bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing our conceptual understanding of state and trait self-efficacy by correlational analysis of four self-efficacy scales in people with spinal cord injury
Authors: van Diemen Tijn , Craig Ashley , van Nes Ilse J. W. ,   SELF-SCI Group, van Laake Charlotte , Bloemen Jos , Stolwijk-Swuste Janneke , Scholten Eline , Faber Willemijn , Boerrigter Joke , Beurskens Martine , Spijkerman Dorien , Postma Karin , Groenewegen Esther , Snoek Govert , Martens Iris , van Nes Ilse , van Diemen Tijn , Roels Ellen , Sprik Joke , Stolwijk-Swuste Janneke M. , Geertzen Jan H. B. , Middleton James , Post Marcel W. M.
Published: October 2020

Background

Self-efficacy is an important determinant of adjustment following spinal cord injury. Self-efficacy is defined as the belief that one can successfully execute behavior required to produce the desired outcomes. In its original conceptualization, self-efficacy refers to the confidence that people have in their ability to accomplish specific tasks and behaviors within a specific context. Over the years these situation specific aspects have been unconfined and multiple constructs of self-efficacy have been proposed. The most common is a division in trait and state self-efficacy. Another used division that is utilized is between general, domain-specific and task-specific self-efficacy. The scientific support for these constructs is to date still unclear. The objective of this study was to enhance the understanding of the self-efficacy construct by comparing four self-efficacy scales designed to measure three aspects of self-efficacy (general versus domain-specific versus task-specific) in people with spinal cord injury.

Methods

Dutch and Australian adults with spinal cord injury (N = 140) completed four frequently used self-efficacy scales; the Moorong Self-efficacy Scale, General Self-efficacy Scale, University of Washington Self-efficacy Scale and a Self-care Self-efficacy Scale approximately 6 months after their inpatient rehabilitation. Pearson correlations examined inter-relationships between the scales.

Results

Hypothesized strong correlations between scales measuring similar aspects of self-efficacy were found (correlations 0.50–0.65). However, the hypothesized weak to moderate correlations between scales measuring diverging aspects of self-efficacy were only partly found (correlations 0.31–0.74), with 7 out of 12 correlations being strong instead of moderate.

Conclusions

The expected distinctions between the three aspects of self-efficacy was not demonstrated. All four scales measure a common latent construct, most likely general self-efficacy aspects. Further research is necessary to find ways to improve the measurement of domain-specific and task-specific aspects of SE, so that they are sensitive enough to capture change over time, and thus enhance clinical outcomes of people with SCI as they adjust to their disability.
What is beyond the edges? Gated communities and their role in China’s desire for harmonious cities
Authors: Hamama Badiaa , Liu Jian
Published: October 2020

During the rapid process of urbanization in post-reform China, cities assumed the role of a catalyst for economic growth and quantitative construction. In this context, territorially bounded and well delimited urban cells, globally known as ‘gated communities’,xiaoqu, continued to define the very essence of Chinese cities becoming the most attractive urban form for city planners, real estate developers, and citizens alike. Considering the guidelines in China’s National New Urbanization Plan (2014–2020), focusing on the promotion of humanistic and harmonious cities, in addition to the directive of 2016 by China’s Central Urban Work Conference to open up the gates and ban the construction of new enclosed residential compounds, this paper raises the following questions: As the matrix of the Chinese urban fabric, what would be the role of the gated communities in China’s desire for a human-qualitative urbanism? And How to rethink the gated communities to meet the new urban challenges? Seeking alternative perspectives, this paper looks at the gated communities beyond the apparent limits they seem to represent, considering them not simply as the ‘cancer’ of Chinese cities, rather the container of the primary ingredients to reshape the urban fabric dominated by the gate.
Argument annotation and analysis using deep learning with attention mechanism in Bahasa Indonesia
Authors: Suhartono Derwin , Gema Aryo Pradipta , Winton Suhendro , David Theodorus , Fanany Mohamad Ivan , Arymurthy Aniati Murni
Published: October 2020

Argumentation mining is a research field which focuses on sentences in type of argumentation. Argumentative sentences are often used in daily communication and have important role in each decision or conclusion making process. The research objective is to do observation in deep learning utilization combined with attention mechanism for argument annotation and analysis. Argument annotation is argument component classification from certain discourse to several classes. Classes include major claim, claim, premise and non-argumentative. Argument analysis points to argumentation characteristics and validity which are arranged into one topic. One of the analysis is about how to assess whether an established argument is categorized as sufficient or not. Dataset used for argument annotation and analysis is 402 persuasive essays. This data is translated into Bahasa Indonesia (mother tongue of Indonesia) to give overview about how it works with specific language other than English. Several deep learning models such as CNN (Convolutional Neural Network), LSTM (Long Short-Term Memory), and GRU (Gated Recurrent Unit) are utilized for argument annotation and analysis while HAN (Hierarchical Attention Network) is utilized only for argument analysis. Attention mechanism is combined with the model as weighted access setter for a better performance. From the whole experiments, combination of deep learning and attention mechanism for argument annotation and analysis arrives in a better result compared with previous research.
Prevention, Detection and Response to incidences of substandard and falsified medical products in the Member States of the Southern African Development Community
Authors: Kniazkov Stanislav , Dube-Mwedzi Sakhile , Nikiema Jean-Baptiste
Published: October 2020

Background

Medical products are an integral and pivotal part of health care delivery. They need to be available, affordable and quality-assured. The SADC region is prone to threats arising from the availability and use of substandard and falsified (SF) medical products. This is something that needs to be actively addressed.

Method

A survey, constructed around four themes, was carried out between September 2018 and January 2019. The National Medicines Regulatory Authorities (NMRAs) of the 16 Member States within the SADC region were asked to respond to the survey questionnaire. The objective was to map existing fameworks, mechanisms and approaches to prevention, detection and response (PDR) to SF medical products.

Results

Responses were received from twelve out of the sixteen NMRAs. Only three of the twelve respondents had included elements for PDR for SF medical products in their national medicine policies. Regardless of the status in terms of policies, legislation is however in place for the majority of NMRAs. The mandate for regular sampling, an important detection mechanism, was enshrined in the legislation of nine of the twelve respondents. In terms of response mechanisms, six of the respondents had both inter-agency and intra-agency co-ordination for responding to SF products.

Conclusion

Though findings point to some deficiencies in terms of policies and implementation plans, the majority of countries have the mandate and legislation to deal with substandard and falsified medical products. Effective enforcement requires more investments into human resources, infrastructure, stakeholder coordination and public outreach. WHO has an important source of actionable information about incidience of substandard and falsified medical products. It needs to be leveraged to improve outreach to stakeholders and to raise awareness about SF problem and mechanisms available to address it. The extent, to which mechanisms and procedures are in place, varies. Some elements of the desired approach exist in the region; however, they will benefit from targeted strengthening to ensure a holistic approach across 12 action areas recommended by WHO.
Pose estimation by extended Kalman filter using noise covariance matrices based on sensor output
Authors: Saito Ayuko , Kizawa Satoru , Kobayashi Yoshikazu , Miyawaki Kazuto
Published: October 2020

This paper presents an extended Kalman filter for pose estimation using noise covariance matrices based on sensor output. Compact and lightweight nine-axis motion sensors are used for motion analysis in widely various fields such as medical welfare and sports. A nine-axis motion sensor includes a three-axis gyroscope, a three-axis accelerometer, and a three-axis magnetometer. Information obtained from the three sensors is useful for estimating joint angles using the Kalman filter. The extended Kalman filter is used widely for state estimation because it can estimate the status with a small computational load. However, determining the process and observation noise covariance matrices in the extended Kalman filter is complicated. The noise covariance matrices in the extended Kalman filter were found for this study based on the sensor output. Postural change appears in the gyroscope output because the rotational motion of the joints produces human movement. Therefore, the process noise covariance matrix was determined based on the gyroscope output. An observation noise covariance matrix was determined based on the accelerometer and magnetometer output because the two sensors’ outputs were used as observation values. During a laboratory experiment, the lower limb joint angles of three participants were measured using an optical 3D motion analysis system and nine-axis motion sensors while participants were walking. The lower limb joint angles estimated using the extended Kalman filter with noise covariance matrices based on sensor output were generally consistent with results obtained from the optical 3D motion analysis system. Furthermore, the lower limb joint angles were measured using nine-axis motion sensors while participants were running in place for about 100 s. The experiment results demonstrated the effectiveness of the proposed method for human pose estimation.
Rodent-mediated plant community competition: what happens to the seeds after entering the adjacent stands?
Authors: Kang Haibin , Chang Mingjie , Liu Shutong , Chao Zhi , Zhang Xinping , Wang Dexiang
Published: October 2020

Background

Seed dispersal by scatter-hoarding animals can affect the developmental dynamics of plant communities. However, how animals might participate in plant inter-community competition has rarely been investigated. Forest community junction is an area where the competition between plant communities is most prominent and animal activity is more frequent. At present, little is known about how scatter-hoarding animals might assist competitions by adjacent plant communities. Thus, for 3 years (2015–2017), we tracked the fate of 2880 tagged seeds (Quercus aliena var. acuteserrata, Pinus tabuliformis, and P. armandii seed) placed near an edge where the forest composition changes from a pine forest to an oak forest in northwestern China.

Results

We found that the seed fates differed when Quercus and Pinus seeds entered adjacent stands. In contrast to Pinus seeds, acorns that entered pine forests were characterized by higher caching rates and longer dispersal distances. Pinus seeds had the highest probability of being predated (85%) by rodents, and eleven Q. aliena var. acuteserrata seedlings were established in pine forests, although none survived in the later stages. In addition, rodents exhibited obvious selectivity in terms of the microhabitats for the seed caching sites.

Conclusions

Seed fates differed when Quercus and Pinus seeds entered adjacent stands. The predation pressure by rodents on the seeds of Pinus species limited the germination of seeds and seedling establishment in oak forests. The different seed fates after their bidirectional dispersal could affect the differences in natural regeneration between pine and oak forests, and they might increase the recruitment rates for oak at the edge of an adjacent community. Rodent-mediated seed dispersal could potential unintentionally affect the competition between plant communities.
Guidelines for oral fluid-based surveillance of viral pathogens in swine
Authors: Henao-Diaz Alexandra , Giménez-Lirola Luis , Baum David H. , Zimmerman Jeffrey
Published: October 2020

Recent decades have seen both rapid growth and extensive consolidation in swine production. As a collateral effect, these changes have exacerbated the circulation of viruses and challenged our ability to prevent, control, and/or eliminate impactful swine diseases. Recent pandemic events in human and animal health, e.g., SARS-CoV-2 and African swine fever virus, highlight the fact that clinical observations are too slow and inaccurate to form the basis for effective health management decisions: systematic processes that provide timely, reliable data are required. Oral fluid-based surveillance reflects the adaptation of conventional testing methods to an alternative diagnostic specimen. The routine use of oral fluids in commercial farms for PRRSV and PCV2 surveillance was first proposed in 2008 as an efficient and practical improvement on individual pig sampling. Subsequent research expanded on this initial report to include the detection of ≥23 swine viral pathogens and the implementation of oral fluid-based surveillance in large swine populations (> 12,000 pigs). Herein we compile the current information regarding oral fluid collection methods, testing, and surveillance applications in swine production.
Long-term monitoring reveals invariant clutch size and unequal reproductive costs between sexes in a subtropical lacertid lizard
Authors: Lin Jhan-Wei , Chen Ying-Rong , Li Tsui-Wen , Shaner Pei-Jen L. , Lin Si-Min
Published: October 2020

Based on 20,000 records representingc. 11,000 individuals from an 8-year capture-mark-recapture (CMR) study, we tested and confirmed a new case of invariant clutch size (ICS) in a sexually dichromatic lacertid lizard,Takydromus viridipunctatus. In the grassland habitat of the early succession stage, females showed strictly low and invariant clutch size, multiple clutches in a breeding season, high reproductive potential, and annual breeding cycles that correspond to the emergence of male courtship coloration. The hatchlings mature quickly, and join the adult cohort for breeding within a few months, whereas adults show low survival rates and a short lifespan, such that most die within one year. Mortality increased in both sexes during the breeding season, especially in females, indicating an unequal cost of reproduction in survival. These life history characters may be explained by two non-exclusive hypotheses of ICS—arboreal hypothesis and predation hypothesis—within the ecological context of their habitat. Our study highlights a confirmed case of ICS, which adapts well to thisr-selected grassland habitat that experiences seasonal fluctuation and frequent disturbance.
Leading indicators and maritime safety: predicting future risk with a machine learning approach
Authors: Kretschmann Lutz
Published: October 2020

The shipping industry has been quite successful in reducing the number of major accidents in the past. In order to continue this development in the future, innovative leading risk indicators can make a significant contribution. If designed properly, they enable a forward-looking identification and assessment of existing risks for ship and crew, which in turn allows the implementation of mitigating measures before adverse events occur. Right now, the opportunity for developing such leading risk indicators is positively influenced by the ongoing digital transformation in the maritime industry. With an increasing amount of data from ship operation becoming available, these can be exploited in innovative risk management solutions. By combining the idea of leading risk indicators with data and algorithm-based risk management methods, this paper firstly establishes a development framework for designing maritime risk models based on safety-related data collected onboard. Secondly, the development framework is applied in a proof of concept where an innovative machine learning-based approach is used to calculate a leading maritime risk indicator. Overall, findings confirm that a data- and algorithm-based approach can be used to determine a leading risk indicator per ship, even though the achieved model performance is not yet regarded as satisfactory and further research is planned.
Development and evaluation of the Singapore Caregiver Quality of Life Scale - Dementia
Authors: Cheung Yin Bun , Teo Irene , Lim Wee Shiong , Hum Allyn , Neo Shirlyn H. S. , Yang Grace M. , Lee Geok Ling , Tan Gretchen , Seow Dennis C. C.
Published: October 2020

Purpose

To develop and evaluate a measurement scale for multi-domain assessment of the quality of life of family caregivers of persons with dementia (PWD) in Singapore, a multi-ethic society in South-East Asia where English is the lingua franca.

Methods

Items from the Singapore Caregiver Quality of Life Scale (SCQOLS), which was originally developed in the context of advanced cancers, were adopted as candidate items. Furthermore, a multi-disciplinary panel reviewed dementia-specific caregiver quality of life scales to identified items not covered in SCQOLS for inclusion as candidate items. A pilot study of 31 family caregivers of PWD was conducted to solicit inputs on candidate items; 102 family caregivers of PWD were surveyed for evaluation of the scale’s measurement properties.

Results

Factor analysis confirmed a 5-domain structure of the 63 candidate items. The Root Mean Square Error of Approximation was 0.056 and Comparative Fit Index was 0.928. Convergent validity of the total and domain scores was demonstrated in terms of correlation with the Brief Assessment Scale for Caregivers and its sub-scales. The scores also showed an expected pattern of correlation with hours spent on caregiving per week. Known-group validity was demonstrated by differences in mean scores between functional staging groups. Cronbach’s alpha of the total and domain scores ranged from 0.89 to 0.95. Test-retest reliability (intraclass correlation coefficient) ranged from 0.77 to 0.92.

Conclusions

The Singapore Caregiver Quality of Life Scale – Dementia (SCQOLS-D) is a quality of life measurement scale for family caregivers of persons with dementia that is valid and reliable.
Diagnostic value of matrix metalloproteinase-2 and high mobility group box 1 in patients with refractory epilepsy
Authors: Salih Khalid S. , Hamdan Farqad B. , Al-Mayah Qasim S.
Published: October 2020

Introduction

There are large numbers of inflammatory molecules and humoral mediators that can be involved in the epileptogenesis such as cytokines, matrix metalloproteinases (MMP), and high mobility group box-1 (HMGB1). We aimed to evaluate serum levels and the diagnostic value of MMP-2 and HMGB1 in Iraqi patients with epilepsy.

Methods

One hundred epileptic patients comprised 60 controlled epileptics and 40 refractory patients to treatment with multi antiepileptic drugs (AEDs). Other 50 family-unrelated age- and sex-matched healthy subjects were selected to represent the control group. Serum levels of MMP-2 and HMGB1 were estimated using ELISA. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of these markers when required.

Results

MMP-2 level was significantly higher in controls than epileptic patients in general (controlled and refractory patients). ROC curve, showed poor diagnostic value of MMP-2 in discriminating epileptics into responsive or refractory to treatment from controls (AUC = 0.679 (95% CI = 0.536-0.823), and AUC = 0.77 (95% CI = 0.637-902), respectively). Serum HMGB1 level in epileptic patients and controls was in close approximation to each other.

Conclusions

MMP-2 is significantly decreased in patients particularly those with refractory epilepsy (RE); however, it has poor diagnostic value. No difference in the serum HMGB1 level between epileptic patients and controls.
Mitigation the adverse effect of salinity stress on the performance of the tomato crop by exogenous application of chitosan
Authors: Ullah Naeem , Basit Abdul , Ahmad Imran , Ullah Izhar , Shah Syed Tanveer , Mohamed Heba I. , Javed Shahryar
Published: October 2020

Background

In recent years, ecofriendly compounds such as chitosan has been used to alleviate the destructive effects of salt stress. Chitosan is a natural biodegradable compound with no toxicity in nature and act as a stress tolerance inductor involved in physiological processes and prevent water loss through transpiration. Tomato cv. Rio Grande grown in pots was subjected with salinity stress in the form of 4 levels (0, 50, 100 and 150 mM) whose effect was mediated by treating it with different concentration of chitosan (0, 50, 100 and 150 mg L−1).

Results

The data revealed that various application of salinity had a negative effect on almost all the studied parameters. Tomato plants treated with distilled water having no salinity (control) recorded maximum plant height (cm), average number of compound leaves plant−1, leaf area (cm2), stem diameter (mm), number of fruits plant−1, fruit firmness (kg cm−2), leaf chlorophyll content (SPAD), fruit juice pH, yield plant−1(kg) and minimum total soluble solids (Brix°). Whereas, minimum plant height (cm), average number of compound leaves plant−1, leaf area (cm2), stem diameter (mm), number of fruits plant−1, fruit firmness (kg cm−2), leaf chlorophyll content (SPAD), fruit juice pH, yield plant−1(kg) and maximum total soluble solids (Brix°) were found in plants treated with salinity level of 150 mM. Chitosan concentration of 150 mg L−1significantly mediated the effect of salinity stress and recorded maximum plant height (cm), average number of compound leaves plant−1, leaf area (cm2), stem diameter (mm), number of fruits plant−1, fruit firmness (kg cm−2), leaf chlorophyll content (SPAD), total soluble solids (Brix°) and yield plant−1(kg) with minimum fruit juice pH.

Conclusion

It is concluded that foliar application of chitosan at the rate of 150 mg L−1and salinity stress 150 mM could have positive impact on performance of tomato.
Combined subthalamic and nucleus basalis of Meynert deep brain stimulation for Parkinson’s disease with dementia (DEMPARK-DBS): protocol of a randomized, sham-controlled trial
Authors: Daniels Christine , Steigerwald Frank , Capetian Philipp , Matthies Cordula , Malzahn Uwe , Heuschmann Peter U. , Volkmann Jens
Published: October 2020

Introduction

Dementia in Parkinson’s disease (PDD) is a common non-motor symptom of advanced disease, associated with pronounced neocortical cholinergic deficits due to neurodegeneration of the nucleus basalis of Meynert (NBM) and its cholinergic terminals. In advanced PD, patients often require advanced therapies such as infusion therapy or deep brain stimulation (DBS) to improve motor control. However, patients with associated dementia are commonly excluded from DBS because of potential deterioration of cognitive functions. Yet marked reductions in dopaminergic medication and the subsequent risk of side effects (e.g., cognitive decline, psychosis, delirium) suggest that critical re-consideration of DBS of the subthalamic nucleus (STN-DBS) for advanced stages of PD and PDD is worthwhile. In this Phase 1b study, we will provide STN-DBS to a cohort of PDD patients with severe motor fluctuations and combine two additional electrodes for augmentative neurostimulation of the NBM.

Methods

We aim to include 12 patients with mild-to-moderately severe PDD who fulfill indication criteria regarding motor symptoms for STN-DBS. Eligible patients will undergo implantation of a neurostimulation system with bilateral electrodes in both the STN and NBM. After 12 weeks of STN-DBS (visit 1/V1), participants will be randomized to receive either effective neurostimulation of the NBM (group 1) or sham stimulation of the NBM (group 2). NBM-DBS will be activated in all participants after 24 weeks of blinded treatment (visit 2/V2). The primary outcome will be the safety of combined bilateral STN- and NBM-DBS, determined by spontaneously-reported adverse events. Other outcome measures will comprise changes on scales evaluating cognition, activities of daily living functioning and clinical global impression, as well as motor functions, mood, behavior, caregiver burden and health economic aspects, and several domain-specific cognitive tests. Changes in scores (V1 – V2) for both treatment arms will undergo analysis of covariances, with baseline scores as covariates.

Perspective

The feasibility and safety of combined STN-NBM-DBS in patients with PDD will be assessed to determine whether additional NBM-DBS improves or slows the progression of cognitive decline. Positive results would provide a basic concept for future studies evaluating the efficacy of NBM-DBS in larger PDD cohorts. Indirectly, proof-of-safety of STN-DBS in PDD might influence patient selection for this standard treatment option in advanced PD.

Trial registration

ClinicalTrials.gov identifier (NCT number): NCT02589925.
Feminizing genitoplasty in childhood: aiming for achievable outcomes
Authors: AbouZeid Amr Abdelhamid
Published: October 2020

Background

Early genital reconstruction may be recommended in cases of congenital adrenal hyperplasia to avoid the stigma that can affect these individuals with variable degrees through different cultures. However, the separation and mobilization of a high vagina has remained challenging with less satisfactory surgical outcomes. Therefore, the value of early vaginal reconstruction has been questioned in favour of delaying the whole repair after puberty. In this report, the author has adopted the third option in-between, which comprises early reconstruction of the external genitalia and delaying the more challenging vaginal reconstruction (if needed) to be performed after puberty.

Results

The study included ten consecutive cases of CAH who underwent feminizing genitoplasty during the period 2016 through 2019. Their age at operation ranged from 8 to 84 months (mean 31; median 15).

In five cases (50%), the technique of limited urogenital sinus mobilization adopted in this report succeeded in bringing the vaginal introitus down to the perineum. Those cases had originally a low vagina. In the rest of cases, labial retraction showed a common but wide urogenital introitus perfectly lined by urogenital mucosa. The outcomes have been considered satisfactory to a great extent for both parents and doctors regarding cosmesis and lack of functional complications (voiding problems). Longer follow up is still needed to assess the sexual function when these girls become sexually active.

Conclusion

In cases of congenital adrenal hyperplasia, reduction clitoroplasty combined with partial urogenital sinus mobilization can achieve predictable and satisfactory outcomes. In about 50% of cases, this approach is sufficient to bring the vagina down to the perineum. In the other half of cases with higher vagina, the possibility of satisfactory sinus intercourse can be studied when these girls grow and become sexually active; otherwise, a delayed vaginal reconstruction may turn to be necessary.
Rising Circulating Tumor DNA As a Molecular Biomarker of Early Disease Progression in Metastatic Breast Cancer
Authors: Velimirovic Marko , Juric Dejan , Niemierko Andrzej , Spring Laura , Vidula Neelima , Wander Seth A. , Medford Arielle , Parikh Aparna , Malvarosa Giuliana , Yuen Megan , Corcoran Ryan , Moy Beverly , Isakoff Steven J. , Ellisen Leif W. , Iafrate Anthony , Chabner Bruce , Bardia Aditya
Published: October 2020

PURPOSE

Accurate monitoring of therapeutic response remains an important unmet need for patients with metastatic breast cancer (MBC). Analysis of tumor genomics obtained via circulating tumor DNA (ctDNA) can provide a comprehensive overview of tumor evolution. Here, we evaluated ctDNA change as an early prognostic biomarker of subsequent radiologic progression and survival in MBC.

PATIENTS AND METHODS

Paired blood samples from patients with MBC were analyzed for levels of ctDNA, carcinoembryonic antigen, and cancer antigen 15-3 at baseline and during treatment. A Clinical Laboratory Improvement Amendments–certified sequencing panel of 73 genes was used to quantify tumor-specific point mutations in ctDNA. Multivariable logistic regression analysis was conducted to evaluate the association between ctDNA rise from baseline to during-treatment (genomic progression) and subsequent radiologic progression and progression-free survival (PFS).

RESULTS

Somatic mutations were detected in 76 baseline samples (90.5%) and 71 during-treatment samples (84.5%). Patients with genomic progression were more than twice as likely to have subsequent radiologic progression (odds ratio, 2.04; 95% CI, 1.74 to 2.41; P < .0001), with a mean lead time of 5.8 weeks. Genomic assessment provided a high positive predictive value of 81.8% and a negative predictive value of 89.7%. The subset of patients with genomic progression also had shorter PFS (median, 4.2 v 8.3 months; hazard ratio, 2.97; 95% CI, 1.75 to 5.04; log-rank P < .0001) compared with those without genomic progression.

CONCLUSION

Genomic progression, as assessed by early rise in ctDNA, is an independent biomarker of disease progression before overt radiologic or clinical progression becomes evident in patients with MBC.
Estrogen Receptors in Nonfunctioning Pituitary Neuroendocrine Tumors: Review on Expression and Gonadotroph Functions
Authors: Haydar Ali Tajuddin Amalina , Kamaruddin Norazmi , Sukor Norlela , Azizan Elena Aisha , Omar Ahmad Marzuki
Published: October 2020

AbstractEstrogen (17β-estradiol or E2) is a crucial regulator of the synthesis and secretion of pituitary reproductive hormones luteinizing hormone, follicle-stimulating hormone, and prolactin. In this review, we summarize the role of estrogen receptors in nonfunctioning pituitary neuroendocrine tumors (NF-Pitnets), focusing on immunoexpression and gonadotroph cell proliferation and apoptosis. Gonadotroph tumors are the most common subtype of NF-Pitnets. Two major estrogen receptor (ER) isoforms expressed in the pituitary are estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ). Overall, estrogen actions are mostly exerted through the ERα isoform on the pituitary. The G protein–coupled estrogen receptor (GPER) located at the plasma membrane may contribute to nongenomic effects of estrogen. Nuclear immunoreactivity for ERα and ERβ was highest among gonadotroph and null cell tumors. Silent corticotroph tumors are the least immunoreactive for both receptors. A significantly elevated ERα expression was observed in macroadenomas compared with microadenomas. ERα and ERβ may act in opposite directions to regulate the Slug-E-cadherin pathway and to affect invasiveness of NF-Pitnets. In the cellular pathway, ERs regulate estrogen-induced proliferation and differentiation and impact several signaling pathways including the MAPK and PI3K/Akt pathway. Estrogen was the first-discovered inducer of pituitary tumor transforming gene 1 that was abundantly expressed in NF-Pitnets. ERα can be a potential biomarker for predicting tumor size and invasiveness as well as therapeutic target for NF-Pitnets. Selective estrogen receptor modulators or antiestrogen may represent as an alternative choice for the treatment of NF-Pitnets.
From Confusion to Conversion
Authors: Morrey Douglas
Published: October 2020

Submission (2015), a novel in which a Muslim political party is elected to govern France, has been widely interpreted as part of a ubiquitous discourse of “declinism” in contemporary French intellectual culture. The novel has been accused of complicity with a reactionary politics favoring a return to strong patriarchal authority and national pride, while the narrative of the triumph of political Islam is frequently interpreted as a thinly veiled act of Islamophobia. This ideological interpretation is, however, complicated by the bad faith of the novel’s unreliable narrator, and by the ironic treatment of his narrative voice. By taking the elusiveness of this narration more fully into account, it becomes possible to read Submission as a tentative — if never unambiguous — narrative of religious conversion. To this extent, the treatment of Islam in Submission can be seen as consistent with the persistent but ambivalent role of religion in Houellebecq’s wider work.
Beyond Faith and Reason
Authors: Horstkotte Silke
Published: October 2020

This article approaches postsecularity from a historical angle by considering three recent German-language novels which reflect present-day ambivalences regarding religion and secularity through a genealogy of the present. Daniel Kehlmann’s Measuring the World, Ilija Trojanow’s Collector of Worlds, and Sibylle Lewitscharoff’s Blumenberg explore the gaps, fissures, and contradictions in the dichotomy of faith and reason which so haunts the present engagement with religion. They depict nineteenth- and twentieth-century protagonists who embrace a disenchanted outlook on the world, yet struggle with the specters of an older, enchanted cosmos. Through variants of the literary fantastic, and unreliable and polyperspectival narration, these books develop a view of the world that goes beyond facile dichotomies of faith and reason.
Healthcare providers’ perspective on barriers to optimal HIV index testing: an interview-based study
Authors: Katamba Cibangu
Published: October 2020

Background: HIV testing services (HTS) and antiretroviral therapy have seen a substantial scale-up. Poorly targeted HTS have continued to miss people living with HIV who do not know their HIV status. This requires new and targeted approaches to reach undiagnosed people with HIV, such as HIV partner services. The aim of this study was to assess the barriers to optimal index testing for improved HIV testing yield in Lusaka, Zambia.

Methods: One-to-one interviews were conducted with index testing providers to explore provider-related and client-related barriers to testing, and document other experiences arising during the process of HIV index testing. An interview guide was utilized for consistency of information collected.

Results: Provider related challenges included inadequate elicitation skills among healthcare workers; low number of volunteers trained in index testing; inadequate index testing knowledge among staff; limited elicitation of index partners to only wife and husband (not eliciting all sexual partners); and limited transport for contact tracing. On the other hand, client-related challenges were mobile communities due to seasonal activities such as cross boarder trades, sex work and farming; some key populations and adolescent index clients do not have contact details for their casual relationships; provider’s age or gender difference for some clients; missing details on client locator forms or wrong details provided; and limited space dedicated to conduct elicitation of index clients.

Discussion: The challenges identified have future implications for index partner testing. These barriers were also gender and age specific. HIV testing services need to adapt to the social context of Zambia where HIV-related stigma and discrimination is still persistent and overwhelming. As Zambia makes significant progress towards achieving HIV epidemic control, more effort is needed to reach specific high risk but hard to reach populations in HIV programs, such as men and adolescent girls and young women.
The influence of human genetic variation on early transcriptional responses and protective immunity following immunization with Rotarix vaccine in infants in Ho Chi Minh City in Vietnam: A study protocol for an open single-arm interventional trial
Authors: de Alwis Ruklanthi , My Phuc Tran , Yu Hang Bai Benjamin , Le Thi Quynh Nhi , Thi Thanh Tam Pham , Thi Ngoc Dung Tran , Thi Thanh Nhan Nguyen , Vinh Chau , Van Hien Ho , Thanh Hoang Nhat Le , Thi Thu Hong Nguyen , Thi Mong Tuyen Nguyen , Thi Thuy Trang Hoang , Phuong Thao Le , Thi Ngoc Diep Vo , Thi Hai Chau Pham , Quan Thinh Le , Thi Ngoc Thu Huynh , Nguyet Hang Ngo , Cong Danh Mai , Doan Hao Tran , Anh Dao Truong , Dai Lam , Thi Huyen Diu Vo , Thi En Nguyen , Thi Tuyet Hanh Nguyen , Thi Hanh Le , Pham Thu Hien Huynh , Thi Thuy Linh Nguyen , Darton Thomas C. , Thwaites Guy E , Kestelyn Evelyne , Lan Vi Lu , Thi Thuy Tien Bui , Thi Diem Tuyet Hoang , Anderson Carl , Baker Stephen
Published: October 2020

Background: Rotavirus (RoV) remains the leading cause of acute gastroenteritis in infants and children aged under five years in both high- and low-middle-income countries (LMICs). In LMICs, RoV infections are associated with substantial mortality. Two RoV vaccines (Rotarix and Rotateq) are widely available for use in infants, both of which have been shown to be highly efficacious in Europe and North America. However, for unknown reasons, these RoV vaccines have markedly lower efficacy in LMICs. We hypothesize that poor RoV vaccine efficacy across in certain regions may be associated with genetic heritability or gene expression in the human host.

Methods/design: We designed an open-label single-arm interventional trial with the Rotarix RoV vaccine to identify genetic and transcriptomic markers associated with generating a protective immune response against RoV. Overall, 1,000 infants will be recruited prior to Expanded Program on Immunization (EPI) vaccinations at two months of age and vaccinated with oral Rotarix vaccine at two and three months, after which the infants will be followed-up for diarrheal disease until 18 months of age. Blood sampling for genetics, transcriptomics, and immunological analysis will be conducted before each Rotarix vaccination, 2-3 days post-vaccination, and at each follow-up visit (i.e. 6, 12 and 18 months of age). Stool samples will be collected during each diarrheal episode to identify RoV infection. The primary outcome will be Rotarix vaccine failure events (i.e. symptomatic RoV infection despite vaccination), secondary outcomes will be antibody responses and genotypic characterization of the infection virus in Rotarix failure events.

Discussion: This study will be the largest and best powered study of its kind to be conducted to date in infants, and will be critical for our understanding of RoV immunity, human genetics in the Vietnam population, and mechanisms determining RoV vaccine-mediated protection.

Registration: ClinicalTrials.gov, ID: NCT03587389. Registered on 16 July 2018.
On Queue-Length Information when Customers Travel to a Queue
Authors: Hassin Refael , Roet-Green Ricky
Published: October 2020

Problem definition: We consider a service system in which customers must travel to the queue to be served. In our base model, customers observe the queue length and then decide whether to travel. We also consider alternative information models and investigate how the availability of queue-length information affects customer-equilibrium strategies, throughput, and social welfare. Academic/practical relevance: A common assumption in queueing models is that once a customer decides to join the queue, joining is instantaneous. This assumption does not fit real-life settings, where customers possess online information about the current wait time at the service, but while traveling to the service, its queue length may change. Motivated by this realistic setting, we study how queue-length information prior to traveling affects customers’ decision to travel. Methodology: We prove that a symmetric equilibrium exists in our base model. We perform the calculation numerically as a result of the model complexity, which is due to the fact that the arrival rate to the traveling queue depends on the current state of the service queue, and vice versa. The alternative models are tractable, and we present their analytical solution. Results: When customers can observe the service-queue length prior to traveling, their probability of traveling is monotonically nonincreasing with the observed queue length. We find that customers may adopt a generalized mixed-threshold equilibrium strategy: Travel when observing short queue lengths, avoid traveling when observing long queue lengths, and mix between traveling and not traveling when observing intermediate queue lengths, with a decreasing probability of traveling. Managerial implications: Our results imply that when system congestion is high, the provider can increase throughput by disclosing the queue-length information, whereas at low congestion, the provider benefits from concealing the information. With respect to social welfare, queue-length information prior to departure is beneficial when congestion is at intermediate to high levels and yields the same social welfare otherwise.
Moving Violations: Pairing an Illegitimate Learning Hierarchy with Trainee Status Mobility for Acquiring New Skills When Traditional Expertise Erodes
Authors: Kellogg Katherine C. , Myers Jenna E. , Gainer Lindsay , Singer Sara J.
Published: October 2020

We explore how members of a community of practice learn new tools and techniques when environmental shifts undermine existing expertise. In our 20-month comparative field study of medical assistants and patient-service representatives learning to use new digital technology in five primary care sites, we find that the traditional master-apprentice training model worked well when established practices were being conferred to trainees. When environmental change required introducing new tools and techniques with which the experienced members had no expertise, third-party managers selected newer members as trainers because managers judged them to be agile learners who were less committed to traditional hierarchies and more willing to deviate from traditional norms. This challenged community members’ existing status, which was based on the historical distinctions of long tenure and expertise in traditional tasks. In three sites, the introduction of this illegitimate learning hierarchy sparked status competition among trainees and trainers, and trainees collectively resisted learning new tools and techniques. In the other two sites, managers paired the new, illegitimate learning hierarchy with the opportunity for trainee status mobility by rotating the trainer role; here, trainees embraced learning in order to exit the lower-status trainee group and join the higher-status trainer group. Drawing on ideas of status group legitimacy and mobility, we suggest that managers’ pairing of an illegitimate learning hierarchy with the opportunity for trainee status mobility is a mechanism for enabling the situated learning of new techniques when traditional expertise erodes.
Webs of Influence: Secondary Stakeholder Actions and Cross-National Corporate Social Performance
Authors: Odziemkowska Kate , Henisz Witold J.
Published: October 2020

We analyze the relationship between the actions and interactions of secondary stakeholders with an interest in corporate social performance (CSP) and variation in firm-level CSP across countries. Our work represents a significant theoretical shift in research exploring comparative CSP, which, to date, has focused on cross-national variation in institutions. We propose that stakeholders can also drive cross-country heterogeneity in CSP by influencing the salience of the issues for which they advocate. Stakeholders raise salience of CSP issues through their interactions with important sociopolitical actors within a country, signaling their collective ability to change expectations on CSP. CSP issue salience is also heightened where heterogeneous stakeholder groups advocate for CSP issues, signaling that issues have garnered widespread acceptance or legitimacy. Managers are also more attuned to the urgency of issues through the direct actions that stakeholders take against firms in the country. We also argue and find that these effects are moderated by interstakeholder interactions, which signal the degree of consensus among stakeholders on issues and their ability to mobilize repeatedly against firms. We draw on a novel data set of 250 million media-reported events to identify secondary stakeholders with interests in the environmental and social issues that constitute CSP, their direct actions against firms, and their interactions with important sociopolitical actors and each other. We show empirically that variation in secondary stakeholder actions and interactions between countries, and within countries over time, is associated with differences in firm-level CSP among a sample of 2,852 firms spanning 36 countries from 2004 to 2013.
Prescribing in end of life care
Authors: Robertson Deborah
Published: October 2020

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided
Preparing to Prescribe: an online implementation tool kit for non-medical prescribers
Authors: Carey Nicola , Stenner Karen
Published: October 2020

With the demand for medication continually growing, Nicola Carey and Karen Stenner discusses how non-medical prescribing can ease the burden; showcasing a new online toolkit ‘Preparing to Prescribe’, that will aid the future training of prescribers
Quantifying the impact of the COVID-19 pandemic on orthopaedic trainees
Authors: Sheridan Gerard A. , Hughes Andrew J. , Quinlan John F. , Sheehan Eoin , O'Byrne John M.
Published: October 2020

Aims

We aim to objectively assess the impact of COVID-19 on mean total operative cases for all indicative procedures (as outlined by the Joint Committee on Surgical Training (JCST)) experienced by orthopaedic trainees in the deanery of the Republic of Ireland. Subjective experiences were reported for each trainee using questionnaires.

Methods

During the first four weeks of the nationwide lockdown due to COVID-19, the objective impact of the pandemic on each trainee’s surgical caseload exposure was assessed using data from individual trainee logbook profiles in the deanery of the Republic of Ireland. Independent predictor variables included the trainee grade (ST 3 to 8), the individual trainee, the unit that the logbook was reported from, and the year in which the logbook was recorded. We used the analysis of variance (ANOVA) test to assess for any statistically significant predictor variables. The subjective experience of each trainee was captured using an electronic questionnaire.

Results

The mean number of total procedures per trainee over four weeks was 36.8 (7 to 99; standard deviation (SD) 19.67) in 2018, 40.6 (6 to 81; SD 17.90) in 2019, and 18.3 (3 to 65; SD 11.70) during the pandemic of 2020 (p = 0.043). Significant reductions were noted for all elective indicative procedures, including arthroplasty (p = 0.019), osteotomy (p = 0.045), nerve decompression (p = 0.024) and arthroscopy (p = 0.024). In contrast, none of the nine indicative procedures for trauma were reduced. There was a significant inter-unit difference in the mean number of total cases (p = 0.029) and indicative cases (p = 0.0005) per trainee. We noted that 7.69% (n = 3) of trainees contracted COVID-19.

Conclusion

During the COVID-19 pandemic, the mean number of operative cases per trainee has been significantly reduced for four of the 13 indicative procedures, as outlined by the JCST. Reassignment of trainees to high-volume institutions in the future may be a plausible approach to mitigate significant training deficits in those trainees worst impacted by the reduction in operative exposure.