bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating Temporal Memory Strength and Time-Based Impulse Control Using the DRL Task
Authors: Cheng Ruey-Kuang , Liao Ruey-Ming
Published: September 2022

Differential reinforcement of low rate (DRL) responding is a schedule-controlled behavior sometimes used in timing research, but also received critics of not providing a pure measure of timing due to the influence of the subject’s motivation or inhibitory control. Nevertheless, we argue that the DRL task provides a unique approach to study how timing and emotion interact with each other. Here, we review evidence showing that male rats prenatally treated with choline supplementation had difficulty in acquiring longer criterion times in the DRL task. This was possibly due to the stronger memory strength of their previously learned shorter criterion times. Female rats, in contrast, performed better than male rats in the same task, but those receiving prenatal choline supplementation were the best performers in this task with longer criterion times because they required less training. Like all female rats, male rats treated with prenatal choline supplementation made very few burst responses, suggesting that the treatment improved male rats’ emotional regulation when facing ‘frustrating’ outcomes. The differential impulse control plus different memory strength of the rats trained in the DRL task revealed the potential interaction of sex hormones and prenatal choline supplementation, a rare combination in a single animal study on timing and time perception. In summary, although the DRL task is certainly not the best timing task, it may be useful in assisting us in better understanding how time perception participates in emotional regulation, especially relevant when the emotion is triggered by a failure in timing.
The Extended Computational Case Method: A Framework for Research Design
Authors: Pardo-Guerra Juan Pablo , Pahwa Prithviraj
Published: September 2022

This paper considers the adoption of computational techniques within research designs modeled after the extended case method. Echoing calls to augment the power of contemporary researchers through the adoption of computational text analysis methods, we offer a framework for thinking about how such techniques can be integrated into quasi-ethnographic workflows to address broad, structural sociological claims. We focus, in particular, on how this adoption of novel forms of evidence impacts corpus design and interpretation (which we tie to matters of casing), theoretical elaboration (which we associate to moving empirical claims across scales and empirical domains), and verification (which we see as a process of reflexive scaffolding of theoretical claims). We provide an example of the use of this framework through a study of the marketization of social scientific knowledge in the United Kingdom.
Retroperitoneal hematoma in patients with COVID-19 infection during anticoagulant therapy: A case series and literature review
Authors: Hashemi Huriyeh , Moradi Hazhir , Hashemi Marzieh , Naderi Zohre , Jafarpisheh Saleh
Published: September 2022

Due to the hypercoagulable status of patients with severe COVID-19 infection, anticoagulants are often used to prevent thrombosis. However, these agents may cause bleeding events such as retroperitoneal hematoma (RPH). We report here on six patients with COVID-19 who developed RPH during treatment. Early evidence of bleeding led to confirmatory diagnosis with imaging. Four patients recovered with supportive treatment (IV fluids and blood transfusions) and two patients recovered by angioembolization. RPH should be considered in COVID patients on anticoagulants as soon as haemoglobin or blood pressure falls. Further studies are required to provide guidance and recommendations on use of anticoagulants in critically ill patients with COVID-19.
A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying
Authors: Lee Wei , DiGiacomo Michelle , Draper Brian , Agar Meera R. , Currow David C.
Published: September 2022

Objective: To ascertain palliative physicians’ and consultation-liaison psychiatrists’ perceptions of depression care processes in patients with very poor prognoses, exploring key challenges and postulating solutions. Methods: A qualitative focus group study involving three 1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted between November-December 2020. Fellows and trainees were recruited from Australian and New Zealand Society of Palliative Medicine (n  =  11) and Royal Australian and New Zealand College of Psychiatrists (n  =  4). Data underwent conventional qualitative content analysis. Results: Participants perceived depression care to be complex and challenging. Perceived barriers included: inadequate palliative care psychiatry skills with variation in clinical approaches; lack of supportive health infrastructure (poor access to required interventions and suboptimal linkage between palliative care and psychiatry); lack of research support; and societal stigma. Suggested solutions included integrating care processes between palliative care and psychiatry to improve clinician training, establish supportive health systems and promote innovative research designs. Conclusions: Developing clinician training, supportive health systems and innovative research strategies centering on integrating palliative care and psychiatry care processes may be integral to optimising depression care when providing care to people with very poor prognoses.
Correlation analysis of microstructure evolution on microhardness and residual stress for cutting Ti-6Al-4V titanium alloy
Authors: Wang Zong-Yuan , Ren Jun-Xue , Zhou Jin-Hua , Cai Ju
Published: September 2022

Microstructural variation of material directly affects the macroscopic and microscopic mechanical properties of the machined surface. This research investigates the correlation between microstructure evolution and the variation of microhardness and residual stress for cutting Ti-6Al-4V titanium alloy. Firstly, a 2D customized finite element (FE) model has been performed to predict dynamic recrystallization (DRX) and resultant grain size by implementing modified Johnson-Cook(J-C) constitutive model and Johnson-Mehl-Avrami-Kolmogorov(JMAK) model. Then, orthogonal cutting experiments are conducted to verify the accuracy of the established FE model. The predicted values agree well with the measured values and the average error is 8.94% for average grain size. Finally, microhardness and residual stress along with radial direction are measured. The results of simulation and experiment indicate that both microhardness and residual stress profile present an opposite correlation with average grain size profile under different cutting conditions. The correlation analysis between microstructural variation and macroscopic mechanical properties on the surface further deepens the understanding of the machined surface integrity system.
Digital twin and deep reinforcement learning enabled real-time scheduling for complex product flexible shop-floor
Authors: Chang Xiao , Jia Xiaoliang , Fu Shifeng , Hu Hao , Liu Kuo
Published: September 2022

Real-time scheduling methods are essential and critical to complex product flexible shop-floor due to the dynamic events in the production process, such as new job insertions, machine breakdowns and frequent rework. Recently, digital twin (DT) technology can help identify disturbances by continuously comparing physical space with virtual space, which enables real-time scheduling and greatly reduces the deviation between pre-schedule and actual schedule. However, the conventional scheduling models and algorithms cannot satisfy the adaptiveness and timeliness requirements of optimization in DT enabled shop-floor (DTS). To address above challenges, an overall framework of DT enabled real-time scheduling (DTE-RS) for complex product shop-floor is proposed to effectively reduce adverse impacts of the dynamic disturbances and minimize the makespan. Firstly, complex product flexible job shop scheduling problem (CPFJSP) is formulated as Markov Decision Process (MDP), taking into account machine breakdown and new job insertions. Then, deep Q-network (DQN) based solution is developed to achieve optimal task dispatching according to real-time production state. Finally, the case study for aircraft overhaul shop-floor is conducted to demonstrate effectiveness and feasibility of the proposed real-time scheduling method. Through experimental comparison, it is indicated that the proposed method could effectively respond to dynamic disturbances and outperform the dynamic scheduling method in terms of makespan.
Holocene desertification, traditional ecological knowledge, and human resilience in the eastern Gobi Desert, Mongolia
Authors: Rosen Arlene M , Janz Lisa , Dashzeveg Bukhchuluun , Odsuren Davaakhuu
Published: September 2022

Dryland regions are particularly challenging for human survival over the course of deep time. This is true for institutionally complex communities as well as small-scale societies that have existed in semi-arid regions throughout the Holocene. This paper examines some of the successful strategies employed by small-scale mobile communities which enhanced their ability to thrive in drylands over the course of thousands of years. Small-scale societies living in drylands must rely on the transmission of Traditional Ecological Knowledge across generations. Some of this knowledge relates to the availability and use of wetlands and other more ephemeral water sources, the exploitation of a diverse range of resources, and the potential for natural storage of food resources as a buffer against regularly occurring drought years in these regions. We compare this understanding with our environmental archeological findings at the Mid-Holocene site of Zaraa Uul in the eastern Gobi Desert of Mongolia. At the site of Zaraa Uul, we show how hunter-gatherer groups returned to a campsite near the edge of a wetland environment over the course of at least two phases during the Mid-Holocene. Here they took advantage of a greater diversity of animal species and plants, including small-grained-grasses and sedges, which could enhance their caloric intake and increase the potential for storable commodities which could be collected as needed from their natural habitat.
Workload Measurement in Subspecialty Placental Pathology in Canada
Authors: Wright James R. , Chan Suzanne , Morgen Eric K. , Maung Raymond T. A. ,   and the Canadian Association of Pathologists’ Pan-Canadian Pediatric-Perinatal Pathology Workload Committee, Brundler Marie-Anne , El Demellawy Dina , Fraser Robert B. , Kurek Kyle C. , Magee Fergall , Nizalik Elizabeth , Oligny Luc L. , Somers Gino R. , Stefanovici Camelia , Terry Jefferson
Published: September 2022

Background

Workload measurement is important to help determine optimal staffing and workload distribution for pathology laboratories. The Level 4 Equivalent (L4E) System is the most widely used Anatomical Pathology (AP) workload measurement tool in Canada. However, it was initially not developed with subspecialties in mind.

Methods

In 2016, a Pan-Canadian Pediatric-Perinatal Pathology Workload Committee (PCPPPWC) was organized to adapt the L4E System to assess Pediatric-Perinatal Pathology workload. Four working groups were formed. The Placental Pathology Working Group was tasked to develop a scheme for fair valuation of placental specimens signed out by subspecialists in the context of the L4E System. Previous experience, informal time and motion studies, a survey of Canadian Pediatric-Perinatal Pathologists, and interviews of Pathologists’ Assistants (PA) informed the development of such scheme.

Results

A workload measurement scheme with average L4E workload values for examination and reporting of singleton and multiple gestation placentas was proposed. The proposal was approved by the Canadian Association of Pathologist - Association canadienne des pathologistes Workload and Human Resources Committee for adoption into the L4E System.

Conclusion

The development of a workload measurement model for placental specimens provides an average and fair valuation of these specimen types, enabling its use for resource planning and workload distribution.
The Effects of chronic smoking on retinal vascular densities and choroidal thicknesses measured by optical coherence tomography angiography
Authors: Gokmen Onur , Ozgur Gokhan
Published: September 2022

Purpose

To examine the effects of chronic smoking on vascular density in superficial and deep retinal vascular plexuses and choroidal thicknesses.

Method

Superficial and deep vessel densities and choroidal thicknesses of smoking volunteers and healthy non-smoking volunteers were measured with the Topcon DRI OCT-1 Tritron® device and compared with each other.

Results

This study included 108 eyes of 54 smoking volunteers and 108 eyes of 54 healthy volunteers as a control group. The average superficial vascular density index and deep vascular density indexes of smokers were found to be 39.81 ± 1.5% and 42.53 ± 1.9%, respectively (P = 0.53), while the non-smoking control group was 40.09 ± 1.3% and 41.57 ± 1.6%, respectively (P = 0.006). Average choroidal thicknesses were 284.22 ± 59 in smokers and 270.72 ± 61 in the control group (P = 0.247). Also, smoking quantity per day x years was found to be significantly negatively correlated with average choroidal thicknesses. (P = 0,011).

Discussion

In this study, it was determined that chronic smoking increases deep retinal vascular densities on retinal vascular plexus. However, the cumulative effect of smoking was found to be negatively correlated with choroidal thicknesses. Smoking has microvascular effects on vessels such as vasodilatation, vasoconstriction, increased platelet aggregation, endothelial dysfunction. However, studies in the literature are in dispute with the effects of smoking on choroidal and retinal vessels. This study may show that chronic smoking may have different vascular effects on the superficial and deep plexuses and choroidal vessels, as well as different effects from acute use.
Compositional characteristics of neighbourhoods and of schools as correlates of youths’ mental health: A cross-sectional study among Swedish adolescents
Authors: Lindstrand Sofia , Andersson Filip , Galanti Maria Rosaria
Published: September 2022

Aims:

The study aimed to analyse the association between neighbourhood- and school-level socio-demographic factors and self-reported mental health among adolescents.

Methods:

The study population consisted of 3959 adolescents in southern and central Sweden (the KUPOL study), surveyed in the seventh grade (13 years old) and again in the ninth grade (15 years old). Cross-sectional associations were studied between socio-demographic indicators at neighbourhood level (proportion of adults with high education, without employment, of foreign-born residents) and at school level (proportion of students with at least one parent with high education, of students with a foreign background, mean qualification points in ninth grade) and mental health problems. These were assessed through the Strengths and Difficulties Questionnaire (SDQ). We derived odds ratios (OR) and corresponding 95% confidence intervals (CI) of scale scores above the threshold using multilevel logistic regression models.

Results:

After adjustment for individual- and family-level socio-demographic factors, there was an indication of higher OR of mental health problems with increasing proportions of foreign-born and residents without employment, especially among girls and in public schools. Stronger associations in the expected direction were found with the internalising subscale. Socio-demographic factors at the school level were not associated with adolescents’ mental health, except in private schools, where increasing proportions of students with highly educated parents were significantly associated with SDQ scores under the threshold (OR=0.91; 95% CI 0.85–0.97).

Conclusions:

The results indicate that equal living conditions may represent important cues to improve the mental health of adolescents. Longitudinal studies are needed to determine any causality.
Deep transfer learning for connection defect identification in prefabricated structures
Authors: Tang Hesheng , Xie Yajuan
Published: September 2022

Defect and damage identification is a crucial task in structural health monitoring (SHM) systems. Recent advances in deep neural networks (DNNs) show success in identification from data for a wide range of SHM systems. However, this approach faces challenges in terms of robustness and scalability with respect to data scarcity. Data collection for the training of DNNs from both the field and laboratory experiments is costly. To address this issue, we employ transfer learning (TL) through the use of deep convolutional neural networks (CNNs) for defect identification in the context of a sensor network’s vibration data. A deep TL (DTL) paradigm is used herein so that a pretrained CNN, primarily trained for generalized defect identification tasks where sufficient training data exist (source domain), can be re-trained partially (fine-tuned) as a later secondary process that targets this application domain (target domain) specifically. Different DTL cases are compared, and training data are enhanced with numerical simulation data. The efficacy and robustness of this method are demonstrated on defect identification for full-scale prefabricated concrete shear wall structures with different levels of data scarcity. This method utilizes dynamic responses collected using a sensor network. This is an extension of deep learning vision for non-vision tasks. Defect features are extracted from the dataset of dynamic responses using this DTL frame. Experimental results show that this approach can improve identification models on datasets with few samples.
Poems Upon Reading “Say Goodbye to the Toddler Stars of the Pandemic Office Zoom” in Bloomberg Law
Authors: Gringle Meredith R
Published: September 2022

I wrote the poems that comprise this work after reading a news article about the changing expectations of remote work and childcare. The article is ostensibly about negotiating the terms and expectations of remote work, yet it also read to me like a manual of maternal erasure. The message quickly evolves into making first care-work and then mothers disappear. The poems span from free verse, to limerick, to villanelle, concluding with a poem that, as its title announces, is not a poem at all. All are meant to speak(back) to discourses around mothering, care, and labor in the United States.
A qualitative study of purchaser unit employees’ experiences of patient pathways from specialist healthcare to primary healthcare in Norway
Authors: Killie Paul , Jakobsen Rita , Sørensen Kari Engen , Debesay Jonas
Published: September 2022

Introduction

Understanding the purchaser–provider split model in the patient pathway is important. The purchaser is a key player in managing the flow between specialist and municipal healthcare services. A smoother patient transfer has been a priority in Norway, but also challenging. Accordingly, this study aims to describe and explain how the purchasers operate as liaisons during patient transfers from specialist to primary healthcare services.

Methods

Eleven interviews were conducted with employees at purchaser units in primary healthcare in Norway. The interviewees’ professional backgrounds were in nursing and physiotherapy, as well as casework, and management. The interviews took place in 2018–2019 and analyzed with Graneheim and Lundman's content analysis strategy.

Results

The interviewees’ views reflected the changes they experienced in the wake of healthcare reforms in specialist healthcare services and municipal healthcare institutions. Three themes emerged from the analyses: (1) increased efficiency requirements after the Coordination Reform, (2) better reporting systems and the need for role clarifications in contact with hospitals, and (3) the need for good assessments for safe transfer to the municipality.

Discussion

Purchaser unit employees’ experiences with patient pathways point towards a need for certain changes. There is a need for increased efficiency requirements for purchasing units, even with new electronic tools, as well as a growing need for better reporting systems and a common understanding between the service levels about what patients can expect in the municipalities.
Making sense of decision support systems: Rationales, translations and potentials for critical reflections on the reality of child protection
Authors: Jørgensen Andreas Møller , Nissen Maria Appel
Published: September 2022

Decision support systems, which incorporate artificial intelligence and big data, are receiving significant attention in the public sector. Decision support systems are sociocultural artefacts that are subject to a mix of technical and political choices, and critical investigation of these choices and the rationales they reflect are paramount since they are inscribed into and may cause harm, violate fundamental rights and reproduce negative social patterns. Applying and merging the concepts of sense-making and translation, this article investigates the rationales, translations and critical reflections that shape the development of a decision support system to support social workers assessing referrals concerning child neglect. It presents findings from a qualitative case study conducted in 2019–2020 at the Citizen Centre Children and Young People, Copenhagen Municipality, Denmark. The analysis shows how key actors through processes of translation construct, negotiate and readjust problem definitions, roles, interests, responsibilities and ideas of ambiguity and accountability. Although technological solutionism is present in these processes, it is not the only rationale invested. Rather, technological and data-driven rationales are adjusted to and merged with rationales of efficiency, return on investment and child welfare. Through continuous renegotiation of roles, responsibilities and problems according to these rationales, the key actors attempt to orchestrate ways of managing the complexity facing child welfare services by projecting images of future potentials of the decision support system that are yet to be realised.
Timely intervention, monitoring and education MATTERS in MS (TIME MATTERS in MS): Development of a globally applicable quality improvement tool
Authors: Hobart Jeremy , Butzkueven Helmut , Haartsen Jodi , Ziemssen Tjalf , Lane Thirusha , Giovannoni Gavin
Published: September 2022

Background

Previously, consensus MS care standards were defined by MS specialist neurologists from 19 countries. We developed, piloted and refined an Excel-based quality improvement tool to enable MS services to benchmark against these standards. Here, we examine the refined tool.

Objective

To determine the applicability of the quality improvement tool in different healthcare settings.

Methods

MS centres across the globe were invited to pilot the quality improvement tool by coding the medical records of 36 adults with MS. We invited feedback on user friendliness, quality improvement tool usefulness and relevance of data collected.

Results

Seventeen centres from 14 countries participated; 14 completed the post-service evaluation survey. Over 50% of responders rated the tool ‘very easy’ or ‘easy’ to use and ‘very relevant’ to their service. Almost 85% of responders (11/13) planned to introduce changes to their service, including improvements in documentation, communication, interactions with colleagues and referrals; 85% would use a future shorter version of the tool.

Conclusions

The quality improvement tool can enable MS centres globally to benchmark their services. Widespread uptake of a shorter tool may help MS centres to work towards achieving consensus standards for brain health-focused care. Incorporation into routine clinical practice would drive adoption.
Relationship Between Diabetes-Related Complications and Sleep Complaints in Older Mexican Americans
Authors: Sultana Rizwana , Downer Brian , Chen Nai-wei , Raji Mukaila , Fernandez David , Al Snih Soham
Published: September 2022

Introduction/Objective:

The prevalence of Type 2 Diabetes Mellitus is increasing in the older American population, especially Mexican Americans. Sleep disorders are common in older adults with T2DM. This study examined the relationship between T2DM-related complications and sleep complaints in older Mexican Americans over 9 years of follow-up.

Methods:

Study included 310 participants aged 77 years or older with self-reported diabetes from the Hispanic Established Population for the Epidemiological Study of the Elderly (2007/08-2016).

Results:

Of the 310 participants, the mean age was 82.04 years. The cohort had significantly more females (69.03%) than males (30.97%). A substantial number of participants had trouble falling asleep (16.13%), waking up several times (36.45%), trouble staying asleep (15.16%), and feeling tired and worn out after waking up (12.90%). The percent of diabetes complications were 70.2% for circulation problems, 58.2% for eye disorders, 15.9% for kidney disease, and 4.4% for amputation. Participants who experienced sleep complaints for 15 or more days in a month were more likely to experience diabetic complications.

Discussion:

This study demonstrated a significant relationship between T2DM macro- and micro-vascular complications and increased risk of sleep disorders in older Mexican Americans.
Retention in Care among Patients Attending a Large HIV Clinic in Nigeria Who Were Treated for Tuberculosis
Authors: Adekanmbi Olukemi , Ilesanmi Stephen , Ogunbosi Babatunde , Moradeyo Dasola , Lakoh Sulaiman
Published: September 2022

A retrospective study of 2764 patients was conducted at an HIV clinic in Nigeria to evaluate retention in care in patients treated for TB. At 6 and 12 months after commencement of TB treatment, 1842(66.6%) and 1624(58.8%) participants remained in care. Of the 922 and 1140 not in care at 6 and 12 months, 814(88.3%) and 1006(88.2%) respectively were lost to follow-up (LTFU). VL < 1000copies/ml was associated with higher odds of retention in care at 6 and 12 months (OR  =  2.351 and 2.393) than VL > 1000 copies/ml. HAART use was associated with high likelihood of being in care at 12 months (OR  =  3.980). CD4 counts of 200–350 and >350 cells/mm3 were associated with increased odds of remaining in care at 12 months compared with CD4 < 200 cells/mm3 (p  =  0.005 and p  =  0.001). Targeted interventions such as early HAART and close follow-up for high risk groups are likely to improve retention in care.
Characteristics and outcomes of out-of-hospital cardiac arrest patients before and during the COVID-19 pandemic in Thailand
Authors: Phattharapornjaroen Phatthranit , Nimnuan Waratchaya , Sanguanwit Pitsucha , Atiksawedparit Pongsakorn , Phontabtim Malivan , Mankong Yahya
Published: September 2022

Background

Out-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand.

Methods

This single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital’s emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected.

Results

A total of 136 patients were included (78 men [59.1%]; mean [SD] age, 67.9 [18] years); 60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period).

Conclusions

During the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups.

Trial registration

This trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006.
A top-down approach for a multi-scale identification of risk areas in infrastructures: particularization in a case study on road safety
Authors: Rúa Erik , Comesaña-Cebral Lino , Arias Pedro , Martínez-Sánchez Joaquín
Published: September 2022

Introduction

Transport infrastructures have an important function in society and the development of a country. In Spain, the most used modes of traveler transport are road and rail, far ahead of other means of transport such as air or maritime transport. Both rail and road infrastructures can be affected by numerous hazards, endangering their performance and the safety of users. This study proposes a methodology with a multiscale top-down approach to identify the areas affected by fire, landslide, and safety in road and rail infrastructures in Galicia (Northwest Spain).

Methodology

The methodology is developed in three steps, coinciding with the three scales considered in this work: network-, system-, and object-level. In the first step, risk areas are identified and prioritized, resulting in the most critical safety risk in a motorway section. This area defines a study scenario composed of a location (A-55 motorway) and the associated risk (road safety). In the second step, the road safety factors within this scenario are selected, hierarchized, and weighted using a combination of Multi-Criteria Decision-Making methods including the Analytical Hierarchy Process and the Best–Worst Method. Finally, a risk map is generated based on the weighting of infrastructure-related safety factors and compared to real historical accident data for validation. The methodology is based on road and risk assessment standards and only information in the public domain is used.

Results

Results show that only 3 segments out of 153 were classified incorrectly, which supports a probability higher than 95% of agreement with real data (at 5% significance level). In a conclusion, the overall methodology exhibits a high potential for hazard prevention and road-safety enhancement.
Microbiological characteristics of different tongue coatings in adults
Authors: He Caihong , Liao Qiaoyun , Fu Peng , Li Jinyou , Zhao Xinxiu , Zhang Qin , Gui Qifeng
Published: September 2022

Background

Tongue coating is an important health indicator in traditional Chinese medicine (TCM). The tongue coating microbiome can distinguish disease patients from healthy controls. To study the relationship between different types of tongue coatings and health, we analyzed the species composition of different types of tongue coatings and the co-occurrence relationships between microorganisms in Chinese adults.

From June 2019 to October 2020, 158 adults from Hangzhou and Shaoxing City, Zhejiang Province, were enrolled. We classified the TCM tongue coatings into four different types: thin white tongue fur (TWF), thin yellow tongue fur (TYF), white greasy tongue fur (WGF), and yellow greasy tongue fur (YGF). Tongue coating specimens were collected and used for 16S rRNA gene sequencing using the Illumina MiSeq system. Wilcoxon rank-sum and permutational multivariate analysis of variance tests were used to analyze the data. The microbial networks in the four types of tongue coatings were inferred independently using sparse inverse covariance estimation for ecological association inference.

Results

The microbial composition was similar among the different tongue coatings; however, the abundance of microorganisms differed. TWF had a higher abundance of Fusobacterium periodonticum and Neisseria mucosa, the highest α-diversity, and a highly connected community (average degree = 3.59, average closeness centrality = 0.33). TYF had the lowest α-diversity, but the most species in the co-occurrence network diagram (number of nodes = 88). The platelet-to-lymphocyte ratio (PLR) was associated with tongue coating (P = 0.035), and the YGF and TYF groups had higher PLR values. In the co-occurrence network, Aggregatibacter segnis was the “driver species” of the TWF and TYF groups and correlated with C-reactive protein (P < 0.05). Streptococcus anginosus was the “driver species” in the YGF and TWF groups and was positively correlated with body mass index and weight (P < 0.05).

Conclusion

Different tongue coatings have similar microbial compositions but different abundances of certain bacteria. The co-occurrence of microorganisms in the different tongue coatings also varies. The significance of different tongue coatings in TCM theory is consistent with the characteristics and roles of the corresponding tongue-coating microbes. This further supports considering tongue coating as a risk factor for disease.
Association between secondhand smoke exposure in pregnant women and their socioeconomic status and its interaction with age: a cross-sectional study
Authors: Zhou Wensu , Zhu Xidi , Hu Zhao , Li Shaojie , Zheng Baohua , Yu Yunhan , Xie Donghua
Published: September 2022

Background

Existing evidence highlights that exposure to secondhand smoke (SHS) is a risk factor for pregnant women’s health and is possibly affected by individual characteristics. This study aimed to explore the effect of individual socioeconomic status (SES) on SHS exposure among pregnant women in the third trimester and the interaction effect of age.

Methods

A total of 678 nonsmoking pregnant women with a median age of 29.0 years from 14 communities in a medium-sized city were recruited for this survey. Exposure to SHS was defined as the self-reported smoking habit of a spouse/partner. Individual SES characteristics consisted of marital status, educational attainment, employment and per capita monthly income.

Results

There were 238 (35.1%) participants who suffered from SHS exposure. Compared to the pregnant women who were employed, those who were unemployed were more likely to suffer from SHS exposure (OR = 1.572, 95% CI: 1.013–2.441). Participants who had a high school or technical secondary school education were more likely to be exposed to SHS than those with a college education or above (OR = 1.601, 95% CI: 1.029–2.449). Advanced age was a protective factor for participants with a college education or above (OR = 0.939, 95% CI: 0.884–0.997), but age increased the risk of SHS exposure among women who had unstable marriages (OR = 1.256, 95% CI: 1.019–1.549).

Conclusion

Exposure to SHS was very common among pregnant women in the third trimester. Pregnant women with a low SES and an older age should be considered a key population for the implementation of public health interventions.
Quantitative assessment of eye movements using a binocular paradigm: comparison among amblyopic, recovered amblyopic and normal children
Authors: Zhou Yulian , Bian Hewei , Yu Xiaobin , Wen Wen , Zhao Chen
Published: September 2022

Background

To investigate the eye movement functions in children with amblyopia and recovered amblyopia by a binocular eye-tracking paradigm.

Methods

Eye movements of 135 pediatric subjects (age range: 4–14 years), including 45 amblyopic children, 45 recovered amblyopic children and 45 age-similar normal controls, were recorded under binocular viewing with corrected refractive errors (if any). The deviation of gaze positions relative to the target location was recorded as the mean from both eyes. Main outcome measures included fixation deviations (degree) along horizontal and vertical axes in the sustained fixation test (Fix-X, Fix-Y) and visually guided saccade test (Sac-X, Sac-Y), which were compared across the three groups and between each two groups.

Results

All the four deviations were significantly larger in the amblyopia group compared to the other two groups, indicating increased inaccuracy of sustained and post-saccadic fixations in amblyopia. However, there was no significant difference in deviations between recovered amblyopic children and normal controls. Repeated measures showed similar results overall and within each group. Mild to moderate amblyopes and severe amblyopes did not differ in the four deviations. No significant interaction was found between subject groups and clinical characteristics (age, refractive status, and anisometropia).

Conclusion

Amblyopic children have poor eye movement functions with increased inaccuracy of sustained and post-saccadic fixations, which appear to be restored in children with recovered amblyopia. Binocular assessment of eye movements provides valuable indicators of functional recovery in amblyopia.
Predictors and changes of physical activity in idiopathic pulmonary fibrosis
Authors: Badenes-Bonet Diana , Rodó-Pin Anna , Castillo-Villegas Diego , Vicens-Zygmunt Vanesa , Bermudo Guadalupe , Hernández-González Fernanda , Portillo Karina , Martínez-Llorens Juana , Chalela Roberto , Caguana Oswaldo , Sellarés Jacobo , Molina-Molina Maria , Duran Xavier , Gea Joaquim , Rodríguez-Chiaradia Diego Agustín , Balcells Eva
Published: September 2022

Background

Different clinical predictors of physical activity (PA) have been described in idiopathic pulmonary fibrosis (IPF), but studies are lacking evaluating the potential role of muscle strength and anxiety and depression symptoms in PA limitation. Moreover, little is known about the impact of changes in PA in the course of the disease. The aim of the present study was to investigate the relationship between baseline PA and a wide range of variables in IPF, to assess its longitudinal changes at 12 months and its impact on progression free-survival.

Methods

PA was assessed by accelerometer and physiological, clinical, psychological factors and health-related quality of life were evaluated in subjects with IPF at baseline and at 12 month follow-up. Predictors of PA were determined at baseline, evolution of PA parameters was described and the prognostic role of PA evolution was also established.

Results

Forty participants with IPF were included and 22 completed the follow-up. At baseline, subjects performed 5765 (3442) daily steps and spent 64 (44) minutes/day in moderate to vigorous PA. Multivariate regression models showed that at baseline, a lower six-minute walked distance, lower quadriceps strength (QMVC), and a higher depression score in the Hospital Anxiety and Depression scale were associated to lower daily step number. In addition, being in (Gender-Age-Physiology) GAP III stage, having a BMI ≥ 25 kg/m2and lower QMVC or maximum inspiratory pressure were factors associated with sedentary behaviour. Adjusted for age, gender and forced vital capacity (FVC) (%pred.) a lower progression-free survival was evidenced in those subjects that decreased PA compared to those that maintained, or even increased it, at 12 months [HR 12.1 (95% CI, 1.9–78.8);p = 0.009].

Conclusion

Among a wide range of variables, muscle strength and depression symptoms have a predominant role in PA in IPF patients. Daily PA behaviour and its evolution should be considered in IPF clinical assessment and as a potential complementary indicator of disease prognosis.
Association between patient care ownership and personal or environmental factors among medical trainees: a multicenter cross-sectional study
Authors: Fujikawa Hirohisa , Son Daisuke , Aoki Takuya , Eto Masato
Published: September 2022

Background

Patient care ownership (PCO) is crucial to enhancing accountability, clinical skills, and medical care quality among medical trainees. Despite its relevance, there is limited information on the association of personal or environmental factors with PCO, and thus, authors aimed to explore this association.

Methods

In 2021, the authors conducted a multicentered cross-sectional study in 25 hospitals across Japan. PCO was assessed by using the Japanese version of the PCO Scale (J-PCOS). To examine the association between personal (level of training, gender, and department) or environmental factors (hospital size, hospital type, medical care system, number of team members, number of patients receiving care, mean working hours per week, number of off-hour calls per month, and perceived level of the workplace as a learning environment) and PCO after adjusting for clustering within hospitals, the authors employed a linear mixed-effects model.

Results

The analysis included 401 trainees. After adjusting for clustering within hospitals, it was confirmed that the senior residents had significantly better J-PCOS total scores (adjusted mean difference: 8.64, 95% confidence interval [CI]: 6.18–11.09) than the junior residents and the perceived level of the workplace as a learning environment had a positive association with J-PCOS total scores (adjusted mean difference per point on a global rating of 0–10 points: 1.39, 95% CI: 0.88–1.90). Trainees who received calls after duty hours had significantly higher J-PCOS total scores than those who did not (adjusted mean difference: 2.51, 95% CI: 0.17–4.85). There was no clear trend in the association between working hours and PCO.

Conclusions

Seniority and the perceived level of the workplace as a learning environment are associated with PCO. An approach that establishes a supportive learning environment and offers trainees a reasonable amount of autonomy may be beneficial in fostering PCO among trainees. The study findings will serve as a useful reference for designing an effective postgraduate clinical training program for PCO development.
Perspectives of health care professionals’ on delivering mHealth sexual and reproductive health services in rural settings in low-and-middle-income countries: a qualitative systematic review
Authors: Laar Alexander Suuk , Harris Melissa L. , Shifti Desalegn Markos , Loxton Deborah
Published: September 2022

Background

In low to middle income countries (LMICs) with limited health care providers (HCPs) and health infrastructure, digital technologies are rapidly being adopted to help augment service delivery. In this sphere, sexual and reproductive health (SRH) services are increasingly leveraging mobile health (mHealth) technologies to improve service and information provision in rural areas. This systematic review aimed to identify HCPs perspectives on barriers to, and facilitators of, mobile phone based SRH services and information in rural areas of LMICs from current literature.

Methods

Searches were conducted using the following databases: Medline, Scopus, PsychINFO, CINAHL and Cochrane Library. Based on the inclusion and exclusion criteria, twelve full text qualitative studies published in English between January 2000 and December 2020 were included. The methodological quality of papers was assessed by two authors using the critical skills appraisal programme and synthesized using the narrative thematic analysis approach.

Results

Positive HCPs experiences surrounding the provision of mHealth based SRH services in LMICs included saving consultation time, ability to shift tasks, reduction in travel costs, easy referrals and follow up on clients, convenience in communicating health information confidentially, and the ability to consult groups of clients remotely rather than face-to-face. Barriers to the provision of mHealth reported by HCPs included lack of technological infrastructure, unreliable networks, limited power, the cost of mobile airtime/data and mobile phones and limited technological literacy or skills.

Conclusions

Implementing innovative mHealth based SRH services could bridge a service provision and access gap of SRH information and services in rural areas of LMICs. Despite the advantages of this technology, several challenges associated with delivering mHealth SRH services need to be urgently addressed to enable scale-up and integration of sexual and reproductive mHealth into rural health systems.
Bristol Rabbit Pain Scale (BRPS): clinical utility, validity and reliability
Authors: Benato L. , Murrell J. , Rooney N.
Published: September 2022

Background

The Bristol Rabbit Pain Scale (BRPS) was developed using a combination of methods, focus groups and behavioural observation, that led to a composite pain scale of six categories (Demeanour, Locomotion, Posture, Ears, Eyes and Grooming) with four intensities of pain (0, 1, 2, and 3), and a total score of 0–18. The aim of this study was to assess the clinical utility, validity and reliability of the BRPS.

Materials and methods

The clinical utility of the BRPS was tested using a questionnaire composed of ten questions each on a five-point Likert scale ranging from one (strongly disagree) to five (strongly agree). The respondents, (veterinary surgeons and veterinary nurses), were asked to assess up to four rabbits in acute pain, using the novel pain. They then completed the questionnaire which asked whether the BRPS was easy and quick to use and whether it provided information that was clinically useful. The questionnaire was tested for internal reliability using the Cronbach’s alpha reliability coefficient. The construct validity (how well the tool measures the concept it was designed for) was measured by observers blindly rating 20 rabbits pre- and post-surgery whilst the criterion validity (the degree to which the tool correlates with a gold standard) was assessed by correlating BRPS scores with scores using a numerical rating scale (NRS) with a total score of 0–10. Inter-rater reliability was tested by quantifying the agreement in the pain scores given by nine participants when assessing the same 40 video clips. The intra-rater reliability was measured by testing how consistent the participants were when rating the same clips one month later.

Results

The median score of the ten questions of the clinical utility test was 4 (range 2–5). The Cronbach’s alpha reliability coefficient of the clinical utility test was good (α = 0.811) demonstrating good internal consistency. The median (range) pain score of the BRPS and the NRS were 3 (0–14) and 0 (0–8) before surgery and 12 (1–18) and 7 (0–10) after surgery respectively. The BRPS demonstrated high construct validity (Z = -11.452; p < 0.001) and there was a strong correlation between the BRPS and the NRS (Rho = 0.851; p < 0.001) indicating high criterion validity. The inter-rater and the intra-rater agreements were α = 0.863 and α = 0.861 respectively, which is considered good.

Conclusions

This study showed that the BRPS is a suitable tool for quantifying pain in rabbits in a clinically useful, valid and reliable way.