bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Lamb wave-based damage diagnosis in composite materials using a pseudo-damage boosted convolutional neural network approach
Authors: Gonzalez-Jimenez Alvaro , Lomazzi Luca , Junges Rafael , Giglio Marco , Manes Andrea , Cadini Francesco
Published: August 2023

Damage diagnosis of thin-walled structures has been successfully performed through methods based on tomography and machine learning-driven methods. According to traditional approaches, diagnostic signals are excited and sensed on the structure through a permanently installed network of sensors and are processed to obtain information about the damage. Good performance characterizes methods that process Lamb waves, which are described by long propagation distances and high sensitivity to anomalies. Most of the methods require extracting damage-sensitive features from the diagnostic signals to drive the damage diagnosis task. However, this process can lead to loss of information, and the choice of the specific feature to extract may introduce biases that hamper damage diagnosis. Furthermore, traditional approaches do not perform well when composites are considered, due to the anisotropy, inhomogeneity, and complex damage mechanisms shown by this type of material. To boost the performance of methods for damage diagnosis of composite plates, this work proposes a convolutional neural network (CNN)-based algorithm that localizes damage by processing Lamb waves. Different from other methods, the proposed method does not require extracting features from the acquired signals and allows localizing damage through the regression approach. The method was tested against experimental observations of Lamb waves propagating in two composite panels and in a hybrid panel, and the performance of two different sensor arrays was investigated. The pseudo-damage approach was used to generate large enough datasets for training the CNNs, and the performance of the framework was evaluated by localizing pseudo-damage and real damage determined by low-velocity impacts. The CNN-driven method accurately localized damage in all the considered scenarios, and it also outperformed traditional damage indices-based approaches, such as the reconstruction algorithm for probabilistic inspection of defects.
Ultrasound Assessment of the Ulnar Nerve Around the Elbow and Diagnosis of Cubital Tunnel Syndrome, Clinical Outcomes
Authors: Catanzaro Michael , Santangelo Gabrielle , Speach David , Ketonis Constantinos
Published: August 2023

Background:

There is increased interest in ultrasound (US) for the diagnosis of cubital tunnel syndrome (CuTS). We hypothesize that ulnar nerve cross-sectional area (CSA) correlates with disease severity and electrodiagnostic studies (EDX).

Methods:

ARetrospective review was performed at a tertiary medical center. One hundred seventeen patients (166 ulnar nerves) were evaluated. Maximum CSA at 3 points around the elbow (proximal, groove, and distal) and EDX results (American Board of Electrodiagnostic Medicine-certified physiatrist’s interpretations) were collected.

Results:

US was positive (CSA > 0.1 cm2) in 95/117 cases (81.20%) versus 84/117 (71.79%) positive for EDX. CuTS patients treated surgically had significantly greater (0.13 cm2, standard deviation [SD] 0.038) preoperative CSA than non-operative patients (0.10 cm2, SD 0.033) ( p = .003). CSA increased as EDX increased in severity; mild (0.116 cm2, SD 0.031), moderate (0.121 cm2, SD 0.035), and severe (0.163 cm2, SD 0.047) with a significant difference between the mild and severe groups ( P = .001) and between the moderate and severe groups ( p = .01). Significant differences were seen between patients with positive US and EDX studies compared to those with negative US and EDX in the average physical function scores (57.26, SD 8.57 versus 43.18, SD 7.70; p < .001); average sleep scores (50.14, SD 9.53 versus 56.62, SD 7.31; p = .02); average physical function scores (43.04, SD 8.68 versus 57.08, SD 6.34; p < .001) and average depression scores (49.10, SD 10.88 versus 45.043, SD 7.06; p = .02).

Conclusions:

US is a reliable tool for diagnosis and surgical decision-making for CuTS.

Type of Study/Level of Evidence:

Diagnostic/III.
Perceptions of White Women’s Stigma-Based Solidarity Claims and Disingenuous Allyship
Authors: Chaney Kimberly E. , Cipollina Rebecca , Sanchez Diana T.
Published: August 2023

Efforts to promote allyship often focus on creating a common ingroup identity between marginalized and privileged groups, including making salient stigma-based solidarity. In addition, research on allyship perceptions highlights that allies are viewed as more genuine when they are not perceived as motivated by self-interests. Integrating research on allyship perceptions and stigma-based solidarity, the present research examined Black Americans’ perceptions of White women’s allyship messages that focus on stigma-based solidarity. In three experiments ( Ntotal = 851), White women claiming stigma-based solidarity highlighting shared perpetrators (Studies 1–3) or shared discrimination (Study 3) were perceived as less genuine allies (i.e., less trustworthy and self-sacrificing) who were motivated to reduce racism for their own self-interests compared to allyship claims that only highlighted racism (Studies 1–3) or no allyship claims (Study 2). These findings add to a growing literature documenting marginalized groups’ suspicion of privileged groups’ motives when claiming allyship.
Psychological stressors and needs among essential workers at a Singapore hospital during the COVID-19 pandemic
Authors: Ho Ezra , Oh Hong Choon , Lim Chau Sian , Soon Siew Peng , Ei Ei Khaing Nang
Published: August 2023

Background

Hospital workers have borne a large burden of the COVID-19 pandemic, exposed to risks of infection, while enduring elevated workloads, increased workplace stress, prolonged hours in uncomfortable working conditions, and public stigmatisation.

Objectives

In this cross-sectional study, we examined the psychological stressors of COVID-19 on hospital essential services workers and their needs at a tertiary hospital in Singapore. Methods: We conducted a study of 246 outsourced essential workers comprising housekeeping, maintenance staff, and porting staff. Psychological distress was measured by the Kessler-6 scale. We also surveyed respondents through a questionnaire on the main concerns that worried them, supportive resources available, and additional resources that would most help them.

Results

Among the survey respondents, concerns related to employment, finances, accommodation, transportation, and likelihood of receiving medical attention for COVID-19 were significantly associated with moderate to severe psychological distress ( p<0.05). Stress from isolation and fear of COVID-19 infection constituted the greatest psychosocial burdens. Respondents felt that main supportive resources came from their employers and social circles. They also listed enhanced individual ability to cope, and additional financial aid from their employers and the government would help them the most.

Conclusions

Financial and accommodation-related stressors reflect structural factors that exacerbated the psychosocial burdens faced by non-medical hospital workers. Most respondents tended to individualise their coping strategies, which point towards the need for stronger social protections and mental health provisions for hospital essential services workers.
The electoral consequences of policy-making in coalition governments
Authors: Ellger Fabio , Klüver Heike , Alberto Anthea
Published: August 2023

Does policy-making in coalition governments affect cabinet parties’ electoral performance? Previous research shows that about two thirds of all propositions promised in coalition agreements are actually enacted. But does non-compliance with pledges made in the agreement affect subsequent electoral support? Drawing on the literature on performance voting, we expect that non-compliance is punished by voters, but the effect is conditioned by the importance of the issue and by a parties’ seniority status within the coalition. To test our argument, we have compiled the new comparative COALITIONPOLICY dataset on the enactment of more than 7000 policy pledges by 217 cabinet parties in 19 Western and Eastern European countries from 2000 to 2015. Across a broad range of models, we find no effect of pledge fulfillment on subsequent electoral performance. If anything, adherence to policy-promises only increases support for the prime minister party. These results have important implications for our understanding of political representation, coalition governance, and electoral competition in multiparty democracies.
Teaching as Learning: Etymological Investigation, Canonical Analysis, and Experiential Reflection in the Chinese Cultural Context
Authors: Li Lin
Published: August 2023

Purpose

This study re-examines the relationship between jiao (lit. teaching) and xue (lit. learning)—the foundational education concepts in the traditional Chinese cultural context—to enlighten our contemporary understandings of education and educational research.

Design/Approach/Methods

This study first lays its foundation on an etymological investigation. It then integrates two mutually connected approaches— the classics and the self as method—to present a comprehensive analysis. Finally, it critically reviews the methodology used in this study.

Findings

The interdependency of xue and jiao has an etymological foundation, supported by canonical doctrines and verified by individualized experiences. The interpretation of xue as xiao (to imitate) describes the origin and process of education in which the junior imitated and followed the elder, while the extended interpretation of xue as jue (to awaken) stresses the effects and functions of education. In the classical Chinese context, greater significance was placed on xue—the keyword concurrently connoting the meaning of teaching and learning in the modern sense. It is misleading to narrowly render the originally meaningful word group xuexi as learning in modern English.

Originality/Value

This study consults sources in multiple languages and integrates both the classics and the self as method. Based on this, the etymological investigation, canonical analysis, and experiential reflection are collated to provide a rich and deep discussion. By focusing on the core characteristics and the concepts they imply, this study also touches on the key characteristics of the hieroglyphic system and the unique way of thinking it represents.
If it Bothers Someone it’s a Mistake! How Chinese College Students Conceptualize Transgressions
Authors: Liu Jianjin , Lee Chin-Ling , Midgette Allegra
Published: August 2023

Given that college-attending emerging adults have greater autonomy and thus may be engaging in behaviors they later find problematic, there is a need to investigate how they make sense of transgressions. The present study investigated through six focus groups ( N = 40) how Chinese college students ( M age = 19.6, SD = 1.41, 60% women) made sense of social and moral transgressions (i.e., mistakes) and the strategies they use to self-correct. Mistakes were conceptualized to include violating standards (moral, social, personal) as well as negatively influencing others (causing harm, but also “being a bother” as part of communal living). Participants reported using strategies (mindfulness, seeking assistance) which required making additional effort in everyday life to self-correct. These findings have implications for considering the important role of community and social support in assisting the promotion of college students’ moral agency, so that they may learn from their mistakes.
Reliability of the Single-Arm and Double-Arm Jobe Test for the Diagnosis of Full-Thickness Supraspinatus Tendon Tear
Authors: Katepun Surangkana , Boonsun Phanuwat , Boonsaeng Waraporn Srikhum , Apivatgaroon Adinun
Published: August 2023

Background:

The Jobe test is commonly used to diagnose full-thickness (FT) supraspinatus (SSP) tendon tear. The original Jobe test used single-arm testing, although the double-arm Jobe test has also been used in clinical practice.

Purpose:

To evaluate the reliability, accuracy, and diagnostic value of the single-arm and double-arm Jobe test for diagnosis of FT SSP tear.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Patients with shoulder pain requiring magnetic resonance imaging (MRI) of the shoulder between March 1, 2021, and March 31, 2022, were enrolled. Each patient underwent both single-arm and double-arm Jobe tests by 2 orthopaedic surgeons independently, and the presence of pain, weakness, or both during the test was documented. Diagnosis of FT SSP tear on MRI scan was used as the gold standard to compare the diagnostic value of the Jobe test. The interrater reliability of the Jobe test, and the inter- and intrarater reliability of the MRI evaluation (patients with vs without FT SSP tear) was performed using the kappa (κ) coefficient.

Results:

A total of 80 patients (57 females [71%]; mean age, 61.46 ± 9.61 years) were included. MRI scans revealed FT SSP tears in 32 (40%) of the patients. Both single- and double-arm Jobe tests had low diagnostic values (accuracy, 46.25% to 60%; sensitivity, 46.9% to 84.4%; specificity, 25% to 66.7%). The single-arm test with weakness revealed the highest sensitivity (84.4%). The double-arm test with weakness plus pain revealed the highest specificity (66.7%). Double-arm testing with pain had the highest accuracy (60%), with the highest positive likelihood ratio (1.5). The interrater reliability of the Jobe test indicated substantial agreement (double-arm vs single-arm, κ = 0.771 and 0.716, respectively, agreement 85%; P < .05). The interrater reliability of MRI scan evaluation of the FT SSP tear indicated substantial agreement (κ = 0.750, agreement 85%; P < .05), while the intrarater reliability indicated almost perfect agreement (κ = 0.917, agreement 96%; P < .05).

Conclusion:

The Jobe test, either single- or double-arm, had low accuracy and diagnostic value in diagnosing FT SSP tear. The concern with a single-arm examination for weakness is that it may be an inappropriate diagnostic test for ruling out FT SSP with 84% sensitivity, while a double-arm examination provides a higher specificity.
Investigating the Prevalence of Computer Vision Syndrome (CVS) Among Undergraduate Nursing Students: A Cross-Sectional Study
Authors: Mrayyan Majd T. , Alseid Abdel Rahman Hasan , Ghoolah Tasneem Sameer , Al-Shaikh Ali Marwan H. , Mrayan Manar
Published: August 2023

Introduction

During the pandemic, health issues associated with using digital devices and exploring social media, such as Computer Vision Syndrome (CVS), have increased considerably.

Objectives

This study looked into CVS and its significance in Jordan and the CVS outcomes of undergraduate nursing students who used digital devices to surf social media during COVID-19.

Methods

To assess CVS, a quantitative cross-sectional research design was used. Data were collected in 2022 through an online diagnostic and formative survey utilizing the CVS-Questionnaire (CVS-Q) with 310 undergraduate nursing students from a government and a private university in Jordan. Descriptive statistics and the univariate general linear model were used to analyze the collected data.

Results

To report the prevalence of CVS among the studied sample, the median score was 1.80. The median prevalence score was 24.50 (range = 13–31), and 26.75% of participants reported having intense social media searches. For a student in this study to be diagnosed with CVS, they must receive a score of at least 5, and the current sample score was around 2, indicating they didn’t have a CVS; however, it was moderate when it occurred. About 26.75% of participants reported having problematic social media searches. Back and neck pain and headaches were the typical signs of CVS. The average daily hours spent using digital devices for social media searches increased during the pandemic utilizing mobile phones, especially among male nursing students. Being a junior student with no social media account and unable to balance study and social media were among the predictors of CVS. Most students used protective tools on their digital devices, such as protective films and phone screens, to prevent or accommodate CVS.

Conclusion

There were no prior collected data about CVS in Jordan, and based on the international trend, the COVID-19 pandemic didn’t directly contribute to the prevalence of CVS. However, when the CVS occurred, it was moderate, which mandates proactive and prophylactic redesigning of our educational system.
Chasing Shadows: Why There Cannot be a “Simple” Science of Literacy
Authors: Yaden David B.
Published: August 2023

The rhetoric of the reading wars has become more than just an armchair academic debate, but is encoded now in the very laws, house and senate bills, and legislative policies of the majority of the states. In turn, these policies are powered by staggering sums of money such as the 90-million-dollar investment of Fulton County, Georgia in a revamp of the failed No Child Left Behind initiative of two decades ago since, according to district officials, “Some college programs don’t sufficiently prepare future teachers to teach reading.” And Tennessee plans to spend 100 million dollars on their Reading 360—a program which stresses the development of “strong, phonics-based reading skills.” In this address, I contest the narrow perceptions of what has been called the science of reading movement and focus rather upon another contender for the science throne—that of Developmental Science. Using examples from emergent bilingual children's early writing, I attempt to show that any “simple” model of reading not only wastes useful data about children's literacy performances, but conflates the data with static states of being which, in turn, reduce the conceptual complexity of what is happening in terms of literacy development. Developmentally speaking, my contention is that models based upon the science of reading demand a slavish focus on the alphabet and figural convention. However, Developmental Science challenges the literacy field to embrace the complexity of the developmental processes, and as Vygotsky further argued, “bring the child to an internal understanding of writing” in whatever language that may be.
The Impact of Large-scale Agricultural Investments in Low-income Economies
Authors: Aragie Emerta A.
Published: August 2023

Recent years have witnessed an increasing interest in large-scale agricultural land acquisitions in developing countries. The accompanying socio-economic implications have been areas of debate among politicians, policymakers and development agents. This paper argues that the traditional way of simulating the impacts of these investments in developing countries is misleading as the approach implies that the new investments are identical to the semi-subsistence way of farming that dominates agricultural practices in the host countries. In this study, we incorporate the peculiarity of large-scale agro-investments into an existing database for economy-wide models, i.e., social accounting matrix (SAM), and capture welfare and distributional outcomes properly. SAM-based multiplier models applied to Ethiopian data justify the need to account for the peculiarity of the investments in terms of production technology and their geographic distribution.
Why did it make sense at the time? Applying an ecological dynamics perspective to analyse local rationality
Authors: Stretton Paul
Published: August 2023

Increasingly, a compassionate and curious approach to patient safety recognises the importance of recognising local rationality, asking why decisions made sense at the time they were made. This approach enables increased learning and removes the potential judgement resultant from hindsight bias. The guidance from safety science literature as to how to most effectively learn from this perspective, however, is lacking. Ecological dynamics is a methodology utilised in high-performance environments, where they seek to understand decision making in dynamic, complex environments. This paper explores how ecological dynamics can provide a method to enable organisations to learn more effectively from patient safety events when understanding local rationality. A framework is provided to enable organisations to shift from a response that invokes blame to one that generates rich learning and improvement opportunities, which could be used alongside or incorporated within other systemic methodologies currently used such as SIEPS 2.0.
The modified Borg/6-min walk distance ratio: a method to assess exertional breathlessness and leg discomfort using the 6-min walk test
Authors: Ekström Magnus , Li Pei Zhi , Lewthwaite Hayley , Bourbeau Jean , Tan Wan C. , Jensen Dennis
Published: August 2023

Background

The 6-min walk test (6MWT) is widely used to assess exercise capacity across chronic health conditions, but is currently not useful to assess symptoms, as the scores do not account for the 6-min walk distance (6MWD). We aimed to 1) develop normative reference equations for breathlessness and leg discomfort intensity expressed as modified Borg (mBorg)/6MWD ratios; and 2) validate the equations in people with COPD.

Methods

Analysis of people aged ≥40 years who performed two 6MWTs (on a 20-m course) in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study: a healthy cohort (n=291; mean±sdage 67.5±9.4 years; 54% male) with normal 6MWD and lung function, and a COPD cohort (n=156; age 66.2±9.0 years; 56% male; forced expiratory volume in 1 s (FEV1)/forced vital capacity 56.6±8.2%; FEV174.4±18.6% pred). The mBorg score was calculated as the Borg 0–10 category ratio intensity rating of breathlessness or leg discomfort recorded at the end of the 6MWT +1 (range 1–11), to avoid zeros and yield ratios proportional to the symptom score and 6MWD−1.

Results

Using data from the healthy cohort, sex-specific normative reference equations for breathlessness and leg discomfort mBorg/6MWD ratios were developed using multivariable linear regression, accounting for age, and body mass or body mass index. In the COPD cohort, abnormal breathlessness and leg discomfort (mBorg/6MWD>upper limit of normal) showed strong concurrent validity with worse airflow limitation, Medical Research Council breathlessness and COPD Assessment Test scores.

Conclusion

Normative references for the mBorg/6MWD ratio are presented to assess breathlessness and leg discomfort responses to the 6MWT in COPD.
Transcriptome profiling analysis of uterus during chicken laying periods
Authors: Sun Tiantian , Xiao Cong , Yang Zhuliang , Deng Jixian , Yang Xiurong
Published: August 2023

The avian eggshell is formed in the uterus. Changes in uterine function may have a significant effect on eggshell quality. To identify the vital genes impacting uterine functional maintenance in the chicken, uteri in three different periods (22W, 31W, 51W) were selected for RNA sequencing and bioinformatics analysis. In our study, 520, 706 and 736 differentially expressed genes (DEGs) were respectively detected in the W31 vs W22 group, W51 vs W31 group and W51 vs W22 group. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated DEGs were enriched in the extracellular matrix, extracellular region part, extracellular region, extracellular matrix structural constituent, ECM receptor interaction, collagen-containing extracellular matrix and collagen trimer in the uterus (P < 0.05). Protein–protein interaction analysis revealed that FN1, LOX, THBS2, COL1A1, COL1A2, COL5A1, COL5A2, POSTN, MMP13, VANGL2, RAD54B, SPP1, SDC1, BTC, ANGPTL3 might be key candidate genes for uterine functional maintenance in chicken. This study discovered dominant genes and pathways which enhanced our knowledge of chicken uterine functional maintenance.
Genome-wide identification and expression analyses of the pectate lyase (PL) gene family in Fragaria vesca
Authors: Huang Xiaolong , Sun Guilian , Wu Zongmin , Jiang Yu , Li Qiaohong , Yi Yin , Yan Huiqing
Published: August 2023

Background

Pectate lyase (PL, EC 4.2.2.2), as an endo-acting depolymerizing enzyme, cleaves α-1,4-glycosidic linkages in esterified pectin and involves a broad range of cell wall modifications. However, the knowledge concerning the genome-wide analysis of the PL gene family in Fragaria vesca has not been thoroughly elucidated.

Results

In this study, sixteen PLs members in F. vesca were identified based on a genome-wide investigation. Substantial divergences existed among FvePLs in gene duplication, cis-acting elements, and tissue expression patterns. Four clusters were classified according to phylogenetic analysis. FvePL6, 8 and 13 in cluster II significantly contributed to the significant expansions during evolution by comparing orthologous PL genes from Malus domestica, Solanum lycopersicum, Arabidopsis thaliana, and Fragaria×ananassa. The cis-acting elements implicated in the abscisic acid signaling pathway were abundant in the regions of FvePLs promoters. The RNA-seq data and in situ hybridization revealed that FvePL1, 4, and 7 exhibited maximum expression in fruits at twenty days after pollination, whereas FvePL8 and FvePL13 were preferentially and prominently expressed in mature anthers and pollens. Additionally, the co-expression networks displayed that FvePLs had tight correlations with transcription factors and genes implicated in plant development, abiotic/biotic stresses, ions/Ca2+, and hormones, suggesting the potential roles of FvePLs during strawberry development. Besides, histological observations suggested that FvePL1, 4 and 7 enhanced cell division and expansion of the cortex, thus negatively influencing fruit firmness. Finally, FvePL1-RNAi reduced leaf size, altered petal architectures, disrupted normal pollen development, and rendered partial male sterility.

Conclusion

These results provide valuable information for characterizing the evolution, expansion, expression patterns and functional analysis, which help to understand the molecular mechanisms of the FvePLs in the development of strawberries.
Sequential viral introductions and spread of BA.1 across Pakistan provinces during the Omicron wave
Authors: Bukhari Ali Raza , Ashraf Javaria , Kanji Akbar , Rahman Yusra Abdul , Trovão Nídia S. , Thielen Peter M. , Yameen Maliha , Kanwar Samiah , Khan Waqasuddin , Kabir Furqan , Nisar Muhammad Imran , Merritt Brian , Hasan Rumina , Spiro David , Rasmussen Zeba , Aamir Uzma Bashir , Hasan Zahra
Published: August 2023

Background

COVID-19 waves caused by specific SARS-CoV-2 variants have occurred globally at different times. We focused on Omicron variants to understand the genomic diversity and phylogenetic relatedness of SARS-CoV-2 strains in various regions of Pakistan.

Methods

We studied 276,525 COVID-19 cases and 1,031 genomes sequenced from December 2021 to August 2022. Sequences were analyzed and visualized using phylogenetic trees.

Results

The highest case numbers and deaths were recorded in Sindh and Punjab, the most populous provinces in Pakistan. Omicron variants comprised 93% of all genomes, with BA.2 (32.6%) and BA.5 (38.4%) predominating. The first Omicron wave was associated with the sequential identification of BA.1 in Sindh, then Islamabad Capital Territory, Punjab, Khyber Pakhtunkhwa (KP), Azad Jammu Kashmir (AJK), Gilgit-Baltistan (GB) and Balochistan. Phylogenetic analysis revealed Sindh to be the source of BA.1 and BA.2 introductions into Punjab and Balochistan during early 2022. BA.4 was first introduced in AJK and BA.5 in Punjab. Most recent common ancestor (MRCA) analysis revealed relatedness between the earliest BA.1 genome from Sindh with Balochistan, AJK, Punjab and ICT, and that of first BA.1 from Punjab with strains from KPK and GB.

Conclusions

Phylogenetic analysis provides insights into the introduction and transmission dynamics of the Omicron variant in Pakistan, identifying Sindh as a hotspot for viral dissemination. Such data linked with public health efforts can help limit surges of new infections.
Cesarean sections and early-term births according to Robson classification: a population-based study with more than 17 million births in Brazil
Authors: Rocha Aline S. , Paixao Enny S. , Alves Flavia Jôse O. , Falcão Ila R. , Silva Natanael J. , Teixeira Camila S. S. , Ortelan Naiá , Fiaccone Rosemeire L. , Rodrigues Laura C. , Ichihara Maria Yury , Barreto Mauricio L. , de Almeida Marcia F. , de Cássia Ribeiro-Silva Rita
Published: August 2023

Background

Cesarean section (CS) rates are increasing worldwide and are associated with negative maternal and child health outcomes when performed without medical indication. However, there is still limited knowledge about the association between high CS rates and early-term births. This study explored the association between CSs and early-term births according to the Robson classification.

Methods

A population-based, cross-sectional study was performed with routine registration data of live births in Brazil between 2012 and 2019. We used the Robson classification system to compare groups with expected high and low CS rates. We used propensity scores to compare CSs to vaginal deliveries (1:1) and estimated associations with early-term births using logistic regression.

Results

A total of 17,081,685 live births were included. Births via CS had higher odds of early-term birth (OR 1.32; 95% CI 1.32–1.32) compared to vaginal deliveries. Births by CS to women in Group 2 (OR 1.50; 95% CI 1.49–1.51) and 4 (OR 1.57; 95% CI 1.56–1.58) showed the highest odds of early-term birth, compared to vaginal deliveries. Increased odds of an early-term birth were also observed among births by CS to women in Group 3 (OR 1.30, 95% CI 1.29–1.31), compared to vaginal deliveries. In addition, live births by CS to women with a previous CS (Group 5 - OR 1.36, 95% CI 1.35–1.37), a single breech pregnancy (Group 6 - OR 1.16; 95% CI 1.11–1.21, and Group 7 - OR 1.19; 95% CI 1.16–1.23), and multiple pregnancies (Group 8 - OR 1.46; 95% CI 1.40–1.52) had high odds of an early-term birth, compared to live births by vaginal delivery.

Conclusions

CSs were associated with increased odds of early-term births. The highest odds of early-term birth were observed among those births by CS in Robson Groups 2 and 4.
The burden of untreated insomnia disorder in a sample of 1 million adults: a cohort study
Authors: Grandner Michael , Olivieri Antonio , Ahuja Ajay , Büsser Alexander , Freidank Moritz , McCall William V.
Published: August 2023

Background

Insomnia disorder is a highly prevalent, significant public health concern associated with substantial and growing health burden. There are limited real-world data assessing the burden of insomnia disorder on daytime functioning and its association with comorbidities. The objective of this study was to leverage large-scale, real-world data to assess the burden of untreated insomnia disorder in terms of daytime impairment and clinical outcomes.

Methods

This United States medical claims database study compares patients diagnosed with insomnia disorder but not receiving treatment (‘untreated insomnia’ cohort) to patients without an insomnia disorder diagnosis and without treatment (‘non-insomnia’ cohort). International Classification of Disease, Tenth Revision codes were used as a proxy to represent the three symptom domains (Sleepiness, Alert/Cognition, Mood) of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), a newly developed and validated tool used in clinical studies to assess daytime functioning in insomnia disorder. Chronic Fatigue (R53.83) and Other Fatigue (R53.83), Somnolence (R40.0) and Disorientation (R41.0) were selected as categories representing one or more IDSIQ domains. Clinical outcomes included cardiovascular events, psychiatric disorders, cognitive impairment and metabolic disorders.

Results

Approximately 1 million patients were included (untreated insomnia: n = 139,959; non-insomnia: n = 836,975). Compared with the ‘non-insomnia’ cohort, the ‘untreated insomnia’ cohort was more likely to experience daytime impairments, with mean differences in occurrences per 100 patient-years for: (a) fatigue, at 27.35 (95% confidence interval [CI] 26.81, 27.77, p < 0.01); (b) dizziness, at 4.66 (95% CI 4.40, 4.90, p < 0.01); (c) somnolence, at 4.18 (95% CI 3.94, 4.43, p < 0.01); and (d) disorientation, at 0.92 (95% CI 0.77, 1.06, p < 0.01). During the 1-year look-back period, patients in the ‘untreated insomnia’ cohort were also more likely to have been diagnosed with arterial hypertension (40.9% vs. 26.3%), psychiatric comorbidities (40.1% vs. 13.2%), anxiety (29.2% vs. 8.5%), depression (26.1% vs. 8.1%) or obesity (21.3% vs. 11.1%) compared with those in the ‘non-insomnia’ cohort.

Conclusions

This large-scale study confirms the substantial burden of insomnia disorder on patients in a real-world setting, with significant daytime impairment and numerous comorbidities. This reinforces the need for timely insomnia disorder diagnosis and treatments that improve both sleep, as well as daytime functioning.
A nano-Liposomal formulation potentiates antioxidant, anti-inflammatory, and fibrinolytic activities of Allolobophora caliginosa coelomic fluid: formulation and characterization
Authors: Farouk Asmaa E. , Fahmy Sohair R. , Soliman Amel M. , Ibrahim Sherif Abdelaziz , Sadek Shimaa A.
Published: August 2023

Background

Coelomic fluid, a pharmacologically active compound in earthworms, exhibits a range of biological activities, including antioxidant, anti-inflammatory, and anticancer. However, the biological activities exerted by the coelomic fluid can be restrained by its low bioavailability and stability. Liposomes are progressively utilized as an entrapment system for natural bioactive compounds with poor bioavailability and stability, which could be appropriate for coelomic fluid. Thus, the present study was designed to fabricate, characterize, and evaluate the stability of liposomal formulation for Allolobophora caliginosa coelomic fluid (ACCF) as a natural antioxidant compound.

Methods

The ACCF-liposomes were developed with a subsequent characterization of their physicochemical attributes. The physical stability, ACCF release behavior, and gastrointestinal stability were evaluated in vitro. The biological activities of ACCF and its liposomal formulation were also determined.

Results

The liposomal formulation of ACCF had a steady characteristic absorption band at 201 nm and a transmittance of 99.20 ± 0.10%. Its average hydrodynamic particle size was 98 nm, with a PDI of 0.29 ± 0.04 and a negative zeta potential (-38.66 ± 0.33mV). TEM further confirmed the formation of vesicular, spherical nano-liposomes with unilamellar configuration. Additionally, a remarkable entrapment efficiency percent (77.58 ± 0.82%) with a permeability rate equal to 3.20 ± 0.31% and a high retention rate (54.16 ± 2.20%) for ACCF-liposomes were observed. The Fourier transform infrared spectroscopy (FTIR) result demonstrated that ACCF successfully entrapped inside liposomes. The ACCF-liposomes exhibited a slow and controlled ACCF release in vitro. Regarding stability studies, the liposomal formulation enhanced the stability of ACCF during storage and at different pH. Furthermore, ACCF-liposomes are highly stable in intestinal digestion conditions comparable to gastric digestion. The current study disclosed that liposomal formulation potentiates the biological activities of ACCF, especially antioxidant, anti-inflammatory, and thrombolytic activities.

Conclusion

These promising results offer a novel approach to increasing the bioaccessibility of ACCF, which may be crucial for the development of pharmaceuticals and nutraceutical-enriched functional foods.
Associations between weight-adjusted waist index and bone mineral density: results of a nationwide survey
Authors: Zhang Ya , Wu Haiyang , Li Cheng , Liu Changxiong , Liu Mingjiang , Liu Xiaozhu , Yin Qiming , Li Xianzhe , Xie Ruijie
Published: August 2023

Background

The weight-adjusted waist circumference index (WWI) is a novel obesity indicator that offers improved accuracy in assessing both muscle and fat mass compared to traditional measures. This study aimed to investigate the association between WWI and bone mineral density (BMD) in adults.

Methods

Weighted multivariate logistic regression, subgroup analysis, interaction tests and restricted cubic spline (RCS) curves were used to explore the relationship between WWI and BMD based on data from the National Health and Nutrition Examination Survey (NHANES).

Results

This study had 40,568 individuals in total. At all four measurement sites, we detected a negative linear correlation between WWI and BMD. Even when quartile factors for WWI were created, this unfavorable connection maintained. In comparison to those in the lowest quartile, those in the highest percentile of WWI showed declines in lumbar BMD of 0.08 g/cm2 and femoral neck BMD of 0.03 g/cm2, respectively. This adverse correlation, nevertheless, differed among several categories.

Conclusions

Our findings suggest an adverse correlation between WWI and BMD among US adults. Employing WWI as a tool for osteoporosis prevention in the general population may enhance interventions.
Genetic diversity and natural selection of Plasmodium vivax reticulocyte invasion genes in Ecuador
Authors: Núñez Andrés , Ntumngia Francis B. , Guerra Yasel , Adams John H. , Sáenz Fabián E.
Published: August 2023

Background

Knowledge of the diversity of invasion ligands in malaria parasites in endemic regions is essential to understand how natural selection influences genetic diversity of these ligands and their feasibility as possible targets for future vaccine development. In this study the diversity of four genes for merozoite invasion ligands was studied in Ecuadorian isolates of Plasmodium vivax.

Methods

Eighty-eight samples from P. vivax infected individuals from the Coast and Amazon region of Ecuador were obtained between 2012 and 2015. The merozoite invasion genes pvmsp-1-19, pvdbpII, pvrbp1a-2 and pvama1 were amplified, sequenced, and compared to the Sal-1 strain. Polymorphisms were mapped and genetic relationships between haplotypes were determined.

Results

Only one nonsynonymous polymorphism was detected in pvmsp-1-19, while 44 nonsynonymous polymorphisms were detected in pvdbpII, 56 in pvrbp1a-2 and 33 in pvama1. While haplotypes appeared to be more related within each area of study and there was less relationship between parasites of the coastal and Amazon regions of the country, diversification processes were observed in the two Amazon regions. The highest haplotypic diversity for most genes occurred in the East Amazon of the country. The high diversity observed in Ecuadorian samples is closer to Brazilian and Venezuelan isolates, but lower than reported in other endemic regions. In addition, departure from neutrality was observed in Ecuadorian pvama1. Polymorphisms for pvdbpII and pvama1 were associated to B-cell epitopes.

Conclusions

pvdbpII and pvama1 genetic diversity found in Ecuadorian P. vivax was very similar to that encountered in other malaria endemic countries with varying transmission levels and segregated by geographic region. The highest diversity of P. vivax invasion genes in Ecuador was found in the Amazonian region. Although selection appeared to have small effect on pvdbpII and pvrbp1a-2, pvama1 was influenced by significant balancing selection.
Identifying meaningful subpopulation segments among older public assistance recipients: a mixed methods study to develop tailor-made health and welfare interventions
Authors: Ueno Keiko , Nishioka Daisuke , Saito Junko , Kino Shiho , Kondo Naoki
Published: August 2023

Background

Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively.

Methods

We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment.

Results

A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments.

Conclusions

A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.
Anoikis resistance––protagonists of breast cancer cells survive and metastasize after ECM detachment
Authors: Dai Yalan , Zhang Xinyi , Ou Yingjun , Zou Linglin , Zhang Duoli , Yang Qingfan , Qin Yi , Du Xiuju , Li Wei , Yuan Zhanpeng , Xiao Zhangang , Wen Qinglian
Published: August 2023

Breast cancer exhibits the highest global incidence among all tumor types. Regardless of the type of breast cancer, metastasis is a crucial cause of poor prognosis. Anoikis, a form of apoptosis initiated by cell detachment from the native environment, is an outside-in process commencing with the disruption of cytosolic connectors such as integrin-ECM and cadherin-cell. This disruption subsequently leads to intracellular cytoskeletal and signaling pathway alterations, ultimately activating caspases and initiating programmed cell death. Development of an anoikis-resistant phenotype is a critical initial step in tumor metastasis. Breast cancer employs a series of stromal alterations to suppress anoikis in cancer cells. Comprehensive investigation of anoikis resistance mechanisms can inform strategies for preventing and regressing metastatic breast cancer. The present review first outlines the physiological mechanisms of anoikis, elucidating the alterations in signaling pathways, cytoskeleton, and protein targets that transpire from the outside in upon adhesion loss in normal breast cells. The specific anoikis resistance mechanisms induced by pathological changes in various spatial structures during breast cancer development are also discussed. Additionally, the genetic loci of targets altered in the development of anoikis resistance in breast cancer, are summarized. Finally, the micro-RNAs and targeted drugs reported in the literature concerning anoikis are compiled, with keratocin being the most functionally comprehensive.
Enhancer RNAs: mechanisms in transcriptional regulation and functions in diseases
Authors: Li Qianhui , Liu Xin , Wen Jingtao , Chen Xi , Xie Bumin , Zhao Yang
Published: August 2023

In recent years, increasingly more non-coding RNAs have been detected with the development of high-throughput sequencing technology, including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), circular RNAs (circRNAs), small nucleolar RNAs (snoRNAs), and piwi-interacting RNA (piRNAs). The discovery of enhancer RNAs (eRNAs) in 2010 has further broadened the range of non-coding RNAs revealed. eRNAs are non-coding RNA molecules produced by the transcription of DNA cis-acting elements, enhancer fragments. Recent studies revealed that the transcription of eRNAs may be a biological marker responding to enhancer activity that can participate in the regulation of coding gene transcription. In this review, we discussed the biological characteristics of eRNAs, their functions in transcriptional regulation, the regulation factors of eRNAs production, and the research progress of eRNAs in different diseases.
Downregulation of mitochondrial complex I induces ROS production in colorectal cancer subtypes that differently controls migration
Authors: Bastin Jean , Sroussi Marine , Nemazanyy Ivan , Laurent-Puig Pierre , Mouillet-Richard Sophie , Djouadi Fatima
Published: August 2023

Background

Colorectal cancer (CRC) can be classified into four molecular subtypes (CMS) among which CMS1 is associated with the best prognosis, while CMS4, the mesenchymal subtype, has the worst outcome. Although mitochondria are considered to be hubs of numerous signaling pathways, the study of mitochondrial metabolism has been neglected for many years. Mitochondrial Complex I (CI) plays a dual role, both in energy and reactive oxygen species (ROS) production. However, the possible contribution of CI to tumorigenesis in cancer remains unclear. The purpose of this study was to investigate the CI under the prism of the CMS classification of CRC in ex vivo models.

Methods

Biochemical dosages, bioenergetics analysis and western-blot were used to characterize CI expression, function and redox balance in LoVo and MDST8 cell lines, belonging to CMS1 and CMS4 subgroups, respectively. Cell proliferation and migration were assessed by xCELLigence technology. Overproduction or scavenging of mitochondrial ROS (mtROS) were performed to analyze the effect of mtROS on proliferation, migration, and mesenchymal markers. Focal adhesion kinase (FAK) and its activation were analyzed by immunofluorescence. We assessed the distribution of two CI scores in CRC cohorts according to CMS classification and their relevance for patient survival.

Results

We found that CI is downregulated in CMS4 cells and is associated with elevated mtROS. We establish for the first time that in these migrating cells, mtROS production is maintained at optimal levels not only through changes in CI activity but also by inactivation/acetylation of superoxide dismutase 2 (SOD2), a major mitochondrial antioxidant enzyme. We show that promoting or scavenging mtROS both mitigate CMS4 cells’ migration. Our results also point to a mtROS-mediated focal adhesion kinase (FAK) activation, which likely sustains their migratory phenotype. Using cohorts of CRC patients, we document that the expression of CI is downregulated in the CMS4 subgroup, and that low CI expression is associated with poor prognosis. Patients’ datasets reveal an inverse correlation between CI and the epithelial-mesenchymal transition (EMT) pathway.

Conclusion

We showed that inhibition of CI contributes to heighten mtROS, which likely foster MDST8 migration and might account for the specific EMT signature of CMS4 tumors. These data reveal a novel role of mitochondrial CI in CRC, with biological consequences that may be targeted with anti- or pro-oxidant drugs in clinical practice.