bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of process parameters on surface roughness of NiCu alloy in fluid jet polishing
Authors: Choudhary Shubham , Duvedi Ravinder Kumar , Saini Jaswinder Singh
Published: April 2023

Fluid jet polishing is a non-contact and flexible type of polishing process for generating high-quality surface finish in optical dies manufactured from ductile materials like Monel-400 (NiCu alloy). This article presents an investigation of fluid jet polishing of Monel-400 die material with a 3D printed Ti64 tool and silicon carbide abrasive slurry with an effect of pressure, stand-off distance and polishing time on the surface finish. The response surface methodology method was used to develop the experimental plan and Analysis of Variance analysis was carried out to identify the optimized values of the control parameters to maximize the percentage change in surface roughness. The validation of the developed regression model was done by polishing the plate of Monel-400 using the optimized parameters: the pressure of 9.6 bar, stand-off distance of 32.2 mm and polishing time of 170 s. The optimized fluid jet polishing parameters successfully generated a surface roughness of 90 nm in one of the experimental tests. The predicted results were in close agreement with the experimental results. Further improving the polishing efficiency, the optimal feed rate of 20 mm/min was used to polish the 40 mm × 50 mm Monel-400 plate, the surface roughness was reduced from 300 to 80 nm in 10 multiple passes showing the reduction in peaks and valleys with the surface improvement of 73.33%. The result shows that the fluid jet polishing process tends to improve the life span of Monel-400 die steel workpieces which is beneficial for the application of various industrial components such as optical lenses, marine applications, automotive components and defence applications.
The New Millennium Family Functioning and Health of Generation Z: From a Socioconstructivist Perspective
Authors: Sharma Saumya , Singh Seema , Kumar Navin
Published: April 2023

Background:

From whichever culture a family belongs to, scientific evidence shows the role of family functioning and relationships on the child’s health and well-being. A family can either be a source of an issue or a resource for preventing the problem, especially in a diverse country like India. The foremost step to understanding these aspects is to develop an awareness of the transitional nature of family functioning in the new millennium.

Objectives:

The study proposes to explore the dynamics of family functioning from the conceptualization of parents of Generation Z and intents to analyze the subsequent outcomes on the health of children and adolescents, presenting it as qualitative network construction.

Methods:

Rich descriptive data was collected from 60 parents by a semi-structured interview schedule consisting of 4 predecided questions. The analyses were done by ATLAS.ti7 version 7.5.16, Computer-Assisted Qualitative Data Analysis Software (CAQDAS).

Results:

As an upshot, 2 structural networks were constructed. One network depicts the 3 aspects of family functioning, cohesion, flexibility, and communication, studied according to Indian families of the new millennium. The psychological, socioemotional, and physical impact of the functioning accumulated in the second network. The study revealed the underlying aspects, the level, and quality of all the 3 dimensions and the thought-provoking aftermath for Generation Z.

Conclusion:

The study offers intriguing information about the Indian family functioning of the new millennium and its descriptive association with the health of children and adolescents.
Clinical Profile of Patients Visiting a Private Child and Adolescent Psychiatric Clinic in Delhi
Authors: Gupta Deepak , Sengupta Nabanita
Published: April 2023

Background:

Mental disorders continue to be a concern for everyone as the prevalence rate of disorders varies from study to study and sample to sample. As most of the statistics come from Government setups in India, data from private psychiatric clinics/setups are missing.

Aim:

The current study puts forth the data from a private psychiatric child and adolescent center located in New Delhi, India.

Method:

The data from approximately 15 years (2004-2019) were extracted from the record files and analyzed for the most prevalent disorders among different age groups of children and adolescents.

Results:

ASD and ADHD were found to be most prevalent among others along with multiple diagnoses. Most of the patients who visited the setup were from Delhi NCR only.
Meningoencephalitis caused by concurrent infection with canine distemper virus and a unique Sarcocystis sp. in a gray fox
Authors: Neupane Sarita , Wellehan James F. X. , Childress April L. , Snook Eric R. , Porter Brian F.
Published: April 2023

A deceased 9-wk-old male gray fox ( Urocyon cinereoargenteus) with a history of decreased ambulation and diarrhea was submitted to the Texas A&M Veterinary Medical Diagnostic Laboratory. No significant gross findings were evident on postmortem examination. Histologically, the cerebrum and brainstem had mild necrotizing meningoencephalitis with protozoal schizonts and merozoites. Additionally, glial cells contained intracytoplasmic and intranuclear viral inclusion bodies. Sections of the cerebrum were positive for canine distemper virus (CDV) and negative for Sarcocystis neurona on immunohistochemistry. Bayesian analysis revealed that this Sarcocystis sp. clustered most closely with a clade of unnamed Sarcocystis sp. found in viperid snakes, with a posterior probability of 99%. CDV likely played a significant role in the expression of clinical sarcocystosis in this gray fox.
Embedding Trauma Literacy Into Curriculum: An Examination of the Attitudes of Australian and New Zealand Journalism Educators
Authors: Wake Alexandra , Smith Erin , Ricketson Matthew
Published: April 2023

Australia and New Zealand have reputations as countries prone to catastrophic and frequent natural and man-made disasters. Therefore, it is no surprise that antipodean academics want trauma-informed education for their journalism students. This study presents the Australian-New Zealand results of a 2021 survey exploring educators’ attitudes toward embedding trauma literacy into journalism curriculum. It mirrors a survey from the UK-based Journalism Education and Trauma Research Group. The Australian-New Zealand results confirm that educators want more training to effectively embed trauma-informed reporting into their curricula. The discussion notes the availability of local, research-based teaching materials, and identifies barriers to implementation.
The Importance of Early Percutaneous Dilatational Tracheostomy in Inhalation Injury: A Case Report
Authors: Chandra Ferdinand A , Sedono Rudyanto , Purwamidjaja Dis Bima , Agustin Rita
Published: April 2023

Maintaining a patent airway is critical for treating patients with severe inhalation injuries. Percutaneous Dilatational Tracheostomy (PDT) has been used effectively for many patients treated in the Intensive Care Unit (ICU). In addition to its safety for use at the bedside, according to Friedman et al. PDT has the same or even lower complication rate than surgical tracheostomy. PDT can be performed in a shorter time and is more cost-effective. Herein, we report a 44 year old obese woman who sustained an inhalation injury related to a burn. The patient fell headfirst into a pot of boiling water at the time of the burn. The patient showed signs of inhalation injury and suffered a second-to-third degree burn injury. She was treated in the ICU, and early PDT was performed. The procedure was performed by first locating the trachea, followed by a 1-cm incision made between the second and third tracheal ring. She was intubated successfully and treated in the ICU for 7 days. The anesthesiologist chose to perform an early PDT to prevent further complications. This procedure was done successfully despite many comorbidities from the patient, such as being an obese female and having a short neck, which makes finding the exact location for the incision challenging. In this case, the early decision to proceed with PDT showed promising results in decreasing the patient's mortality risk.
Void and narrative in the clinic of addictions: A theoretical proposal
Authors: Cimolaï Clément , Bréjard Vincent
Published: April 2023

We propose a connection between the void and addiction via psychoanalysis and current developments in narration in the context of the psychoanalytic clinic. We maintain that the addicted subject is shaped in particular by a relationship to the void evolving from the disruptive effects of the narrative. Our modern era is marked by a parallel evolution towards an unbearable void, to be filled at all costs. The neo-liberal promise of ‘filling’ the void with consumer objects in turn feeds the illusion of a so-called freedom, based on alienation to the inseparable duos of growth/jouissance and productivism/consumerism. The void has a multidisciplinary heritage (philosophy, physics, art, psychology) underlining certain aspects of a dialectic of the void that fluctuates between nothing at all and everything as potential. Taking this dialectic into account allows us to construct a concept of the void centred around two types of void: a narrative void and an a-narrative void. We maintain that the toxic in addiction can be interpreted as a narco-narrative that is constructed upon an a-narrative void. The clinical implications and technical proposals are briefly explored as openings to a clinical consideration of the void in the field of addictology.
Mind the gap(s): Moral philosophy, international law and interpretative historical sociology
Authors: Wagner Peter
Published: April 2023

Given the diversity of opinions about whether, how, and towards which end Western societies should defend Ukraine against the ongoing Russian aggression, it would be desirable to spell out clear moral principles and apply them in a contextually adequate way to the situation. This is what Hans-Herbert Kögler tries to do in his contribution to this issue. However, his reasoning remains unclear about the relation between moral philosophy and empirical and historical knowledge about the context of moral action. Furthermore, while he proposes critical-hermeneutic reconstruction as a means to understand the participants in the conflicts, he applies this approach in an asymmetric and insufficiently nuanced way. His view of the conflict as a struggle between democracy and dictatorship about a future world-order is too dichotomic and ignores the history of international law as a practical moral philosophy dealing with situations for which there are no unambiguous principles that could guide action.
Exploring community perspectives on the impacts of COVID-19 on food security and food sovereignty in Nunavut communities
Authors: Horlick Sidney , Chatwood Susan
Published: April 2023

Background:

In Nunavut, where 70% of children are food insecure, many households rely on school breakfast or community food programmes for nourishment. The COVID-19 pandemic and resulting policies to reduce the spread of the disease have the potential to exacerbate existing issues, including increasing food insecurity in households. Funding programmes were implemented to limit the impact of public-health measures on household and community food security. The overall effects of the actions are not yet understood.

Methods:

This project used a qualitative approach to examine the determinants of food security and sovereignty and the impact of the COVID-19 pandemic policy responses on these determinants in Arviat and Iqaluit. Narrative analysis applied within a relational epistemology was used to describe the experiences of community members in Iqaluit and Arviat during the COVID-19 pandemic.

Results:

Seven participants were interviewed in Iqaluit ( n=3) and Arviat ( n=4). Key themes included the importance of decolonisation for food sovereignty, the importance of food sharing to communities and the resilience of communities during COVID-19. Community members wished to see greater support and strengthening of the country (locally harvested) food economy to increase knowledge of food and harvesting skill, and for communities to find ways to reach residents who may fall through the cracks during times of need or crisis.

Conclusions:

This study is one of the first to document Nunavummiut experiences and perspectives of food security and sovereignty in Arviat and Iqaluit during the COVID-19 pandemic.
Poor health status before the COVID-19 pandemic is associated with unfavourable changes in health-related lifestyle
Authors: Jääskeläinen Tuija , Sääksjärvi Katri , Pietilä Arto , Männistö Satu , Kaartinen Niina E , Lundqvist Annamari , Koskinen Seppo , Koponen Päivikki
Published: April 2023

Aims:

The effects of COVID-19 containment measures on health-related lifestyle have been both favourable and unfavourable for health. Factors predisposing to unfavourable changes are still poorly known. In this short communication, we aimed to examine which socioeconomic and health-related factors predicted unfavourable lifestyle changes based on data from the same individuals before (2017) the pandemic and during the second wave (2020) of the pandemic in Finland.

Methods:

This individual-level follow-up study was based on a nationally representative, two-stage stratified cluster sample of Finnish adults from the FinHealth 2017 Study, conducted in Spring 2017, and its follow-up survey, conducted in Autumn 2020. A total of 3834 men and women aged 25–69 years at baseline had information of selected lifestyle factors (vegetable consumption, leisure-time physical activity, sleeping problems and nightmares) available at both time points. Odds ratios and 95% confidence intervals for unfavourable lifestyle changes (yes/no) according to socioeconomic and health-related factors were calculated using logistic regression models taking into account the sampling design and non-response.

Results:

We found that those having poor health (i.e. psychological distress, poor self-rated health or chronic diseases) or disadvantaged socioeconomic background before the pandemic were prone to unfavourable lifestyle changes during the follow-up.

Conclusions:

Observed unfavourable lifestyle changes in vulnerable population groups may accelerate health inequalities. Targeted health promotion actions are needed to prevent this unfavourable development.
Novel radar absorbing material using resistive frequency selective surface based polymer composites for enhanced broadband microwave absorption
Authors: Amudhu Lekkaiyan Baskaran Thamil , Samsingh Ramalingam Vimal , Florence Sundarsingh Esther , Abirami Balakrishnan Sakthi
Published: April 2023

In this paper, a novel approach using glass fibre laminate composite (GFLC) with nanoparticle embedded nanofibres and frequency selective surfaces (FSS) for improved electromagnetic (EM) wave absorption has been proposed. For enhanced absorption, the FSS was coated with polyvinylidene fluoride (PVDF) mixed with multi-walled carbon nanotubes (MWCNTs). The coatings were prepared through electrospinning technique. The composite prepared from FSS, PVDF-MWCNT layers and GFLC showed enhanced absorption properties. It was demonstrated that the fabricated composites reduced reflection of electromagnetic waves by the material when compared to metals. An 80% increase in EM absorption (with respect to metal) was observed over a wide frequency range with the novel composite at an overall thickness of only 3 mm. X-ray diffraction (XRD) spectra showed an improvement in the electroactive β-phases in the electrospun PVDF/MWCNTs compared to Plain PVDF. Scanning electron microscopy analysis on various weight percentages of PVDF/MWCNTs revealed the formation of nano fibres with an average diameter of 75–160 nm. In addition, the proposed novel EM wave absorbing composites were of simple configuration and the mechanical properties of the fabricated composites were comparable to that of GFLC. Experimental results indicated that RAS with 0.25 wt % MWCNT/PVDF had 87.5% bandwidth for over 90% absorption from 8.5 to 12 GHz compared to all other configurations. The tailored composite material could be used as excellent radar absorber structures (RAS) and can find tremendous application in the manufacture of stealth aircrafts.
SHM-informed life-cycle intelligent maintenance of fatigue-sensitive detail using Bayesian forecasting and Markov decision process
Authors: Lai Li , Dong You , Smyl Danny
Published: April 2023

Civil and maritime engineering systems must be efficiently managed to control the failure risk at an acceptable level as their performance is gradually degraded throughout the operational life, caused by fatigue and corrosion. Structural health monitoring develops a timely capability to assess the structural condition and performance metrics. However, using actual long-term monitoring data to guide the life-cycle management under stochastic environments has not been sufficiently studied. To realize an optimal maintenance strategy within the service life, an integrated monitoring-based optimal management framework is developed on the basis of the partially observable Markov decision processes (POMDPs) and Bayesian forecasting. In the proposed framework, the stochastic fatigue processes are quantified by the state transition matrix. The Bayesian dynamic linear model is embedded in POMDPs as a continuous observation part to forecast the cycling impacts and estimate the deterioration rate using long-term dynamic strain responses. In addition, making use of the special features of the problem considered in this paper, an adaptive discretization strategy is proposed to alleviate the complexity of large discrete observed spaces in the POMDP. The applicability and feasibility of the framework are evaluated by intelligent maintenance of fatigue-sensitive components with real-world monitoring data. After solving the POMDP by an efficient offline solver, the results obtained in this paper demonstrate that structural interventions are uneconomical to extend the life when a welded detail is approaching its end of life due to the normal service. Furthermore, if multiple interventions are available, the framework can find optimal maintenance actions based on the trade-off between long-term utility and the corresponding cost. This framework as the prototype could also be adjusted to aid life-cycle intelligent maintenance of other types of components under different deterioration scenarios.
Your patient is a person: A narrative medical approach to weight discrimination in medicine
Authors: Ulrey Anna E.
Published: April 2023

Several studies have established the prevalence of discrimination upon the basis of weight in healthcare; however, these studies lack the element of human experience that makes addressing the issue vital to both individual and public health. Narrative medicine is an interdisciplinary field that utilizes powerful narrative skills and creativity to address the needs of those who seek and deliver healthcare, promoting healing, and self-reflection for both patients and physicians. This paper seeks to re-evaluate key studies regarding the issue of weight discrimination in healthcare through the lens of narrative medicine. In doing so, it further integrates the aspect of human experience into the study of medical ethics in order to improve the lived experience of overweight individuals in medicine.
Student Moral Foundations in the Context of Research Misbehavior: An Experimental Study
Authors: Buljan Ivan , Tokalić Ružica , Tomić Vicko , Viđak Marin , Marušić Ana
Published: April 2023

The study aimed to examine whether the use of words related to different moral foundations can predict the perceived severity of research misconduct. We gave two groups of participants, undergraduate medical students, the same hypothetical scenarios of research misconduct cases containing words related to different aspects of morality, and asked them to assess how inappropriate the described behavior was. Students ranked the described behaviors differently by the inappropriateness of the behavior, but the group wording was not a significant predictor of appropriateness. The reasons for the ranking were not related to any standardized procedures for research integrity but were related to the moral assessment of the students, which was assessed using qualitative approach. The results of this study implicate that personal moral views are an important part in research integrity training.
The Importance of Dietary Fiber for Metabolic Health
Authors: Bulsiewicz William J.
Published: April 2023

Dietary fiber are non-digestible carbohydrates that are diverse, have varied functions, and are acquired by consuming plant-based foods. Some forms of fiber are digested by the gut microbiota and produce bioactive metabolites called short chain fatty acids—butyrate, acetate, and propionate. Dietary fiber is able to alter human physiology through multiple mechanisms that can result in health benefits. Unfortunately, nearly 19 out of 20 Americans do not consume the minimum recommended amount of fiber each day. This bears profound relevance to public health because at least six of the ten leading causes of death are potentially preventable or clinically improved through dietary means. Additionally, these same conditions share a common underlying pathophysiology-metabolic dysfunction. This can manifest as abdominal obesity, high blood pressure, insulin resistance, dyslipidemia, or collectively as metabolic syndrome. In this review, we will assess the evidence that consumption of dietary fiber undermines these forms of metabolic dysfunction, examine the mechanism of action for these physiologic effects, and consider the potential for dietary fiber to improve human health on a public health level by simply encouraging our patients to consume more plant-based foods in abundance and diversity.
Diaphragmatic Breathing and Performance Anxiety in Dental Students
Authors: Pastan Christina D. , Eisen Steven , Finkelman Matthew , White Robyn , Pagni Sarah , Kugel Gerard
Published: April 2023

Purpose/Objectives. The aims of this study were to assess first-year dental students’ attitudes and perceptions of diaphragmatic breathing (DB) and compare students with and without performance anxiety in terms of their attitudes and perceptions of DB.

Methods. A lecture discussing a DB technique was presented to 195 students in the Operative Dentistry course at Tufts University School of Dental Medicine. Post-lecture, a 10-question survey was distributed and addressed students’ attitudes and perceptions towards DB and its potential impact in dental school, personal lives, and future careers. Results. Of the 81 surveys completed, 44 students (54%) reported having heard of DB previously; 59 (73%) reported they experience performance anxiety. Seventy-two students (89%) reported thinking that practicing DB will benefit them as practicing dentists; 71 (88%) reported they would use it if stressed in everyday life. Seventy-six (94%) reported they would be interested in using the technique before a competency exam. Students reporting performance anxiety expressed significantly greater agreement that DB is a valuable coping tool ( P = .016) and willingness to participate in DB before an Operative Dentistry competency exam ( P = .018). Conclusions. Teaching diaphragmatic breathing to first-year dental students may provide them with a valuable coping tool to mitigate stress and anxiety.
Integrating condition-based monitoring with process sensors information for operation and maintenance in a functional modeling framework
Authors: Wu Jing , Zhang Xinxin
Published: April 2023

Safe operations and adequate maintenance are two main means to achieve reliable production and reduce downtime of a plant. While the tasks of operations and maintenance are carried out by two different groups of staff, as a result, the close relationship between the two tasks is split. In this paper, this challenge is handled by a proposed integrated functional modeling framework. In this framework, the Multilevel Flow Modeling (MFM) method with its cause-consequence reasoning rules is used. Condition-based monitoring is a well-accepted strategy for predictive maintenance and fault detection based on measurements is a well-developed technology for operation support. Information fusion including monitoring conditions of assets and process sensors information for both operation and maintenance in the same modeling framework is desired. The qualitative relationship distribution between operations and maintenance can be established based on the function states of the system. In addition, these relationships are visible for both groups of staff. As a result, the detected information in the early stage of the development of the unpleasant scenarios is used to improve their situation awareness, so that the undesired emergency shutdown from both perspectives of operation and maintenance is prevented. Consequently, it can reduce production loss. A case study of operations and maintenance of a seawater injection system is carried out and shows the industrial applicability of the proposed framework. The case study strongly reveals that there is a highly close relation between operation and maintenance for ensuring the system working properly. It demonstrates that the proposed integrated framework is not only able to support operational tasks but also for the maintenance tasks by including relevant maintenance information of the system. The results show that it can potentially help with decreasing downtime of the system.
Time for change? Radiologists highly concordant assessing change in stenoses on follow-up cervical spine MRI
Authors: Costello Justin E , Shah Lubdha M , Peckham Miriam E , Stilwill Sarah E , Safazadeh Ghazaleh , Hutchins Troy A
Published: April 2023

Objective

There is considerable variability among radiologists when grading spinal canal and foraminal stenosis on MRI. However, to date, studies have not evaluated radiologists’ agreement when assessing interval change in cervical spine stenoses. The purpose of this study was to evaluate radiologists’ concordance for change in cervical spine stenoses on follow-up MRIs, a major indication for these exams.

Methods

Initial and follow-up cervical MRIs were retrospectively reviewed by three blinded radiologists. Spinal canal and foramina from C1 through T1 were rated for interval change and concordance between the blinded raters was calculated. The original MRI reports were also reviewed for specific language assessing interval change on the follow-up exams.

Results

40 cervical MRI exams and 40 corresponding MRI follow-ups were assessed. Agreement for interval change in spinal canal and foraminal stenosis was near perfect amongst all readers (kappa values of 0.78–0.94). 97% of the original MRI reports used the standard severity scale. 68% of follow-up MRI reports specifically assessed for change.

Discussion

Blinded radiologists had high agreement when assessing for change in spinal canal and foraminal stenosis on follow-up cervical spine MRIs. Because of inter-rater variability in stenosis grading, reports that do not emphasize change assessment, may imply change that is not truly present. For clarity and consistency in reporting of cervical spine stenoses, change assessment should be emphasized and added to structured reporting templates.
Revamping Sustainable Strategies for Hyper-Local Restaurants: A Multi-Criteria Decision-Making Framework and Resource-Based View
Authors: Muneeb Farhan Muhammad , Ramos Ricardo Filipe , Wanke Peter Fernandes , Lashari Faryal
Published: April 2023

There is a growing emphasis on sustainability within the hospitality industry. However, research on hyper-local restaurants’ strategic sustainable strategies is scarce. Accordingly, this study aims to unveil the hyper-local Chinese restaurateurs’ critical success factors (CSFs). Grounded on the CSFs identified in the literature and validated by experts, data were collected from hyper-local restaurant owners and analysed through multi-criteria decision-making (MCDM), best–worst method (BWM) and hesitant fuzzy shapely order weights average (HSFOWA) approach. Results suggest that green entrepreneurial orientation is symbiotic, and green customer education, ability, motivation, capability, entrepreneurial orientation and high-commitment work practices significantly impact the sustainability of hyper-local restaurants. Findings stimulate sustainable strategies based on available CSFs. Practical and managerial implications are discussed.
Validation of the qSOFA and CRB-65 in SARS-CoV-2-infected community-acquired pneumonia
Authors: Richter Tina , Tesch Falko , Schmitt Jochen , Koschel Dirk , Kolditz Martin
Published: April 2023

Rationale

Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) and CRB-65 (confusion, respiratory rate, blood pressure and age (≥65 years)) risk scores have not been widely evaluated in patients with SARS-CoV-2-positive compared to SARS-CoV-2-negative community-acquired pneumonia (CAP). The aim of the present study was to validate the qSOFA(-65) and CRB-65 scores in a large cohort of SARS-CoV-2-positive and SARS-CoV-2-negative CAP patients.

Methods

We included all cases with CAP hospitalised in 2020 from the German nationwide mandatory quality assurance programme and compared cases with SARS-CoV-2 infection to cases without. We excluded cases with unclear SARS-CoV-2 infection state, transferred to another hospital or on mechanical ventilation during admission. Predefined outcomes were hospital mortality and need for mechanical ventilation.

Results

Among 68 594 SARS-CoV-2-positive patients, hospital mortality (22.7%) and mechanical ventilation (14.9%) were significantly higher when compared to 167 880 SARS-CoV-2-negative patients (15.7% and 9.2%, respectively). All CRB-65 and qSOFA criteria were associated with both outcomes, and age dominated mortality prediction in SARS-CoV-2 (risk ratio >9). Scores including the age criterion had higher area under the curve (AUCs) for mortality in SARS-CoV-2-positive patients (e.g.CRB-65 AUC 0.76) compared to SARS-CoV-2 negative patients (AUC 0.68), and negative predictive value was highest for qSOFA-65=0 (98.2%). Sensitivity for mechanical ventilation prediction was poor with all scores (AUCs 0.59–0.62), and negative predictive values were insufficient (qSOFA-65=0 missed 1490 out of 10 198 patients (∼15%) with mechanical ventilation). Results were similar when excluding frail and palliative patients.

Conclusions

Hospital mortality and mechanical ventilation rates were higher in SARS-CoV-2-positive than SARS-CoV-2-negative CAP. For SARS-CoV-2-positive CAP, the CRB-65 and qSOFA-65 scores showed adequate prediction of mortality but not of mechanical ventilation.
Clinical trial simulations in pulmonary fibrosis: patient-focused insights and adaptations
Authors: Jones Steve , Flewett Maxine , Flewett Ron , Lee Sharon , Vick Bill , Thompson Milla , Pinnetti Sabine , Zoz Donald F. , Hoffmann-Vold Anna-Maria , Kreuter Michael , Maher Toby M.
Published: April 2023

Background

Patient recruitment and retention are a challenge when conducting clinical trials in patients with pulmonary fibrosis, including idiopathic pulmonary fibrosis and other interstitial lung diseases. This study aimed to understand and address the barriers associated with trial participation for these populations.

Methods

Nine patients, nine caregivers and three healthcare professionals participated in virtual simulations of planned phase III trials. During the simulations, participants received information about the trials and either tested a home spirometry device or watched a home spirometry demonstration, before providing their insights in debriefs. The findings were interpreted in advisory boards with representatives from patient organisations and expert investigators.

Results

Regarding barriers to participation, patient fatigue and breathlessness were emphasised as posing challenges for travel, visit length and completion of onsite assessments. Lack of information, support and appreciation were also identified as factors that may exacerbate anxiety and negatively affect participant retention rates. Feedback on the home spirometry was mixed, with participants appreciating being able to complete the test at home but worrying about device handling. Based on the insights gained, patient-friendly adaptations were made to the trial protocol and conduct, including remote assessment of patient-reported outcomes, increased visit flexibility, travel support services, patient and caregiver information campaigns, and training of investigators on patients’ needs.

Conclusions

Participants identified important barriers to participation, which led to patient-friendly changes being made to the planned trials. As a result, participation in the planned trials should be less burdensome, with improved recruitment and retention rates, and ultimately, improved data quality.
The role of the ecological scaffold in the origin and maintenance of whole-group trait altruism in microbial populations
Authors: Jones C. T. , Meynell L. , Neto C. , Susko E. , Bielawski J. P.
Published: April 2023

Background

Kin and multilevel selection provide explanations for the existence of altruism based on traits or processes that enhance the inclusive fitness of an altruist individual. Kin selection is often based on individual-level traits, such as the ability to recognize other altruists, whereas multilevel selection requires a metapopulation structure and dispersal process. These theories are unified by the general principle that altruism can be fixed by positive selection provided the benefit of altruism is preferentially conferred to other altruists. Here we take a different explanatory approach based on the recently proposed concept of an “ecological scaffold”. We demonstrate that ecological conditions consisting of a patchy nutrient supply that generates a metapopulation structure, episodic mixing of groups, and severe nutrient limitation, can support or “scaffold” the evolution of altruism in a population of microbes by amplifying drift. This contrasts with recent papers in which the ecological scaffold was shown to support selective processes and demonstrates the power of scaffolding even in the absence of selection.

Results

Using computer simulations motivated by a simple theoretical model, we show that, although an altruistic mutant can be fixed within a single population of non-altruists by drift when nutrients are severely limited, the resulting altruistic population remains vulnerable to non-altruistic mutants. We then show how the imposition of the “ecological scaffold” onto a population of non-altruists alters the balance between selection and drift in a way that supports the fixation and subsequent persistence of altruism despite the possibility of invasion by non-altruists.

Conclusions

The fixation of an altruistic mutant by drift is possible when supported by ecological conditions that impose a metapopulation structure, episodic mixing of groups, and severe nutrient limitation. This is significant because it offers an alternative explanation for the evolution of altruism based on drift rather than selection. Given the ubiquity of low-nutrient “oligotrophic” environments in which microbes exist (e.g., the open ocean, deep subsurface soils, or under the polar ice caps) our results suggest that altruistic and cooperative behaviors may be highly prevalent among microbial populations.
Genome-wide analysis of key gene families in RNA silencing and their responses to biotic and drought stresses in adzuki bean
Authors: Li Yongqiang , Ma Enze , Yang Kai , Zhao Bo , Li Yisong , Wan Ping
Published: April 2023

Background

In plants, RNA silencing is an important conserved mechanism to regulate gene expression and combat against abiotic and biotic stresses. Dicer-like (DCL) and Argonaute (AGO) proteins and RNA-dependent RNA polymerase (RDR) are the core elements involved in gene silencing and their gene families have been explored in many plants. However, these genes and their responses to stresses have not yet been well characterized in adzuki bean.

Results

A total of 11 AGO, 7 DCL and 6 RDR proteins were identified, and phylogenetic analyses of these proteins showed that they clustered into six, four and four clades respectively. The expression patterns of these genes in susceptible or resistant adzuki bean cultivars challenged with drought, bean common mosaic virus and Podosphaera xanthii infections were further validated by quantitative RT-PCR. The different responses of these proteins under abiotic and biotic stresses indicated their specialized regulatory mechanisms.

Conclusions

In this study, 24 genes of the DCL, AGO and RDR gene families in adzuki bean were identified, and the sequence characterization, structure of the encoded proteins, evolutionary relationship with orthologues in other legumes and gene expression patterns under drought and biotic stresses were primarily explored, which enriched our understanding of these genes in adzuki bean. Our findings provide a foundation for the comparative genomic analyses of RNA silencing elements in legume plants and further new insights into the functional complexity of RNA silencing in the response to various stresses in adzuki bean.
Cognitive impairment and factors influencing depression in adolescents with suicidal and self-injury behaviors: a cross-sectional study
Authors: Chen Hong , Hong Lan , Tong Siyu , Li Mengjia , Sun Shiyu , Xu Yao , Liu Jie , Feng Tianqi , Li Yuting , Lin Guangyao , Lu Fanfan , Cai Qiaole , Xu Dongwu , Zhao Ke , Zheng Tiansheng
Published: April 2023

Background

Non-suicidal self-injury (NSSI) and suicide attempts (SAs) by adolescent patients with depression have become serious public health problems. There is still insufficient research evidence on the effects of NSSI and SAs on neurocognitive functioning in adolescents. Cognitive function alterations may be associated with SAs and self-injury. NSSI and SAs have different influencing factors.

Methods

Participants were recruited from outpatient clinics and included 142 adolescent patients with depression (12–18 years old). This cohort included the SAs group (n = 52), NSSI group (n = 65), and depression without SAs/NSSI control group (n = 25). All participants underwent a clinical interview and neuropsychological assessment for group comparisons, and post-hoc tests were performed. Finally, partial correlation analysis was used to explore factors related to changes in cognitive function.

Results

The SAs group performed significantly worse than the control group in executive function and working memory. The depression score was directly proportional to the executive function of the SAs group, whereas cognitive functioning in the NSSI group was associated with borderline traits and rumination.

Conclusions

These findings suggest that impairment of executive function and working memory may be a common pattern in adolescent depressed patients with SAs. However, borderline traits and rumination may be indicative of NSSI but not SAs.
Polysaccharides extracted from mulberry fruits (Morus nigra L.): antioxidant effect of ameliorating H2O2-induced liver injury in HepG2 cells
Authors: Li Xinle , Hua Yanan , Yang Caixia , Liu Sijing , Tan Li , Guo Jinlin , Li Yang
Published: April 2023

Background

Mori Fructus is an economical and readily available traditional Chinese medicine and food. Polysaccharides in Mori Fructus have clear antioxidant activity and have been found to alleviate oxidative stress (OS)-induced liver damage in experimental studies. The mechanism of regulation of cellular antioxidant activity by mulberry polysaccharides has been suggested to be Nrf2, but it is not clear whether the Nrf2 pathway is mediated by activation of other targets, and the exact process of effects in hepatocytes has yet to be elucidated.

Methods

In this study, the basic characterization of total polysaccharides extracted from mulberry fruits (Morus nigra Linn.) was analyzed. A model of oxidative damage induced by H2O2 in HepG2 cells was established. The levels of cellular oxidation-related markers, including ROS, SOD and Gpx, were then examined. Furthermore, Q-PCR and Western-blot were used to detect the expression of genes and proteins related to the PI3K/Akt-mediated Nrf2 signaling pathway.

Results

The results showed that a total mulberry polysaccharides (TMP) has a molecular weight of 57.5 kDa with a pyranose ring mainly composed of glucose (48.81%), galactose (22.79%) and mannose (18.2%). TMP reduced the accumulation of ROS in HepG2 cells after H2O2 treatment and modulated the activity of SOD and Gpx. Q-PCR and Western-blot showed that TMP could up-regulate the expression of p-PI3K, p-AKT, Nrf2, NQO1 and HO-1.

Conclusions

This study demonstrates that TMP can reduce ROS accumulation in H2O2-treated HepG2 cells and restore cell viability by activating the PI3K/AKT-mediated Nrf2 pathway. TMP may be a potent antioxidant agent that could slow down oxidative damage to the liver.
Adequacy of knowledge of new medical graduates about diagnosis and management of children and adolescents with type 1 diabetes in a developing country
Authors: Alassaf Abeer , Gharaibeh Lobna , Abuna’meh Lina , Odeh Rasha
Published: April 2023

Background

Knowledge of diabetes by the graduate physicians had been reported to be deficient in many aspects of diagnosis and management of type 1 diabetes (T1D). This will reflect on patient care and quality of health services especially in limited-resources countries. Our aim was to assess knowledge of basic management of T1D in new medical graduates in Jordan.

Methods

A questionnaire was developed to collect information concerning demographics and knowledge and was distributed in paper form and online using google forms. The knowledge was assessed using 28 questions on different aspects of the disease.

Results

A total of 358 new medicine graduates responded to the survey and female respondents were significantly higher than male respondents. Average number of lectures concerning diabetes during the medical school years was 3.92 ± 1.37. High knowledge scores were on pathophysiology of T1D, hypoglycemia, and certain aspects of diabetic ketoacidosis. Female gender, higher number of persons with T1D the participant had encountered during medical school, and good or excellent expected degree of self-knowledge of diabetes were associated with high knowledge score, p values = 0.01, 0.009, and < 0.001, respectively. Female gender and good or excellent expected degree of knowledge of diabetes predicted high knowledge score, p value = 0.008, and < 0.001, respectively.

Conclusion

Gaps in knowledge of new medical graduates in certain T1D subjects exist. This can be corrected by many strategies including changes in curricula, elective courses, more clinical exposure, and interprofessional education. These measures must be evaluated for their short and long-term benefits.
Evaluating the feasibility of cognitive impairment detection in Alzheimer’s disease screening using a computerized visual dynamic test
Authors: Perez-Valero Eduardo , Gutierrez Christian A. Morillas , Lopez-Gordo Miguel Angel , Alcalde Samuel López
Published: April 2023

Background

Alzheimer’s disease (AD) is a neurodegenerative disease without known cure. However, early medical treatment can help control its progression and postpone intellectual decay. Since AD is preceded by a period of cognitive deterioration, the effective assessment of cognitive capabilities is crucial to develop reliable screening procedures. For this purpose, cognitive tests are extensively used to evaluate cognitive areas such as language, attention, or memory.

Methods

In this work, we analyzed the potential of a visual dynamics evaluation, the rapid serial visual presentation task (RSVP), for the detection of cognitive impairment in AD. We compared this evaluation with two of the most extended brief cognitive tests applied in Spain: the Clock-drawing test (CDT) and the Phototest. For this purpose, we assessed a group of patients (mild AD and mild cognitive impairment) and controls, and we evaluated the ability of the three tests for the discrimination of the two groups.

Results

The preliminary results obtained suggest the RSVP performance is statistically higher for the controls than for the patients (p-value = 0.013). Furthermore, we obtained promising classification results for this test (mean accuracy of 0.91 with 95% confidence interval 0.72, 0.97).

Conclusions

Since the RSVP is a computerized, auto-scored, and potentially self-administered brief test, it could contribute to speeding-up cognitive impairment screening and to reducing the associated costs. Furthermore, this evaluation could be combined with other tests to augment the efficiency of cognitive impairment screening protocols and to potentially monitor patients under medical treatment.
Prediction of new onset postoperative atrial fibrillation using a simple Nomogram
Authors: Zhu Siming , Che Hebin , Fan Yunlong , Jiang Shengli
Published: April 2023

Background

New onset postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, with an incidence ranging from 15 to 50%. This study aimed to develop a new nomogram to predict POAF using preoperative and intraoperative risk factors.

Methods

We retrospectively analyzed the data of 2108 consecutive adult patients (> 18 years old) who underwent cardiac surgery at our medical institution. The types of surgery included isolated coronary artery bypass grafting, valve surgery, combined valve and coronary artery bypass grafting (CABG), or aortic surgery. Logistic regression or machine learning methods were applied to predict POAF incidence from a subset of 123 parameters. We also developed a simple nomogram based on the strength of the results and compared its predictive ability with that of the CHA2DS2-VASc and POAF scores currently used in clinical practice.

Results

POAF was observed in 414 hospitalized patients. Logistic regression provided the highest area under the receiver operating characteristic curve (ROC) in the validation cohort. A simple bedside tool comprising three variables (age, left atrial diameter, and surgery type) was established, which had a discriminative ability with a ROC of 0.726 (95% CI 0.693–0.759) and 0.727 (95% CI 0.676–0.778) in derivation and validation subsets respectively. The calibration curve of the new model was relatively well-fit (p = 0.502).

Conclusions

Logistic regression performed better than machine learning in predicting POAF. We developed a nomogram that may assist clinicians in identifying individuals who are prone to POAF.