bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the concept of non-violent resistance amongst healthcare workers
Authors: Essex Ryan , Aked Hil , Daniels Rebecca , Newton Paul , Weldon Sharon
Published: October 2022

Background

Non-violent resistance which has involved healthcare workers has been instrumental in securing a number of health-related gains and a force in opposing threats to health. Despite this, we know little about healthcare workers who have engaged in acts of non-violent resistance.

Research aim

Amongst a sample of healthcare workers who had engaged in acts of resistance this study sought to explore their understanding of non-violent resistance and how or whether they felt healthcare workers made a distinct contribution to such action.

Research design

Cross-sectional survey

Participants and research context

Healthcare workers (doctors, nurses, academics and others) from the UK and Europe who had engaged in acts of non-violent resistance.

Ethical considerations

Ethical approval for this study was granted by the University of Greenwich Human Research Ethics Committee (UREC/20.5.6.11).

Findings/results

Most participants spoke about the nature of non-violent resistance, its oppositional, didactic and symbolic functions and the role of violence or harm. While most people understood non-violent resistance as a public, oppositional and collective act, many identified more subtle everyday acts in the workplace that undermined policy or procedures they saw as harmful. When asked about distinctions in non-violent resistance carried out by healthcare workers, most participants referred to their standing in society, noting that healthcare works were a trusted and authoritative source. Some identified an ethical imperative to act while others identified the risks that came with such action, noting their accountability and responsibility they had to patients. About a quarter of participants felt that such action was no different to others carrying out non-violent resistance or dependent on the issue or nature of the action.

Conclusions

These findings speak to the complex and multifaceted nature of non-violent resistance. Additionally our findings suggest healthcare workers have a distinct role to play in leading and supporting non-violent actions.
The Role of Entrepreneurs’ Perceived Competence and Cooperativeness in Early-Stage Financing
Authors: Svetek Mojca
Published: October 2022

Building on social-psychological insights into social perception and judgment and empirical findings from the entrepreneurship literature, we propose that early-stage equity investors look at two main dimensions to assess entrepreneurs seeking early-stage financing: competence and cooperativeness. In all, 84 angel investors and venture capitalists active in Europe participated in a conjoint experiment. The results show that investors prioritize entrepreneurs’ competence over their cooperativeness. Entrepreneurs’ competence is even more appealing to investors when combined with coachability. We find that entrepreneurs can compensate for a lack of experience by demonstrating solid market knowledge and appearing to be coachable. Furthermore, the results suggest that investors differ in their consideration of entrepreneurs’ cooperativeness, but not competence, when making investment decisions—a finding that is conditional on investors’ usual level of involvement in their portfolio ventures. We discuss these findings from a theoretical and practical perspective.
Patterns of Use in Transesophageal Echocardiography for Liver Transplantation: A Systematic Review
Authors: Dunkman W. Jonathan , Manning Michael W. , Williams David A.
Published: October 2022

Transesophageal echocardiography is frequently but not always used to guide anesthetic management during liver transplantation. We performed a systematic review of the literature to identify and summarize any studies reporting on the frequency and characteristics of TEE use for liver transplantation. Studies were identified by searching several relevant terms on PubMed and citation searching of relevant reviews. We identified 5 studies reporting the results of surveys performed between 2003 and 2018. Use of TEE for liver transplantation increased from 11.3% of centers in 2003 to greater than 90% of centers by 2014 and 2018. Only 38%–56% of centers use it routinely with the rest using it only in special circumstances. About a third of centers usually perform a comprehensive exam, with the majority performing a more limited exam based on the needs of the case. Use of TEE for liver transplantation is common but not universal. This review summarizes the current knowledge about the frequency and circumstances of use, but there is an opportunity for further systematic study and discussion.
What Do Arts-Based Methods Do? A Story of (What Is) Art and Online Research With Children During a Pandemic
Authors: Spray Julie , Fechtel Hannah , Hunleth Jean
Published: October 2022

This comic draws viewers behind the final product and into the process of arts-based research. Specifically, we focus on research produced over Zoom during the Covid-19 pandemic. Based on a study of asthma caregiving, we illustrate how a 10-year-old study participant, Becca, and researcher Hannah connected in embodied, sensory and material-spatial ways across digital space through the making and unmaking of art forms using simple sensory-sculptural materials (pipe cleaners, play-doh, balloons). We consider what arts-based methods do: for the participant, the researcher, their relationship, and ethical knowledge production. And we show what research processes can look like as unpredictable, messy and patient communing.
Stories Too Big for a Case File: Unaccompanied Young People Confront the Hostile Environment in Pandemic Times
Authors: Aissatou  , Prokopiou Evangelia , Leon Lucy , Abdullayeva Musharraf , Mirfat  , Osman  , Iyambo Pauline , Rosen Rachel , Rebin  , Meetoo Veena , Zak
Published: October 2022

What imagery best evokes the violence unaccompanied child migrants feel when asked, or made, to tell their story over and over, as well as the violence of not being asked nor being heard? How can we show both strength and struggle in difficult times and often uncaring places such as the UK’s hostile migration regime? Taking these questions as a jumping off point, this article offers three key responses, drawing on experiences of co-producing the research-based film, Stories too big for a case file, which accompanies this text. These reflections highlight the importance of participatory, change-oriented research that ‘cares’ for participants; the value of creative forms of knowledge production and aesthetic modes of expression for communicating the affective complexities of research material; and, the importance of turning the representational gaze outwards towards systems and institutions to avoid situating social inequities as individual failings and to, instead, invite viewers to ‘walk together’ in solidarity with research interlocutors.
Prediction method and experimental verification of vibration response caused by underground high-speed railways
Authors: Li Hao , Yang Wei-guo , Liu Pei , Wang Meng
Published: October 2022

Aiming at the problem of vibration caused by underground high-speed railways, this paper proposes a vibration prediction method based on the multi-point transfer ratio in the frequency domain. The transmission information of vibration signals from the tunnel to the surface was obtained by an in situ hammer excitation test, and the acceleration response near the vibration source was calculated via high-precision vehicle-track coupling analysis and a finite element model of the tunnel. Then, the superposition operation was carried out in consideration of the position change of the train, and the surface vibration response caused by the underground high-speed railway was finally predicted. An in situ vibration test was carried out near an underground high-speed railway line and the measured data were compared with the predicted data. The results demonstrate that the predicted and measured time domain peaks were similar, and the main vibration frequencies were both located in the range of 30–70 Hz. Moreover, the 1/3-octave spectra were also very similar, and the root mean square error of acceleration and the Z vibration level error were less than 1.9%. The comparison results show that the proposed method can be used to predict the vibration response caused by the operation of underground high-speed railways with high precision.
The sounds of memory: Troubling the professionalization of knowledge through Black women’s memoir and interpretive disability studies
Authors: Cagulada Elaine , DeWelles Madeleine
Published: October 2022

In this article, the authors encourage the consideration of the use of Black women’s memoir to inform pre-service early childhood education by exploring Mary Herring Wright’s memoir of growing up Black and deaf in the southern USA in Sounds Like Home and bell hooks’ memoir of childhood in Bone Black: Memories of Girlhood. In their engagement with Wright and hooks, stories of childhood, longing and memory appear as valid forms of knowing that attend to issues of power, hegemony and social inequity. The authors further demonstrate that the standards of practice promoted within the Ontario College of Early Childhood Educators, particularly ‘Standard II: Curriculum and Pedagogy’, understand knowledge as valid primarily if based on empirical and developmental ways of knowing. Black women’s memoirs and counternarratives, engaged with from an interpretive disability studies perspective, trouble this by suggesting that memories and stories of childhood also serve as valid and important forms of knowledge in pre-service early childhood education training and beyond . How might one encourage and support a disability studies approach to inclusion in pre-service early childhood education settings? How might such an approach help blur the child–adult binary that often appears in pre-service early childhood education, and in almost all the relationships that children have with adults? Melding the creative and the critical, the authors argue that Black women’s memoir can deepen our understanding of belonging and love, and therefore is a necessary intervention in educational institutions embedded within a normative order that creates binaries between children and adults.
Gas Chromatography – Ion Mobility Spectrometry as a tool for quick detection of hazardous volatile organic compounds in indoor and ambient air: A university campus case study
Authors: Moura Pedro Catalão , Vassilenko Valentina
Published: October 2022

Society’s concerns about the citizens’ exposure to possibly dangerous environments have recently risen; nevertheless, the assessment of indoor air quality still represents a major contemporary challenge. The volatile organic compounds (VOCs) are among the main factors responsible for deteriorating air quality conditions. These analytes are very common in daily-use environments and they can be extremely hazardous to human health, even at trace concentrations levels. For these reasons, their quick detection, identification, and quantification are crucial tasks, especially for indoor and heavily-populated scenarios, where the exposure time is usually quite long. In this work, a Gas Chromatography – Ion Mobility Spectrometry (GC-IMS) device was used for continuous monitoring indoor and ambient air environments at a large-scale, due to its outstanding levels of sensibility, selectivity, analytical flexibility, and almost real-time monitoring capability. A total of 496 spectra were collected from 15 locations of a university campus and posteriorly analysed. Overall, 23 compounds were identified among the 31 detected. Some of them, like Ethanol and 2-Propanol, were reported as being very hazardous to the human organism, especially in indoor environments. The achieved results confirmed the suitability of GC-IMS technology for air quality assessment and monitoring of VOCs and, more importantly, proved how dangerous indoor environments can be in scenarios of continuous exposure.
Assessing the seam strength of ultrasonically welded polyester and polypropylene spunbond nonwovens
Authors: ÇİNÇİK Emel , İNAN ÜSTÜN Aynur
Published: October 2022

The durability of the products such as personal protective clothes and facemasks are crucial for human health as these products prevent the spread of disease. This study aims to investigate the seam strength of ultrasonically welded spunbond nonwovens used for personal protective clothes, facemasks, diapers and determine the best welding parameters for optimum seams. For these purposes, polyester and polypropylene spunbond nonwoven fabrics with different areal weights were ultrasonically welded by changing process parameters such as vibration frequency (%-kHz) and welding pressure (bar). The welded samples were evaluated according to the standard test method for seam strength and experimental data obtained from tests were statistically assessed by generating models and regression equations. The best seam strength for polyester nonwovens with different areal weights was achieved with 80% vibration amplitude and 1 bar or 1.5 bar welding pressures. In contrast, ultrasonic welding applied with 0.5 bar welding pressure and 63% or 70% vibration amplitudes resulted in the highest seam strengths for polypropylene nonwovens.
graphiclasso: Graphical lasso for learning sparse inverse-covariance matrices
Authors: Dallakyan Aramayis
Published: October 2022

In modern multivariate statistics, where high-dimensional datasets are ubiquitous, learning large (inverse-) covariance matrices is imperative for data analysis. A popular approach to estimating a large inverse-covariance matrix is to regularize the Gaussian log-likelihood function by imposing a convex penalty function. In a seminal article, Friedman, Hastie, and Tibshirani (2008, Biostatistics 9: 432–441) proposed a graphical lasso (Glasso) algorithm to efficiently estimate sparse inverse-covariance matrices from the convex regularized log-likelihood function. In this article, I first explore the Glasso algorithm and then introduce a new graphiclasso command for the large inverse-covariance matrix estimation. Moreover, I provide a useful command for tuning parameter selection in the Glasso algorithm using the extended Bayesian information criterion, the Akaike information criterion, and cross-validation. I demonstrate the use of Glasso using simulation results and real-world data analysis.
Panel unit-root tests with structural breaks
Authors: Chen Pengyu , Karavias Yiannis , Tzavalis Elias
Published: October 2022

In this article, we introduce a new community-contributed command called xtbunitroot, which implements the panel-data unit-root tests developed by Karavias and Tzavalis (2014, Computational Statistics and Data Analysis 76: 391–407). These tests allow for one or two structural breaks in deterministic components of the series and can be seen as panel-data counterparts of the tests by Zivot and Andrews (1992, Journal of Business and Economic Statistics 10: 251–270) and Lumsdaine and Papell (1997, Review of Economics and Statistics 79: 212–218). The dates of the breaks can be known or unknown. The tests allow for intercepts and linear trends, nonnormal errors, and cross-section heteroskedasticity and dependence. They have power against homogeneous and heterogeneous alternatives and can be applied to panels with small or large time-series dimensions.
Extremity Pressure in Splints Wrapped With an Elastic Bandage Versus Bias Cut Stockinette: An Experimental Model
Authors: Schoenfeldt Theodore L. , Bowman Christine A. , MacConnell Ashley E. , Fishman Felicity G.
Published: October 2022

Background:

Many variables affect the pressure caused by splinting or casting. The purpose of this study was to compare pressure underlying a splint wrapped with either an elastic bandage or a bias cut stockinette.

Methods:

Thirty-two plaster volar resting splints were applied to a simulated extremity with a saline bag secured to it. A pressure transducer was connected to the saline bag to monitor changes in pressure once splints were applied, and 15 mL increments of saline were added to the bag to simulate swelling. Each dressing type was tested with normal application and tight application.

Results:

Normal application splints wrapped with either bias cut stockinette or an elastic bandage demonstrated similar initial splint pressures ( P = .81). With simulated swelling, splints wrapped with bias cut stockinette demonstrated a 15 mmHg (95% confidence interval [CI], 1.5-28.5) higher average pressure than those wrapped with an elastic bandage ( P = .035). Tight application splints with an elastic bandage wrap demonstrated a 46 mmHg (95% CI, 16-77) higher initial splint pressure than those wrapped with bias cut stockinette ( P = .009).

Conclusions:

Splints wrapped using either an elastic bandage or bias cut stockinette appear to have a similar safety profile, although in cases of excessive swelling, an elastic bandage may provide additional compliance. Tight splint application appears to be more hazardous with the use of an elastic bandage compared with a bias cut stockinette. Further study of the use of elastic bandages and bias cut stockinettes in the clinical setting may be warranted.
Research on sliding mode controller of the high-speed maglev train under aerodynamic load
Authors: Liu Mengjuan , Wu Han , Xu Junqi , Zeng Xiaohui , Yin Bo , Hao Zhanzhou
Published: October 2022

The high-speed maglev train will be subjected to extremely obvious aerodynamic load and instantaneous aerodynamic impact during passing another train, which brings significant challenges to the train’s suspension stability and safe operation. It’s necessary to consider the influence of aerodynamic load and shock waves in the design of suspension control algorithms. Traditional proportion integration differentiation (PID) control cannot follow the change of vehicle parameters or external disturbance, which is easy to cause suspension fluctuation and instability. To improve the suspension stability and vibration suppression of the high-speed maglev train under aerodynamic load and impact, we design a siding mode controller introducing the primary suspension’s deformation to replace the aerodynamic load on the electromagnet. Furthermore, we establish the train’s dynamic simulation model with three vehicles and compare the designed controller and the PID controller for their performance in controlling the model suspension stability in the presence of the train operating in open air. Simulation results show that the sliding mode control (SMC) method proposed in this paper can effectively restrain the electromagnet fluctuation of the train under aerodynamic loads.
Isolated popliteal artery lesion due to giant cell vasculitis post COVID-19 mRNA vaccine and COVID-19 asymptomatic infection
Authors: Gabrielli Roberto , Siani Andrea , Smedile Gianluca , Rizzo Anna Rita , De Vivo Gennaro , Accrocca Federico , Bartoli Stefano
Published: October 2022

Objective

Giant cell arteritis (GCA) is a rare granulomatous vasculitis, affecting medium and large vessels, usually in old patients. The incidence of GCA has been higher during current COVID-19 pandemia and COVID-19 is recognized for its immune dysregulation. Lower limbs involvement is uncommon but can be limb threatening, resulting in limb loss.

Method

A 43-year-old man presented with a sudden pain in his right calf and foot associated with pallor and hypothermia, and there was objective evidence of ischemia. Symptoms began few days after he received the first dose of a COVID-19 mRNA vaccine and COVID-19 asymptomatic infection 20 days after vaccination. He had no history of any signs of claudication pre-COVID or limb trauma and was very fit. Enhanced computed tomography and magnetic resonance imaging (MRI)suggest diagnosis of popliteal artery cystic adventitial disease. We resected the affected popliteal artery with interposition using a right great saphenous vein graft, through a posterior approach. On the fourth postoperative day, he was discharged. Histopathological examination revealed patchy intramural inflammatory infiltrates composed of lymphocytes and rare multinucleated giant cells at the internal lamina and adventitia consistent with a diagnosis of GCA.

Conclusion and Result

Our case represents the first reported case of isolated popliteal GCA following vaccination with a COVID-19 mRNA vaccine and COVID-19 infection. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing risk factors and recurrent and repetitive microtrauma in popliteal fossa (the patient is a professional runner). Our case suggests the need for further studies about real world incidence of GCA associated vaccination and COVID-19 infection. Currently, data is limited regarding this relationship. We continue to encourage COVID-19 vaccination, even in elderly patients because the benefits of vaccination far outweigh any theoretical risk of immune dysregulation following administration.
Efficacy and safety of bisphosphonates on childhood osteoporosis secondary to chronic illness or its treatment: a meta-analysis
Authors: Zhao Huawei , Ding Yunfei , Yang Jufei , Luo Yijun , Xu Zhenghao , Miao Jing
Published: October 2022

Background:

Bisphosphonates are a type of medication that prevents the loss of bone density. Secondary childhood osteoporosis reduces bone strength and results in an increased risk of fragility fracture. This meta-analysis aims to explore the efficacy and safety of bisphosphonates on secondary childhood osteoporosis.

Methods:

We performed a systematic search of PubMed, Cochrane library, and Web of Science databases up to 31 July 2022 to screen for random clinical trials (RCTs) on bisphosphonate treatment for childhood secondary osteoporosis. Data from selected studies, mainly changes in lumbar spine (LS) bone mineral density (BMD), changes in LS BMD Z-scores, fracture events, and adverse events (AEs), were extracted and analyzed.

Results:

Nine RCTs ( n = 429 in total) were included in our meta-analysis. The meta-analysis indicated that bisphosphonates improved the changes in LS BMD [mean difference (MD) = 0.04, 95% confidence intervals (CIs) = 0.01–0.07, p < 0.01] and LS BMD Z-scores [MD = 0.52, 95% CI = 0.23–0.81, p < 0.01]. Use of bisphosphonates did not increase the risk of AEs [odds ratio (OR) = 1.61, 95% CI = 0.87–2.99, p = 0.13]. Subgroup analysis showed that routes of administration, but not causes of secondary osteoporosis, might influence the efficacy of bisphosphonates. IV bisphosphonates close to significantly improved the incidence of fracture (OR = 0.34, 95% CI: 0.11–1.08, p = 0.07).

Conclusions:

The use of bisphosphonates improves LS BMD without increasing AE rates, which supports the clinical use of bisphosphonates in secondary childhood osteoporosis. Further large RCTs are still warranted, especially for their long-term effects on fracture rates.
Artificial intelligence healthcare service resources adoption by medical institutions based on TOE framework
Authors: Yang Jinxin , Luo Biao , Zhao Chen , Zhang Hongliang
Published: October 2022

Objectives

This study used the Technology-Organization-Environment (TOE) framework to identify the factors involved in the decisions made by integrated medical and healthcare organizations to adopt artificial intelligence (AI) elderly care service resources.

Method

This study identified the Decision-making Trial and Evaluation Laboratory-Interpretive Structural Modeling (DEMATEL-ISM) method was used to construct a multilayer recursive structural model and to analyze the interrelationships between the levels. A MICMAC quadrant diagram was used for a cluster analysis.

Results

The ISM recursive structural model was divided into a total of seven layers. The bottom layer contained the four factors of High risk of data leakage (T1), Lack of awareness of the value and benefits of AI healthcare technology (T5), Lack of management leadership support (O1), and Government policies (E1). Having a low dependency but high driving force, these factors are the root causes of adoption by healthcare organizations. The topmost layer contained the most direct factors, which had a high dependency but the low driving force, influencing adoption: Competitive pressures (E2), Lack of patient trust (E5), and Lack of excellent partnerships (E7). Healthcare organizations are more concerned with technology and their environments when deciding to adopt intelligent healthcare resources.

Conclusion

The combination of the three methods of DEMATEL-ISM-MICMAC construction models provides new ideas for smart healthcare services for hospitals. The DEMATEL method favors the construction dimension of the micro-model, while the ISM method favors the construction dimension of the macro-model. Combining these two methods may reduce the loss of information within the system, simplify the matrix calculation workload, and improve the efficiency of operations while decomposing the complex problems into several sub-problems in a more comprehensive and detailed way. Conducting cluster analysis of the adoption determinants utilizing MICMAC quadrant diagrams may provide strong methodological guidance and decision-making recommendations for government departments, senior decision-makers in healthcare organizations, and policy-makers in associations in the senior care industry.
Short-term exchange programs in Korean Universities: International student mobility stratified by university mission
Authors: Song Inyoung , Kim Yangson
Published: October 2022

The purpose of this study was to explore the internationalization of higher education institutions by analyzing partnerships of short-term exchange programs among universities in Korea and abroad. Based on data from 3 years (2008, 2013, and 2017), we used descriptive statistics to analyze the inbound and outbound statuses of overseas universities that have established credit exchange agreements with Korean universities. The analysis showed that the major components of short-term mobility in Korean universities are changing, and that credit exchanges among universities differ depending on the universities’ missions. The results suggest that the stratification of universities can affect the extent and quality of the international experiences to which students have access. Using university-level data, we proved that international exchange patterns differ according to the characteristics of universities.
Smart technologies for fighting against pandemics: Observations from China during COVID-19
Authors: Li Weijian , Long Ying
Published: October 2022

In recent years, pandemics have become one of the most significant challenges due to their huge socio-economic impacts. Fortunately, smart technologies have provided new ideas to fight against them. Many studies have focused on analyzing particular technologies applied in pandemics, but few have systematically discussed the difference and the relationship among multiple perspectives. China is well represented in the development of technologies and pandemic responses. Therefore, this paper uses China’s response to COVID-19 as an empirical study to systematically review the application of smart technologies and build a case base from multiple perspectives. A total of 1,102 cases from 14 technologies were collected from January 2020 to June 2020 after screening, and a series of analyses were conducted in terms of types, scales, stages, and targets. The result shows various subjects participated in pandemic responses using smart technologies. General technologies such as Big Data and Mobile Internet are most widely used. Besides, most technologies are used on the country or district/city scales and focus on the prevention and control of pandemics. There are significant differences in the penetration of technologies among different perspectives. We hope to provide a reference for applying smart technologies against pandemics in the future.
Eradication of early MRSA infection in cystic fibrosis: a novel study design for the STAR-ter trial
Authors: Cunningham Fiona , Caldwell Ellen , Mayer-Hamblett Nicole , Goss Christopher H. , Muhlebach Marianne S.
Published: October 2022

Introduction

Early eradication of methicillin-resistantStaphylococcus aureus(MRSA) in cystic fibrosis is desirable. Prospective studies are challenging owing to the feasibility of recruiting patients with a rare event in an orphan disease. Our prior randomised study (Staph AureusResistance-Treat Or Observe (STAR-too)) showed improved clearance and outcomes with aggressive therapy compared to no treatment. We present a novel trial design to guide treatment for eradicating incident infection with a focus on feasibility.

Methods

Subjects with cystic fibrosis with incident MRSA infection were enrolled into theStaph AureusResistance-Treat Early And Repeat (STAR-ter) protocol and treated with a combination of an oral antibiotic and topical (nare and throat) decolonisation. The primary outcome was MRSA-negative respiratory culture at Day 28,i.e.14 days after completion of oral antibiotics. What was novel about this study design was that the control/comparator group was the untreated group of the STAR-too trial. This design was developed because having a “no treatment” group would be unethical given prior findings and a superiority design would delay the time to results based on small numbers of eligible subjects. Both studies used the same inclusion and exclusion criteria and drew subjects from the same geographic regions. The main difference between the studies was the use of a single oral antibiotic, trimethoprim-sulfamethoxazole, rather than the combination with oral rifampin used in STAR-too.

Discussion

An innovative approach to address a clinical question for a rare event in an orphan disease, cystic fibrosis, is presented to enhance current clinical evidence to guide cystic fibrosis care in relation to new MRSA infection.
Validation of a small cough detector
Authors: Kuhn Manuel , Nalbant Elif , Kohlbrenner Dario , Alge Mitja , Kuett Laura , Arvaji Alexandra , Sievi Noriane A. , Russi Erich W. , Clarenbach Christian F.
Published: October 2022

Research question

The assessment of cough frequency in clinical practice relies predominantly on the patient's history. Currently, objective evaluation of cough is feasible with bulky equipment during a brief time (i.e.hours up to 1 day). Thus, monitoring of cough has been rarely performed outside clinical studies. We developed a small wearable cough detector (SIVA-P3) that uses deep neural networks for the automatic counting of coughs. This study examined the performance of the SIVA-P3 in an outpatient setting.

Methods

We recorded cough epochs with SIVA-P3 over eight consecutive days in patients suffering from chronic cough. During the first 24 h, the detector was validated against cough events counted by trained human listeners. The wearing comfort and the device usage were assessed using a questionnaire.

Results

In total, 27 participants (mean±sdage 50±14 years) with either chronic unexplained cough (n=12), COPD (n=4), asthma (n=5) or interstitial lung disease (n=6) were studied. During the daytime, the sensitivity of SIVA-P3 cough detection was 88.5±2.49% and the specificity was 99.97±0.01%. During the night-time, the sensitivity was 84.15±5.04% and the specificity was 99.97±0.02%. The wearing comfort and usage of the device was rated as very high by most participants.

Conclusion

SIVA-P3 enables automatic continuous cough monitoring in an outpatient setting for objective assessment of cough over days and weeks. It shows comparable sensitivity or higher sensitivity than other devices with fully automatic cough counting. Thanks to its wearing comfort and the high performance for cough detection, it has the potential for being used in routine clinical practice.
Relevance of comorbidities on initial combination therapy in pulmonary arterial hypertension
Authors: Badagliacca Roberto , D'Alto Michele , Ghio Stefano , Argiento Paola , Brunetti Natale Daniele , Casu Gavino , Cedrone Nadia , Confalonieri Marco , Corda Marco , Correale Michele , D'Agostino Carlo , De Michele Lucrezia , Di Marino Serena , Filomena Domenico , Galgano Giuseppe , Greco Alessandra , Lombardi Carlo , Manzi Giovanna , Mercurio Valentina , Mulè Massimiliano , Paciocco Giuseppe , Papa Silvia , Romeo Emanuele , Scelsi Laura , Stolfo Davide , Vitulo Patrizio , Vizza Carmine Dario
Published: October 2022

Rationale

Demographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.

Methods

The study enrolled 181 treatment-naive PAH patients with a 6-month (IQR 144–363 days) right heart catheterisation and risk assessment after initial oral combination therapy.

Results

Group A included 96 (53.0%) patients without cardiac comorbidities; Group B included 54 (29.8%) patients with one cardiac comorbidity; Group C included 31 (17.1%) patients with two cardiac comorbidities or more. Group C patients were older with a balanced sex distribution. There was a significant difference in PVR reduction moving from the absence to one or at least two cardiac comorbidities, respectively: median −45.0%, −30.3%, −24.3%. A European Respiratory Society/European Society of Cardiology low-risk status was present at first follow-up in 50 (52.0%) patients in Group A, 19 (35.1%) in Group B and 9 (29.0%) in Group C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group A, 15 (27.7%) in Group B and 7 (22.6%) in Group C. Group A patients were 2.3 times more likely to achieve/maintain a low-risk status compared with Group B and C (OR 2.27, 95% CI 1.15–4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.

Conclusion

Initial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment-induced decrease in PVR.
A simplified multiplex methylated DNA testing for early detection of colorectal cancer in stool DNA
Authors: Dai Yanmiao , Zhao Guodong , Yang Jun , Zhou Xilang , Xiong Shangmin , Lu Xirong , Gao Liming , Wu Jianfang , Xu Zouhua , Fei Sujuan , Zheng Minxue , Xu Hongwei
Published: October 2022

Background

ColoDefense1.0 assay has demonstrated its excellent sensitivity and specificity for early detection of colorectal cancer (CRC) by detecting the methylation levels of SDC2 and SEPT9, while exhibited limitations on relatively large sample capacity required and limited detection throughput by applying triplicate PCR reactions for each sample. In this study, ColoDefense1.0 was simplified and optimized into ColoDefense2.0 in a single PCR reaction.

Methods

A total 529 stool specimens were collected, and 244 CRC patients, 34 patients with advanced adenomas (AA), 64 with small polyps (SP) and 187 control subjects were divided in training and validation cohorts. Methylation levels of SEPT9 and SDC2 were examined by qPCR reactions in triplicate or single.

Results

The stool DNA quantity stored in preservative buffer at 37 °C up to 7 days exhibited no significant decrease. In the training cohort, when the number of replicates reduced from 3 to 1, the overall performance of ColoDefense2.0 was identical to that of ColoDefense1.0, showing sensitivities of 71.4% for AA and 90.8% for all stage CRC with a specificity of 92.9%. In the validation cohort, sensitivities of SP, AA and CRC using ColoDefense2.0 were 25.0%, 55.0% and 88.2%, increased from 14.1% (20.3%), 40.0% (40.0%) and 79.4% (67.6%) using SDC2 (SEPT9) alone; along with an overall specificity of 90.2%, decreased from 94.1% (95.1%) using SDC2 (SEPT9) alone.

Conclusion

The simplified ColoDefense test maintained the overall performance while reduced the number of PCR reactions to 1/3, and provided an effective and convenient tool to detect early CRC and precancerous lesions and potentially improve the compliance of screening.
Salivary microbiome in children with Down syndrome: a case-control study
Authors: Morishima Seiji , Takeda Kaori , Greenan Setsue , Maki Yoshinobu
Published: October 2022

Background

Down syndrome (DS), a most frequently occurring genetic disorder, is associated with oral morphological abnormalities and higher incidence rates of oral diseases. Recent studies have analyzed the oral microbiome to elucidate their relationships with oral diseases and general health; however, reports on the oral microbiome in individuals with DS are scarce. This study aimed to characterize the oral microbiome in children with DS.

Methods

A total of 54 children aged 1–13 years were enrolled in this case-control study. Of these children, 27 had DS (Case: DS group) and 27 were age-matched healthy children (Control: ND group). Saliva in the oral cavity was collected with a swab, cultured, and tested for cariogenic and periodontopathic bacteria by quantitative polymerase chain reaction (qPCR) detection, and the salivary microbiome was analyzed using next-generation sequencing. The student’st-test, Fisher’s exact test, Mann–WhitneyUtest, and permutational multivariate analysis of variance were used for statistical analysis.

Results

Results of culture and qPCR detection tests for cariogenic and periodontopathic bacteria showed no significant differences in the detected bacteria between the DS and ND groups, with the exception of a significantly higher detection rate ofCandida albicansin children with DS with mixed dentition. A comparison of the salivary microbiomes by 16S sequencing showed no significant difference in α diversity; however, it showed a significant difference in β diversity. Children with DS had a higher relative abundance ofCorynebacteriumandCardiobacterium, and lower relative abundance of TM7.

Conclusions

This study provided basic data on the salivary microbiome of children with DS and showed the microbiological markers peculiar to children with DS. However, further research to identify the relationship with oral diseases is warranted.
Flaws in advance directives that request withdrawing assisted feeding in late-stage dementia may cause premature or prolonged dying
Authors: Terman Stanley A. , Steinberg Karl E. , Hinerman Nathaniel
Published: October 2022

Background

The terminal illness of late-stage (advanced) Alzheimer’s and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. Options to avoid prolonged dying are limited since advanced dementia patients cannot qualify for Medical Aid in Dying. Physicians and judges can insist on clear and convincing evidence that the patient wants to die—which many advance directives cannot provide. Proxies/agents’ substituted judgment may not be concordant with patients’ requests. While advance directives can be patients’ last resort to attain a peaceful and timely dying consistent with their lifelong values, success depends on their being effective and acceptable. A single flaw can provide opponents justification to refuse the directive’s requests to cease assisted feeding.

Aim

This article considers 24 common advance directive flaws in four categories.Process flawsfocus on how patients express their end-of-life wishes.Content flawsreflect drafters’ selection of conditions and interventions, and how they are described.Inherent flawscan make advance directives unacceptable to authorities concerned about premature dying.Strategiesare needed to compel physicians to write needed orders and to prevent third parties from sabotaging these orders after they are  implemented. The article includes excerpts from “dementia-specific” directives or supplements that exemplify each flaw—mostly from the US and Europe. No directive critiqued here included an effectivestrategyto resolve this long-debated bioethical conflict: the past directive requests “Cease assisted feeding” but the incapacitated patient apparently expresses the desire to “Continue assisted feeding.” Some opponents to the controversial request, cease assisted feeding, use this conflict as a conceptual wedge to practice hard paternalism. This article proposes a protocol to prevent this conflict from emerging. These strategies may prevent authorities from requiring patients to fulfillauthorities’additional clinical criteria as a prerequisite to honor the requests in patients directives.

Conclusion

This critique of flaws may serve as a guide to drafting and to selecting effective and acceptable advance directives for dementia. It also poses several bioethical and clinical questions to those in authority: Does your paternalistic refusal to honor patients’ wishes respect their self-determination? Protect vulnerable patients from harm? Force patients to endure prolonged suffering? Violate the principles of bioethics? Violate the very foundation of patient-centered care?
Lipid metabolic features of T cells in the Tumor Microenvironment
Authors: Lou Wanshuang , Gong Chaoju , Ye Zhuoni , Hu Ynayan , Zhu Minjing , Fang Zejun , Xu Huihui
Published: October 2022

The tumor microenvironment (TME) is characterized by discrete changes in metabolic features of cancer and immune cells, with various implications. Cancer cells take up most of the available glucose to support their growth, thereby leaving immune cells with insufficient nutrients to expand. In the relative absence of glucose, T cells switch the metabolic program to lipid-based sources, which is pivotal to T-cell differentiation and activation in nutrient-stressed TME. Although consumption of lipids should provide an alternative energy source to starving T cells, a literature survey has revealed that it may not necessarily lead to antitumor responses. Different subtypes of T cells behave differently in various lipid overload states, which widely depends upon the kind of free fatty acids (FFA) engulfed. Key lipid metabolic genes provide cytotoxic T cells with necessary nutrients for proliferation in the absence of glucose, thereby favoring antitumor immunity, but the same genes cause immune evasion in Tmem and Treg. This review aims to detail the complexity of differential lipid metabolism in distinct subtypes of T cells that drive the antitumor or pro-tumor immunity in specific TME states. We have identified key drug targets related to lipid metabolic rewiring in TME.
An ex-ante cost-utility analysis of the deemed consent legislation compared to expressed consent for kidney transplantations in Nova Scotia
Authors: Koto Prosper , Tennankore Karthik , Vinson Amanda , Krmpotic Kristina , Weiss Matthew J. , Theriault Chris , Beed Stephen
Published: October 2022

Background

This study was an ex-ante cost-utility analysis of deemed consent legislation for deceased organ donation in Nova Scotia, a province in Canada. The legislation became effective in January 2021. The study's objective was to assess the conditions necessary for the legislation change’s cost-effectiveness compared to expressed consent, focusing on kidney transplantation (KT).

Method

We performed a cost-utility analysis using a Markov model with a lifetime horizon. The study was from a Canadian payer perspective. The target population was patients with end-stage kidney disease (ESKD) in Atlantic Canada waitlisted for KT. The intervention was the deemed consent and accompanying health system transformations. Expressed consent (before the change) was the comparator. We simulated the minimum required increase in deceased donor KT per year for the cost-effectiveness of the deemed consent. We also evaluated how changes in dialysis and maintenance immunosuppressant drug costs and living donor KT per year impacted cost-effectiveness in sensitivity analyses.

Results

The expected lifetime cost of an ESKD patient ranged from $177,663 to $553,897. In the deemed consent environment, the expected lifetime cost per patient depended on the percentage increases in the proportion of ESKD patients on the waitlist getting a KT in a year. The incremental cost-utility ratio (ICUR) increased with deceased donor KT per year. Cost-effectiveness of deemed consent compared to expressed consent required a minimum of a 1% increase in deceased donor KT per year. A 1% increase was associated with an ICUR of $32,629 per QALY (95% CI: − $64,279, $232,488) with a 81% probability of being cost-effective if the willingness-to-pay (WTP) was $61,466. Increases in dialysis and post-KT maintenance immunosuppressant drug costs above a threshold impacted value for money. The threshold for immunosuppressant drug costs also depended on the percent increases in deceased donor KT probability and the WTP threshold.

Conclusions

The deemed consent legislation in NS for deceased organ donation and the accompanying health system transformations are cost-effective to the extent that they are anticipated to contribute to more deceased donor KTs than before, and even a small increase in the proportion of waitlist patients receiving a deceased donor KT than before the change represents value for money.
Neuroinflammatory transcriptional programs induced in rhesus pre-frontal cortex white matter during acute SHIV infection
Authors: Hawes Chase E. , Elizaldi Sonny R. , Beckman Danielle , Diniz Giovanne B. , Shaan Lakshmanappa Yashavanth , Ott Sean , Durbin-Johnson Blythe P. , Dinasarapu Ashok R. , Gompers Andrea , Morrison John H. , Iyer Smita S.
Published: October 2022

Background

Immunosurveillance of the central nervous system (CNS) is vital to resolve infection and injury. However, immune activation within the CNS in the setting of chronic viral infections, such as HIV-1, is strongly linked to progressive neurodegeneration and cognitive decline. Establishment of HIV-1 in the CNS early following infection underscores the need to delineate features of acute CNS immune activation, as these early inflammatory events may mediate neurodegenerative processes. Here, we focused on elucidating molecular programs of neuroinflammation in brain regions based on vulnerability to neuroAIDS and/or neurocognitive decline. To this end, we assessed transcriptional profiles within the subcortical white matter of the pre-frontal cortex (PFCw), as well as synapse dense regions from hippocampus, superior temporal cortex, and caudate nucleus, in rhesus macaques following infection with Simian/Human Immunodeficiency Virus (SHIV.C.CH505).

Methods

We performed RNA extraction and sequenced RNA isolated from 3 mm brain punches. Viral RNA was quantified in the brain and cerebrospinal fluid by RT-qPCR assays targeting SIV Gag. Neuroinflammation was assessed by flow cytometry and multiplex ELISA assays.

Results

RNA sequencing and flow cytometry data demonstrated immune surveillance of the rhesus CNS by innate and adaptive immune cells during homeostasis. Following SHIV infection, viral entry and integration within multiple brain regions demonstrated vulnerabilities of key cognitive and motor function brain regions to HIV-1 during the acute phase of infection. SHIV-induced transcriptional alterations were concentrated to the PFCw and STS with upregulation of gene expression pathways controlling innate and T-cell inflammatory responses. Within the PFCw, gene modules regulating microglial activation and T cell differentiation were induced at 28 days post-SHIV infection, with evidence for stimulation of immune effector programs characteristic of neuroinflammation. Furthermore, enrichment of pathways regulating mitochondrial respiratory capacity, synapse assembly, and oxidative and endoplasmic reticulum stress were observed. These acute neuroinflammatory features were substantiated by increased influx of activated T cells into the CNS.

Conclusions

Our data show pervasive immune surveillance of the rhesus CNS at homeostasis and reveal perturbations of important immune, neuronal, and synaptic pathways within key anatomic regions controlling cognition and motor function during acute HIV infection. These findings provide a valuable framework to understand early molecular features of HIV associated neurodegeneration.