bluuebunny/crossref_metadata_2025 huggingface dataset:
Ouvidos na enfermaria e um chapéu de três pontas: uma leitura literário-sonora da obra de Primo Levi
Authors: Donner Leandro
Published: February 2022

Este artigo coteja fragmentos de duas obras de Primo Levi – É isto um homem? e A trégua – a partir de leituras sonoras de seus escritos. Entende-se por leituras sonoras uma atenção ampliada à musicalidade e a outros aspectos auditivos expressos no conteúdo e na forma literária dessas obras, que resultam em um tecido sonoro-textual de efeito estético singular que permite diversas análises. Nessa perspectiva, busca-se apontar alguns expedientes criativos do autor e sobrevivente da Shoá e as diferentes perspectivas com que ele interage com a música nas duas obras. O pesquisador procura, ainda, estabelecer e enunciar certas poéticas de escuta, particularmente aquelas de maior acento político, pincelando, nesse processo, os quatro elementos sonoros – altura, duração, intensidade e timbre.
What is Radical?
Authors: Alberro Alexander , Bhabha Homi , Castillo Alejandra , Chukhrov Keti , Demos T. J. , Eleison Keyna , Emmelhainz Irmgard , English Darby , Flores Patrick , González Jennifer A. , Groys Boris , Holert Tom , Huyssen Andreas , Jones Amelia , Joselit David , Kee Joan , Mirzoeff Nicholas , Osborne Peter , Roberts John , Shaked Nizan , Smith Terry , Stiles Kristine , Tiampo Ming , Wagner Anne M.
Published: February 2022

What does it mean to think and act radically, and how does this relate to forms of radicalism connected to earlier moments, for example, in the 20th century? What can be the role of radical art and scholarship under the conditions of late capitalism? More generally, how can art and artists serve the ongoing struggle for social justice and the agendas of emancipatory social change? Finally, what kinds of art criticism and art historical scholarship are necessary to address the great challenges of our uncertain future?
The Pedagogy of Evangelism: Moving from a Didactic to a Conversational Model of Evangelism
Authors: Butler James
Published: February 2022

This paper argues that while evangelicalism has sought to maintain the importance of communicating a normative understanding of faith, it has done so primarily through a didactic understanding of evangelism. This has made it difficult to integrate informal and non-verbal expressions into an account of evangelism and, I argue, has contributed to evangelicalism’s problems of understanding the relationship between evangelism and social action. By turning to lived experience, and the ‘theology in four voices’ framework from theological action research, I suggest a conversational model of evangelism which enables a move away from a didactic model without losing a commitment to communicating a normative understanding of Christian faith. This model relates more clearly to the lived experience of participants in my research and enables a more integrated understanding of evangelism, which places greater value on the ordinary and everyday expression of faith.
Investigating Historical Abuses
Authors: Balk Yannick , Frerks Georg , de Graaf Beatrice
Published: February 2022

This article investigates the phenomenon and practice of intercountry adoption from a historical perspective by using applied history methods. In particular, we employed the method of historicizing current concerns, such as the notion of abuses, and contextualizing them in history. With these methods, we contributed to the Dutch governmental assessment and evaluation of intercountry adoption, indicating that our findings (as laid down in the official report) need to be translated into revised governmental policies. In this paper, we describe how we applied our historicizing methods to intercountry adoption abuses by providing a narrative and genealogy of the topic. We also discuss the pitfalls and merits of conducting historical research into practices that are now considered immoral or unjust, but were long standard practice after intercountry adoption started in the Netherlands. In this way, we also contribute to the ongoing discussion on doing historical research in highly politicized contexts, where the danger of contributing to the ‘blame game’ often lies in wait.
Clinical Use of an Electronic Pre-Visit Questionnaire Soliciting Patient Visit Goals and Interim History: A Retrospective Comparison Between Safety-net and Non-Safety-net Clinics
Authors: Shucard Hannah , Muller Emily , Johnson Joslyn , Walker Jan , Elmore Joann G. , Payne Thomas H. , Berman Jacob , Jackson Sara L.
Published: February 2022

Introduction/Objectives

We examined an initial step towards co-generation of clinic notes by inviting patients to complete a pre-visit questionnaire that could be inserted into clinic notes by providers and describe the experience in a safety-net and non-safety-net clinic.

Methods

We sent an electronic pre-visit questionnaire on visit goals and interim history to patients at a safety-net clinic and a non-safety-net clinic before clinic visits. We compared questionnaire utilization between clinics during a one-year period and performed a chart review of a sample of patients to examine demographics, content and usage of patient responses to the questionnaire.

Results

While use was low in both clinics, it was lower in the safety-net clinic (3%) compared to the non-safety-net clinic (10%). We reviewed a sample of respondents and found they were more likely to be White compared to the overall clinic populations ( p < 0.05). There were no statistically significant differences in patient-typed notes (word count and number of visit goals) between the safety-net and non-safety-net samples however, patients at the safety-net clinic were less likely to have all of their goals addressed within the PCP documentation, compared to the non-safety-net clinic.

Conclusions

Given potential benefits of this questionnaire as a communication tool, addressing barriers to use of technology among vulnerable patients is needed, including access to devices and internet, and support from caregivers or culturally concordant peer navigators.
Inhibition of LDHA to induce eEF2 release enhances thrombocytopoiesis
Authors: Chen Qidi , Xin Min , Wang Lingjun , Li Lin , Shen Yingzhi , Geng Yan , Jiang Haojie , Wang Yang , Zhang Lin , Xu Yanyan , Hou Yu , Liu Junling , Fan Xuemei
Published: February 2022

Translation is essential for megakaryocyte (MK) maturation and platelet production. However, how the translational pathways are regulated in this process remains unknown. In this study, we found that MK/platelet–specific lactate dehydrogenase A (LdhA) knockout mice exhibited an increased number of platelets with remarkably accelerated MK maturation and proplatelet formation. Interestingly, the role of LDHA in MK maturation and platelet formation did not depend on lactate content, which was the major product of LDHA. Mechanism studies revealed that LDHA interacted with eukaryotic elongation factor 2 (eEF2) in the cytoplasm, controlling the participation of eEF2 in translation at the ribosome. Furthermore, the interaction of LDHA and eEF2 was dependent on nicotinamide adenine dinucleotide (NADH), a coenzyme of LDHA. NADH-competitive inhibitors of LDHA could release eEF2 from the LDHA pool, upregulate translation, and enhance MK maturation in vitro. Among LDHA inhibitors, stiripentol significantly promoted the production of platelets in vivo under a physiological state and in the immune thrombocytopenia model. Moreover, stiripentol could promote platelet production from human cord blood mononuclear cell–derived MKs and also have a superposed effect with romiplostim. In short, this study shows a novel nonclassical function of LDHA in translation that may serve as a potential target for thrombocytopenia therapy.
Seismic history of western Anatolia during the last 16 kyr determined by cosmogenic 36Cl dating
Authors: Mozafari Nasim , Özkaymak Çağlar , Sümer Ökmen , Tikhomirov Dmitry , Uzel Bora , Yeşilyurt Serdar , Ivy-Ochs Susan , Vockenhuber Christof , Sözbilir Hasan , Akçar Naki
Published: February 2022

Western Anatolia is one of the most seismically active regions worldwide. To date, the paleoseismic history of many major faults, in terms of recurrence intervals of destructive earthquakes, their magnitude, displacement, and slip rates is poorly understood. Regional crustal extension has produced major horst-graben systems bounded by kilometer-scale normal faults locally in carbonates, along which vertical crustal displacements occurred. In this study, we explore the seismic history of western Anatolia using36Cl exposure dating through study of well-preserved carbonate normal fault scarps. To accomplish this,36Cl concentrations in 214 samples from fault plane transects on the Rahmiye and Ören fault scarps were measured and compared with existing36Cl measurements of 370 samples on five fault scraps in western Anatolia. At least 20 seismic events have been reconstructed over the past 16 kyr. The age correlation of the seismic events implies four phases of high seismic activity in western Anatolia, at around 2, 4, 6, and 8 ka. Slips are modeled ranging between 0.6 to 4.2 m per seismic event, but are probably the result of clustered earthquakes of maximum magnitude 6.5 to 7.1. While the average slip rates have values of 0.3 to 1.9 mm/yr, incremental slip rates of the faults range greater than 0.1 to 2.2 mm/yr, showing more activity mostly through late Holocene. Our finding reveals high capability of cosmogenic36Cl dating to explore seismic behavior of active faults beyond the existing earthquake records.
Assessment of potential human health risks in aquatic products based on the heavy metal hazard decision tree
Authors: Ku Hao-Hsiang , Lin Pinpin , Ling Min-Pei
Published: February 2022

Background

Naturally existing and human-produced heavy metals are released into the environment and cannot be completely decomposed by microorganisms, but they continue to accumulate in water and sediments, causing organisms to be exposed to heavy metals.

Results

This study designs and proposes heavy metal hazard decision trees for aquatic products, which are divided into seven categories including pelagic fishes, inshore fishes, other fishes, crustaceans, shellfish, cephalopods, and algae. Based on these classifications, representative fresh and processed seafood products are at the root of the heavy metal hazard decision trees. This study uses 2,107 cases of eating 556 cooked fresh or processed seafood product samples. The constructions of the proposed decision trees consist of 12 heavy metals, which include inorganic arsenic (iAs), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), strontium (Sr), thallium (Tl), and zinc (Zn). The heavy metal concentrations in cooked fresh and processed seafood product samples are subjected to a food safety risk assessment.

Conclusions

The results indicate the relationships among the seven categories of aquatic products, the relationships among 12 heavy metals in aquatic products, and the relationships among potential human health risks. Finally, the proposed heavy metal hazard decision trees for aquatic products can be used as a reference model for researchers and engineers.
Echocardiographic study of myocardial work in patients with type 2 diabetes mellitus
Authors: Liao Lisi , Shi Bobo , Ding Zhimin , Chen Lixin , Dong Fajin , Li Jian , Zhong Yulin , Xu Jinfeng
Published: February 2022

Background

A noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS. We studied the LV PSL and MW in patients with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study included 201 subjects (54 healthy controls and 147 T2DM patients) who underwent complete two-dimensional echocardiography (2DE), including 2D speckle-tracking echocardiography (STE), as well as brachial artery pulse pressure measurement. The PSL was used to determine the global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) of all study participants. The association between T2DM and LV function was evaluated according to these MW indices.

Results

The GLS was significantly lower in the T2DM group than in the control group (P < 0.001), indicating that the LV myocardium had been damaged, although the LV ejection fraction (LVEF) was still normal. The GWI and GWE were decreased (P = 0.022) and the GWW was increased (P < 0.001) in diabetic patients compared with controls, but the GCW was comparable in the two groups (P = 0.160). In all diabetic patients, age, body mass index, systolic blood pressure, smoking history, and LVEF were correlated with GWI, GWW and GWE.

Conclusions

The use of LV PSL is a novel noninvasive technique that could help to depict the relationship between LV myocardial damage and MW in patients with T2DM.
Risk prediction in pulmonary hypertension due to chronic heart failure: incremental prognostic value of pulmonary hemodynamics
Authors: Quan Ruilin , Huang Shian , Pang Lingpin , Shen Jieyan , Wu Weifeng , Tang Fangming , Zhu Xiulong , Su Weiqing , Sun Jingzhi , Yu Zaixin , Wang Lemin , Zhu Xianyang , Xiong Changming , He Jianguo
Published: February 2022

Background

There is no generally accepted comprehensive risk prediction model cooperating risk factors associated with heart failure and pulmonary hemodynamics for patients with pulmonary hypertension due to left heart disease (PH-LHD). We aimed to explore outcome correlates and evaluate incremental prognostic value of pulmonary hemodynamics for risk prediction in PH-LHD.

Methods

Consecutive patients with chronic heart failure undergoing right heart catheterization were prospectively enrolled. The primary endpoint was all-cause mortality. Individual variable selection was performed by machine learning methods. Cox proportional hazards models were conducted to identify the association between variables and mortality. Incremental value of hemodynamics was evaluated based on the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores.

Results

A total of 276 PH-LHD patients were enrolled, with a median follow-up time of 34.7 months. By L1-penalized regression model and random forest approach, diastolic pressure gradient (DPG) and mixed venous oxygen saturation (SvO2) were the hemodynamic predictors most strongly associated with mortality (coefficient: 0.0255 and -0.0176, respectively), with consistent significance after adjusted for SHFM [DPG: HR 1.067, 95% CI 1.024–1.113, P = 0.022; SvO2: HR 0.969, 95% CI 0.953–0.985, P = 0.002] or MAGGIC (DPG: HR 1.069, 95% CI 1.026–1.114, P = 0.011; SvO2: HR 0.970, 95% CI 0.954–0.986, P = 0.004) scores. The inclusion of DPG and SvO2 improved risk prediction compared with using SHFM [net classification improvement (NRI): 0.468 (0.161–0.752); integrated discriminatory index (IDI): 0.092 (0.035–0.171); likelihood ratio test: P < 0.001] or MAGGIC [NRI: 0.298 (0.106–0.615); IDI: 0.084 (0.033–0.151); likelihood ratio: P < 0.001] scores alone.

Conclusion

In PH-LHD, pulmonary hemodynamics can provide incremental prognostic value for risk prediction.

Clinical trial registration: NCT02164526 at https://clinicaltrials.gov.
Daily associations between affect and cognitive performance in older adults with depression and cognitive impairment: a series of seven single-subject studies in the Netherlands
Authors: Tieks Alieke , Oude Voshaar Richard C. , Zuidersma Marij
Published: February 2022

Background

Comorbidity between depression and cognitive impairment is common in older adults, increases the disease burden disproportionally, and leads to diagnostic uncertainty. Insight into individual daily associations between affect and cognitive performance may help in personalizing diagnosis and treatment decisions. Our objective was to get insight into the daily associations between affect and cognitive performance within individual older adults.

Methods

In this single-subject study seven older adults with both depression and cognitive impairment filled in electronic diaries daily for 62-93 consecutive days evaluating positive affect (PA), negative affect (NA), working memory (WM) and visual learning (VL). Time-series analyses using vector autoregressive modelling, Granger causality tests and cumulative orthogonalized impulse response function analyses were performed for each individual separately.

Results

In one patient higher NA was associated with better WM the next day. For another patient days with higher NA and lower PA were days with worse WM. For a third patient better VL was associated with lower NA and higher PA the next day. No associations were found for four patients.

Conclusions

These results highlight heterogeneity in the daily associations between affect and cognitive performance and stress the relevance of single-subject studies. These studies may be an important step towards personalized diagnosis and treatment in old age psychiatry.
Exploring the value of Mycobacterium tuberculosis modified lipoprotein as a potential biomarker for TB detection in children
Authors: Yang Xinxin , Wipperman Matthew F. , Nachman Sharon , Sampson Nicole S.
Published: February 2022

Background

Current TB diagnostic methods available have been developed for adults and development efforts have neglected the differences in disease and sampling that occur between adults and children. Diagnostic challenges are even greater in HIV co-infected children and infants.

Methods and results

We established a sandwich ELISA assay to detect Mycobacterium tuberculosis modified lipoprotein (TLP) ex vivo in plasma. The study population contains plasma samples from 21 patients with active TB and 24 control samples with no TB, collected in the International Maternal Pediatric Adolescent AIDS Clinical Trails (IMPAACT) P1041 study. Retrospective analysis was performed and the results demonstrate that the median plasma levels of TLP in control subjects are 2.7 fold higher than the median plasma values in active TB subjects (p < 0.001).

Conclusions

Plasma levels of TLP are elevated with active TB disease in HIV positive subjects and deserves further exploration as an indicator for TB detection in children.
Artificial intelligence stenosis diagnosis in coronary CTA: effect on the performance and consistency of readers with less cardiovascular experience
Authors: Han Xianjun , Luo Nan , Xu Lixue , Cao Jiaxin , Guo Ning , He Yi , Hong Min , Jia Xibin , Wang Zhenchang , Yang Zhenghan
Published: February 2022

Background

To investigate the influence of artificial intelligence (AI) based on deep learning on the diagnostic performance and consistency of inexperienced cardiovascular radiologists.

Methods

We enrolled 196 patents who had undergone both coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within 6 months. Four readers with less cardiovascular experience (Reader 1–Reader 4) and two cardiovascular radiologists (level II, Reader 5 and Reader 6) evaluated all images for ≥ 50% coronary artery stenosis, with ICA as the gold standard. Reader 3 and Reader 4 interpreted with AI system assistance, and the other four readers interpreted without the AI system. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (area under the receiver operating characteristic curve (AUC)) of the six readers were calculated at the patient and vessel levels. Additionally, we evaluated the interobserver consistency between Reader 1 and Reader 2, Reader 3 and Reader 4, and Reader 5 and Reader 6.

Results

The AI system had 94% and 78% sensitivity at the patient and vessel levels, respectively, which were higher than that of Reader 5 and Reader 6. AI-assisted Reader 3 and Reader 4 had higher sensitivity (range + 7.2–+ 16.6% and + 5.9–+ 16.1%, respectively) and NPVs (range + 3.7–+ 13.4% and + 2.7–+ 4.2%, respectively) than Reader 1 and Reader 2 without AI. Good interobserver consistency was found between Reader 3 and Reader 4 in interpreting ≥ 50% stenosis (Kappa value = 0.75 and 0.80 at the patient and vessel levels, respectively). Only Reader 1 and Reader 2 showed poor interobserver consistency (Kappa value = 0.25 and 0.37). Reader 5 and Reader 6 showed moderate agreement (Kappa value = 0.55 and 0.61).

Conclusions

Our study showed that using AI could effectively increase the sensitivity of inexperienced readers and significantly improve the consistency of coronary stenosis diagnosis via CCTA.

Trial registrationClinical trial registration number: ChiCTR1900021867. Name of registry: Diagnostic performance of artificial intelligence-assisted coronary computed tomography angiography for the assessment of coronary atherosclerotic stenosis.
Hydro-dispersion of subincisional cortex
Authors: Miyoshi Teruyuki , Yoshida Hironori , Shimowake Takahiro , Oshika Tetsuro
Published: February 2022

Background

A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.

Methods

A disposable 27-gauge blunt needle attached to a 5.0-ml syringe containing balanced salt solution (BSS) is introduced through the side port incision into the anterior chamber. The tip of the needle is directed toward the capsule fornix beneath the incision site, and BSS is flushed to disperse the remaining cortex. Thereafter, the coaxial irrigation/aspiration device is used to remove the loosened cortex.

Results

This technique was used in 60 eyes of 60 patients with difficulty of removing cortical remnant in the subincisional space. Subincisional cortical material was successfully removed in 93.3% (56/60 eyes). There were no intraoperative and postoperative complications related to this procedure.

Conclusions

The hydro-dispersion technique is a simple and safe approach to remove the subincisional cortical material that is difficult to manage with the standard coaxial irrigation/aspiration device.
An asymptomatic huge primary retroperitoneal pseudocyst: a case report and review of the literature
Authors: Abedini Lotfolah , Hosseinpour Reza , Mehrabi Saadat , Hejazinia Safoora , Yavari Barhaghtalab Mohammad Javad
Published: February 2022

Background

Retroperitoneal non-pancreatic or idiopathic pseudocysts are very rare lesions. This case report aimed to present our patient and to check all the available literature on this kind of rare disease.

Case presentation

Our patient was a 67-year-old Iranian man admitted with mild abdominal discomfort for three months. Ultrasonography and CT scan revealed a huge cystic structure within the retroperitoneal space. The lesion was excised through midline laparotomy and opening of the retro-peritoneum. The histopathology of the cyst wall revealed a benign cystic lesion with no epithelial lining. A histologic diagnosis of non-neoplastic retroperitoneal pseudocyst was made.

Conclusion

The primary non-pancreatic retroperitoneal pseudocysts are rare lesions and have to be distinguished from other differential diagnoses of retroperitoneal lesions, and a surgeon should be aware of the possible occurrence of these lesions with unknown origin. Surgical excision is the only way to exclude malignancy and confirm the diagnosis.
Perioperative factors influencing the difficulty of retroperitoneal laparoscopic adrenalectomy: a single-center retrospective study
Authors: Wang Jinyao , Yang Bin , Sun Shiwei , Zhang Yangang
Published: February 2022

Purpose

Identifying patients in whom adrenalectomy may be more difficult can help with surgical decision-making. This study investigated the perioperative factors affecting the difficulty of retroperitoneal laparoscopic adrenalectomy (RLA).

Methods

Sixty-eight patients who underwent RLA at our hospital between December 1, 2020 and May 1, 2021 were included. The difficulty of RLA was assessed by operating time and intraoperative blood loss. We analyzed the relationship between surgical difficulty and patient sex, age, and body mass index, pathological type, tumor side, tumor size, distance from the lower pole of the adrenal tumor to the upper pole of the kidney (DAK), and distance from the lower pole of the adrenal tumor to the renal pedicle (DARP).

Results

Mean operating time was 105.38 ± 33.31 min and mean intraoperative blood loss was 32.28 ± 22.88 ml. Univariate linear regression analysis showed that age (P = 0.047), tumor size (P = 0.002), DAK (P = 0.002), and DARP (P < 0.001) were significantly correlated with a longer operating time. Univariate logistic regression analysis showed that DARP (P = 0.001), DAK (P = 0.001), tumor size (P = 0.002), and age (P = 0.033) were significantly correlated with a longer operating time. Multivariate logistic regression indicated that DARP (OR 5.341; 95% CI 1.704–16.739; P = 0.004), and tumor size (OR 4.433; 95% CI 1.434–13.709; P = 0.010) were independent predictors of operating time.

Conclusion

Age, tumor size, DAK, and DARP were predictors of the difficulty of RLA. Older age, lower DARP and DAK, and a larger tumor size were associated with a longer operating time. DARP and tumor size were independent predictors of surgical difficulty.
The higher adherence to a healthy lifestyle score is associated with a decreased risk of type 2 diabetes in Iranian adults
Authors: Farhadnejad Hossein , Teymoori Farshad , Asghari Golaleh , Mokhtari Ebrahim , Mirmiran Parvin , Azizi Fereidoun
Published: February 2022

Background

The combined roles of lifestyle factors in the risk of type 2 diabetes (T2D) are not fully investigated. In the present study, we aimed to assess the relationship between a healthy lifestyle score (HLS) and the risk of T2D in Tehranian adults.

Methods

A total of 3859 individuals without T2D were recruited from participants of the Tehran Lipid and Glucose Study (2009–2011) who were followed up for a mean period of 6 years. A food frequency questionnaire was used to collect individuals' dietary intakes at baseline. HLS scores was calculated based on three pre-defined methods with focusing on 4 lifestyle factors including, no current smoking, no obesity, high physical activity, and greater adherence to the healthy diet[determined using the alternate healthy eating index-2010(AHEI-2010), modified French Programme National Nutrition Santé-Guideline Score(mPNNS-GS), and healthy diet pattern score(HDP)].

Results

Mean ± SD age of participants(44.4% men) was 41.1 ± 12.3 years. After 6-year follow-up of study, 295(7.6%) new cases of T2D were reported. Based on the age and sex-adjusted model, an inverse association was observed between the higher score of HLS-AHEI-2010 (OR = 0.24;95%CI:0.10–0.60), HLS-mPNNS-GS (OR = 0.28;95%CI:0.15–0.50), and HLS-HDP (OR = 0.39;95%CI:0.24–0.64) and the risk of T2D (P for trend < 0.05). Also, the fully-adjusted model showed that after controlling the effects of various confounders, this invers association between the higher score of HLS-AHEI-2010 (OR = 0.25;95%CI:0.10–0.61, P for trend:0.001), HLS-mPNNS-GS (OR = 0.29;95%CI:0.15–0.55,P for trend:0.001), and HLS-HDP (OR = 0.36;95%CI:0.22–0.61,P for trend < 0.001) and risk of T2D was remained significant.

Conclusion

The results of this study suggested that higher score of HLS, characterized by no smoking, normal body weight, vigorous physical activity, and healthy diet, is related to decreased risk of T2D incidence.
Characterizing uncertainty in goals-of-care discussions among black and white patients: a qualitative study
Authors: Chen Annie T. , Tsui Shelley , Sharma Rashmi K.
Published: February 2022

Background

Uncertainty has been associated with distress and poorer quality of life in patients with advanced cancer. Prior studies have focused on prognostic uncertainty; little is known about other types of uncertainty that patients and family members experience when discussing goals of care. Understanding the types of uncertainty expressed and differences between Black and White patients can inform the development of uncertainty management interventions.

Methods

This study sought to characterize the types of uncertainty expressed by Black and White patients and family members within the context of information needs during inpatient goals-of-care discussions. We performed a secondary analysis of transcripts from 62 recorded goals-of-care discussions that occurred between 2012 and 2014 at an urban, academic medical center in the United States. We applied an adapted taxonomy of uncertainty to data coded as describing information needs and used an inductive qualitative analysis method to analyze the discussions. We report the types of uncertainty expressed in these discussions.

Results

Fifty discussions included patient or family expressions of information needs. Of these, 40 discussions (n=16 Black and n=24 White) included statements of uncertainty. Black and White patients and families most frequently expressed uncertainty related to processes and structures of care (system-centered uncertainty) and to treatment (scientific uncertainty). Statements of prognostic uncertainty focused on quantitative information among Whites and on qualitative information and expectations for the future among Blacks.

Conclusions

Black and White patients and families frequently expressed system-centered uncertainty, suggesting this may be an important target for intervention. Addressing other sources of uncertainty, such as prognostic uncertainty, may need more tailored approaches.
Effect of selective gastric residual monitoring on enteral intake in preterm infants
Authors: Elia Serena , Ciarcià Martina , Miselli Francesca , Bertini Giovanna , Dani Carlo
Published: February 2022

Objective

Prefeed gastric residuals (GRs) monitoring has been correlated with an increased time to reach full feeds and longer parenteral nutrition without beneficial effect on necrotizing enterocolitis (NEC) occurrence. We aimed to assess effects of a new local protocol to provide for the selective evaluation of GRs excluding their routine monitoring.

Methods

We carried out a retrospective study based on a “before and after” design in a cohort of infants born at 23+0–31+6 weeks of gestation. The primary outcome was the age at full enteral feeding (150 mL/kg/d). Secondary outcomes included age at regaining of birth weight, and evaluation of Z-scores of weight, length, and head circumference at discharge.

Results

We studied 49 infants in the selective GR group and 59 in the routine GR group. Age at full (150 mL/kg) enteral feeding (17.8 ± 10.1 vs. 22.9 ± 10.5 days, P = 0.017) and regaining of birth weight (11.1 ± 3.0 vs. 12.5 ± 3.5 days, P = 0.039) were lower while the Z-scores of weight at discharge (-1.10 ± 0.83 vs. -1.60 ± 1.45, P = 0.040) were higher in infants in the selective GR group in comparison with infants in the routine GR group.

Conclusions

Selective monitoring of GRs decreased age at full enteral feeding and at regaining of birth weight and induced better Z-scores of weight at discharge in comparison with routine GR monitoring in a cohort of extremely preterm infants without increasing the incidence of NEC. Omitting prefeed GRs monitoring in clinical practice seems reasonable.
Investigating the causal relationships between badges and learning outcomes in SQL-Tutor
Authors: Tahir Faiza , Mitrovic Antonija , Sotardi Valerie
Published: February 2022

The practice of adding game elements to non-gaming educational environments has gained much popularity. Gamification has been shown in some studies to enhance engagement, motivation and learning outcomes in technology-supported learning environments. Although gamification research has matured, there are some shortcomings such as inconsistency in applying gamification theories and frameworks and evaluating multiple game mechanics simultaneously. Moreover, there is little research on applying gamification to Intelligent Tutoring Systems (ITS). This paper investigates the causal effects of gamification on learning in SQL-Tutor, a mature ITS teaching students how to phrase queries in SQL. Having conducted a study under realistic conditions, we present a quantitative analysis of the performance of 77 undergraduate students enrolled in a database course. There are three main findings of our study: (1) gamification affects student learning by mediating the time-on-task; (2) students’ background knowledge does not influence time-on-task unless students achieve badges; and (3) students’ interest in topic (motivational construct) moderates the relationship between badges and time-on-task, but does not improve learning outcomes directly.
MicroRNA548ac expression level in relation to BDCAF scored Behçet’s disease activity and history of treatment response
Authors: Hassouna Sally S. , Tayel Manal Y. , Elzawawy Ashraf I. , Amin Rowayda M. , Tahoun Mona
Published: February 2022

Background

Behçet’s disease gives a challenge to be diagnosed and followed up due to lack of specific biomarkers. MicroRNAs showed relations to different disease states including immunological and inflammatory illnesses. In this study, we are estimating microRNA548ac levels for the first time to be tested in the disease to see if there is a link to disease activity and if microRNA548ac can be used as a biomarker for activity or remission and prognosis of Behçet’s disease. MicroRNA548ac has been shown to have a role in autoimmunity and some inflammatory conditions. Blood samples were taken from patients to measure white blood cells expression of microRNA548ac, and compared to its expression in healthy subjects, disease activity was assessed by usage of Behçet’s Disease Current Activity Form (BDCAF).

Results

MicroRNA548ac expression decreased but not significantly with increased Behçet’s disease activity, and expression was having a significant positive correlation with increased treatment response history.

Conclusions

MicroRNA548ac appeared not to be related to disease activity which needs confirmation in further studies, but it may predict response to treatment so that patients having higher expression of microRNA548ac may have a better response to treatment. Here, microRNA548ac could be used as a disease biomarker for disease prognosis.
First data for sotorasib in patients with pancreatic cancer with KRAS p.G12C mutation: A phase I/II study evaluating efficacy and safety
Authors: Strickler John H , Satake Hironaga , Hollebecque Antoine , Sunakawa Yu , Tomasini Pascale , Bajor David Lawrence , Schuler Martin H. , Yaeger Rona , George Thomas J. , Garrido-Laguna Ignacio , Coveler Andrew L. , Vincent Mark David , Falchook Gerald Steven , Burns Timothy F. , Rha Sun Young , Lemech Charlotte Rose , Juric Dejan , Jafarinasabian Pegah , Tran Qui , Hong David S.
Published: February 2022

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Background: KRAS mutation is present in 90% of pancreatic ductal adenocarcinomas with p.G12C accounting for 1% to 2% of these mutations. Sotorasib, a small molecule that specifically and irreversibly inhibits KRASG12C, has been investigated in the CodeBreaK100 trial in patients with KRASG12C-mutated advanced solid tumors. Herein, we report on the largest dataset evaluating efficacy and safety of a KRASG12C inhibitor in patients with pretreated KRASG12C-mutated pancreatic cancer. Methods: CodeBreaK100 (NCT03600883) is an international, single arm, phase I/II study evaluating the efficacy and safety of sotorasib in patients with KRASG12C-mutated advanced solid tumors with ≥ 1 prior systemic therapy unless intolerant or ineligible for available therapies. The primary efficacy endpoint is confirmed objective response rate (ORR), assessed by blinded independent central review (BICR) per RECIST 1.1. Secondary endpoints include duration of response (DoR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Results: As of November 1, 2021, 38 patients with pancreatic cancer (mean age: 65 years, 76.3% male) from the combined phase I/II study received sotorasib 960 mg once daily. Stage IV disease was present in 55.3% of patients at diagnosis, and in all patients at enrollment. Baseline ECOG scores were 0, 1, or 2 in 31.6%, 57.9%, and 10.5% of patients, respectively. Most patients (79%) had ≥ 2 prior lines of therapy (median: 2 [range: 1-8]). Median treatment duration was 4.1 months with a median follow-up of 16.8 months. Eight patients had confirmed partial response by BICR with a resulting ORR of 21.1% (95% CI: 9.55%-37.32%). DCR was 84.2% (Table 1). Treatment-related adverse events (TRAEs) of any grade occurred in 16 (42.1%) patients. Grade ≥ 3 TRAEs occurred in 6 patients: diarrhea (2); fatigue (2); abdominal pain, ALT increase, AST increase, pleural effusion, and pulmonary embolism (1 each). No TRAEs were fatal or resulted in sotorasib discontinuation. Conclusions: Sotorasib demonstrated clinically meaningful anticancer activity and tolerability in patients with heavily pretreated KRASG12C-mutated advanced pancreatic cancer, who have limited treatment options and poor prognosis. Clinical trial information: NCT03600883. [Table: see text]
Growth Hormone and Insulin-Like Growth Factor 1 Regulation of Nonalcoholic Fatty Liver Disease
Authors: Dichtel Laura E , Cordoba-Chacon Jose , Kineman Rhonda D
Published: February 2022

Patients with obesity have a high prevalence of nonalcoholic fatty liver disease (NAFLD), representing a spectrum of simple steatosis to nonalcoholic steatohepatitis (NASH), without and with fibrosis. Understanding the etiology of NAFLD is clinically relevant since NAFLD is an independent risk factor for diabetes and cardiovascular disease. In addition, NASH predisposes patients to the development of cirrhosis and hepatocellular carcinoma, and NASH cirrhosis represents the fastest growing indication for liver transplantation in the United States. It is appreciated that multiple factors are involved in the development and progression of NAFLD. Growth hormone (GH) and insulin-like growth factor 1 (IGF1) regulate metabolic, immune, and hepatic stellate cell function, and alterations in the production and function of GH is associated with obesity and NAFLD/NASH. Therefore, this review will focus on the potential role of GH and IGF1 in the regulation of hepatic steatosis, inflammation, and fibrosis.
Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study
Authors: Baleanu Felicia , Moreau Michel , Charles Alexia , Iconaru Laura , Karmali Rafik , Surquin Murielle , Benoit Florence , Mugisha Aude , Paesmans Marianne , Rubinstein Michel , Rozenberg Serge , Bergmann Pierre , Body Jean-Jacques
Published: February 2022

Context

Individualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, although their external validation has shown significant differences in their risk prediction ability.

Objective and Methods

Using data from the Fracture Risk Brussels Epidemiological Enquiry study, a cohort of 3560 postmenopausal women aged 60 to 85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Three models of competing risk analysis were developed to predict major osteoporotic fractures (MOFs), all fractures, and central fractures (femoral neck, shoulder, clinical spine, pelvis, ribs, scapula, clavicle, sternum).

Results

Age, a history of fracture, and hip or spine BMD were predictors common to the 3 models. Excessive alcohol intake and the presence of comorbidities were specific additional CRFs for MOFs, a history of fall for all fractures, and rheumatoid arthritis for central fractures. Our models predicted the fracture probability at 5 years with an acceptable accuracy (Brier scores ≤ 0.1) and had a good discrimination power (area under the receiver operating curve of 0.73 for MOFs and 0.72 for central fractures) when internally validated by bootstrap. Three simple nomograms, integrating significant CRFs and the mortality risk, were constructed for different fracture sites. In conclusion, we derived 3 models predicting fractures with an acceptable accuracy, particularly for MOFs and central fractures. The models are based on a limited number of CRFs, and we constructed nomograms for use in clinical practice.
Oxidative Stress Predicts Post-Surgery Complications in Gastrointestinal Cancer Patients
Authors: Leimkühler M. , Bourgonje A. R. , van Goor H. , Campmans-Kuijpers M. J. E. , de Bock G. H. , van Leeuwen B. L.
Published: February 2022

Introduction

An excessive perioperative inflammatory reaction can lead to more postoperative complications in patients treated for gastrointestinal cancers. It has been suggested that this inflammatory reaction leads to oxidative stress. The most important nonenzymatic antioxidants are serum free thiols. The purpose of this study was to evaluate whether high preoperative serum free thiol levels are associated with short-term clinical outcomes.

Methods

Blood samples were drawn before, at the end of, and 1 and 2 days after surgery of a consecutive series of patients with gastrointestinal cancer. Serum free thiols were detected using a colorimetric detection method using Ellman’s reagent. Short-term clinical outcomes were defined as 30-day complications (Clavien-Dindo ≥2) and length of hospital stay. Logistic regression was applied to examine the association between serum free thiol levels and short-term patient outcomes.

Results

Eighty-one patients surgically treated for gastrointestinal cancer were included in the study. Median age was 68 (range 26–87) years, and 28% were female. Patients in the lowest tertile of preoperative serum free thiols had a threefold higher risk to develop postoperative complications (odds ratio [OR]: 3.4; 95% confidence interval [CI]:1.1–10.7) and a fourfold higher risk to have an increased length of stay in the hospital (OR 4.0; 95% CI 1.3–12.9) compared with patients in the highest tertile.

Conclusions

Patients with lower preoperative serum free thiol levels, indicating a decrease in extracellular antioxidant capacity and therefore an increase in systemic oxidative stress, are more likely to develop postoperative complications and show a longer in hospital stay than patients with higher serum free thiol levels.
Art, face and breathscape: From air to cultural texts
Authors: Barbotto Silvia
Published: February 2022

We consider breath as a vast prospect that includes actions and traces of them, that builds images and texts, that involves the human being and the extra-human context; we call this great scenery ‘breathscape’. We then study how breathscape interacts with the human apparatus of the face, both giving rise to signs, but also giving rise to a liminal zone of extremely intriguing interpretative processes on a mereological scale. How and where do the territory of breath and the body interact? Which processes of signification do they give rise to? And which signs are created in their phenomenal and semantic encounter? Art is certainly the most appropriate language for studying this process, as well as for letting opacities emerge and exploring outstanding contrasts. There are various concepts of ‘breathscape’ that, grounded in different cultures, are immediately associated with ancient and contemporary philosophies. As a reverberation from a semiotic interaction and through the discretization and identification of semantic fields relevant to the concerned scenario, and introducing textuality, a phenomenon seen as a crystallization of the transition between outer text (the text of reality) and text (subject/object), we consider those visual texts which are crossed by a common faculty that is both descriptive and inventive: by approaching some inferential and cultural regimes and analysing their specific enunciative practices, we then contribute to their renovation. The texts related to the practices as part of the narratives intrinsic to cultural semiospheres underline the insatiable vastness of epistemological content to be dealt with, and the functional reductionism of the corpus is only a first approach to the field that is intended to shed light on the general panorama and to stimulate subsequent debate and insights.
Urban-human faces and the semiotic right to the city: From the USSR propaganda machinery to the participatory city
Authors: Soro Elsa
Published: February 2022

Now that the usage and meaning of urban spaces have been dramatically challenged by the global pandemic, several debates and reflections are going on around the manner in which cities – both as concerns the public and the private spaces – have been designed. The article observes how “urban-human face” representations have served different models of urbanity across times and cultures.

Using a framework deriving from semiotics of culture, according to which the city represents a model of the world, the article attempts to interpret how portraits of faces have been modelling the city through different urban faciality mechanisms. The focus is on a sample of what we call ‘urban-human faces’, ranging from Soviet propaganda posters to the digital #selfiecity project. The expression refers to series of representations that bring together the city and the face. It can be argued that both the city and the face, produced at a specific historical and cultural moment, with their figurative and plastic elements, deploy the struggle for the city ownership and authorship.

Nonetheless, the commensurability of the city and the face can be just based on the fact that both semiotic configurations represent an excess with the help of cartographic reproduction (the city) and the portrait (the face), respectively. A city can be represented by a face to the extent to which it is also multifaceted as a polylogue. On the basis of such instable commensurability, the article will ultimately attempt to bring together the semiotics of the face and the semiotics of the city.
«Заспівати свою пісню на своім подвірю». Достоменніст простору/достоменніст в просторі
Authors: Duć-Fajfer Olena
Published: February 2022

„Zaśpiewać swoją pieśń na swoim podwórzu” – tożsamość (w) przestrzeni

W artykule ujęte zostały kwestie dynamicznej relacji przestrzenno-tożsamościowej w kontekście destrukcji łemkowskiej przestrzeni etnicznej po wysiedleniach lat 1945-1947. W pierwszej części nakreślone zostało tekstualne wyrażanie się symbiozy, konsolidowania łemkowskiego świata wspólnotowego przez wartości i symbole przestrzenno-pejzażowe, mające cechy archetypiczne. Następnie rozpoznany i wskazany został mechanizm mitu reinwencyjnego, który dąży do ocalenia mocy przestrzeni ojczystej poprzez skontrastowanie jej z przestrzenią obcą z zastosowaniem podziału sacrum- -profanum. Powolne wyczerpywanie się tego mechanizmu w świecie odczarowanym wprowadza do symbolicznego uniwersum coraz więcej obrazów przestrzeni pragmatycznej. Mechanizm mitu uaktywnia się natomiast w rytualnej migracji kolistej, która łączy rozbity świat łemkowski poprzez celebrowanie dorocznych rytuałów/ świąt wspólnotowych ustanawiających nowe sensy przestrzenne. Termin „nowe” nie oznacza ich oderwania od tożsamości przestrzeni i tożsamości przestrzennej bazowej dla łemkowskiej podmiotowości. W części drugiej zasygnalizowany został wpływ czynnika przestrzennego na tożsamość językową Łemków. W oparciu o dane statystyczne, korzystanie z praw językowych oraz zaobserwowane postawy i praktyki językowe wysunięta została teza o zasilaniu przez rodzime wartości przestrzenne mechanizmów i działań rewitalizacyjnych w zakresie języka łemkowskiego.