επιχειρήσεις, και πώς αυτές διαφέρουν μεταξύ συστημάτων.Αυτή η διδακτορική διατριβή βασίζεται σε μια διερευνητική μελέτη που εκτείνεται σε τέσσερα χρόνια και 15 χώρες, με πρόσβαση σε τρία διαφορετικά οικοσυστήματα, και αξιοποιεί τις γνώσεις περισσότερων από 40 εμπλεκόμενων ατόμων από 28 οργανισμούς. Χρησιμοποιώντας αυτό το δείγμα, αυτή η εργασία εφαρμόζει έναν νέο συνδυασμό Θεμελιωμένης Θεωρίας και Θεωρίας Δραστηριοτήτων για να δημιουργήσει ένα πλαίσιο έρευνας για τα Οικοσυστήματα Καινοτομίας. Ως εκ τούτου, καθίσταται δυνατή η διερεύνηση των εσωτερικών λειτουργιών και η κατανόηση των αντιφάσεων που προκύπτουν εντός των συμμετεχόντων οργανισμών, μεταξύ των διαφόρων οργανισμών και μεταξύ των οργανισμών και του οικοσυστήματος.
Η διαχείριση της σταδιοδρομίας στον ελληνικό δημόσιο τομέα σε περίοδο παρατεταμένης ύφεσης
Authors: Βασιλείου Βασιλική
Published: December 2022

Την περίοδο της οικονομικής κρίσης στην Ελλάδα (2010-2016) σημειώθηκαν καταιγιστικές αλλαγές που επέδρασαν στην εργασιακή πραγματικότητα του συνόλου των εργαζόμενων και συνεπώς και των δημοσίων υπαλλήλων. Στην παρούσα διατριβή ερευνάμε πώς οι αλλαγές που σημειώθηκαν σε τεχνολογικό, οργανωσιακό, εργασιακό και προσωπικό επίπεδο επηρέασαν του δημοσίους υπαλλήλους, ώστε να αναπροσδιορίζουν τις στάσεις/αντιλήψεις τους και να αναλάβουν δράσεις για να διασφαλίσουν τη σταδιοδρομία τους. Συγκεκριμένα, στόχος της έρευνας μας είναι να καταδείξει κατά πόσον ο δημόσιος υπάλληλος κάτω από την πίεση των αλλαγών αυτών απομακρύνθηκε από την παραδοσιακή αντίληψη σταδιοδρομίας και υιοθέτησε αντιλήψεις και δράσεις που συνάδουν με μια ασύνορη και πρωτεϊκή οπτική σταδιοδρομίας.
Κοινωνιογλωσσολογική προσέγγιση της γλωσσικής ποικιλίας της Αγιάσου Λέσβου
Authors: Κουνιαρέλλη Ειρήνη
Published: December 2022

Η παρούσα διδακτορική διατριβή βασίζεται στην κοινωνιογλωσσολογική προσέγγιση που επιχειρήθηκε για τη διαλεκτική ποικιλία που ομιλείται στην Αγιάσο της Λέσβου. Στόχος της έρευνας είναι να διερευνήσει τις γλωσσικές στάσεις των κατοίκων της περιοχής της Αγιάσου απέναντι στην τοπική γλωσσική ποικιλία. Η έρευνα εστιάζει στις νεότερες γενιές, ιδιαίτερα στις ηλικιακές ομάδες 20-40 ετών, καθώς ο ρόλος τους θεωρείται κρίσιμος για τη μελέτη της διατήρησης της γλώσσας, της γλωσσικής μετατόπισης ή του γλωσσικού «θανάτου». Η υπόθεση εργασίας πηγάζει από την κοινωνιογλωσσική πραγματικότητα, η οποία χαρακτηρίζεται από το υψηλό κύρος της νεοελληνικής κοινής και το χαμηλό κύρος των τοπικών ποικιλιών, που βρίσκονται γενικότερα σε συρρίκνωση. Τα κύρια ευρήματα αυτής της έρευνας σχετίζονται πρωτίστως με τις θετικές στάσεις τόσο των ομιλητών/τριών όσο και των μη ομιλητών/τριών, αλλά και με τις ιδιαίτερες γλωσσικές τους πρακτικές. Παρατηρείται μια ευρεία χρήση της γλωσσικής ποικιλίας και αναδεικνύονται διάφορες πτυχές της, όπως είναι η γραπτή της χρήση, η παρουσία της στο γλωσσικό και σημειωτικό τοπίο, καθώς και η ανταλλακτική της αξία.