bluuebunny/crossref_metadata_2025 huggingface dataset:
Nomogram for Predicting the Prognoses of Patients With Pancreatic Head Cancer After Pancreaticoduodenectomy: A Population-Based Study on SEER Data
Authors: Zhang Wei , Xu Lin , Che Xu
Published: November 2021

Objective

In this study, we retrieved the data available in the Surveillance, Epidemiology, and End Results database to identify the prognostic factors for patients with pancreatic head cancer who had undergone pancreaticoduodenectomy and developed a prediction model for clinical reference.

Methods

We screened the data between 1973 and 2015. Propensity score matching (PSM) was used to control for the confounding factors. Kaplan-Meier (log-rank test) curves were used to compare the survival rates. A nomogram was established using multifactorial Cox regression.

Results

In total, 4099 patients were identified. Their median survival was 22 months, with 74.2%, 36.5%, and 26.2% survival after 1, 3, and 5 years, respectively. The median cancer-specific survival was 24.0 months, with 71.1%, 32.6%, and 21.9% survival after 1, 3, and 5 years, respectively. The results of the Cox proportional risk regression showed that age, insurance status, gender, histological type, degree of tissue differentiation, T and N stages, tumor size, extent of regional lymph node dissection, and postoperative radiotherapy or chemotherapy are independent factors affecting prognosis. PSM was used twice to eliminate any bias from the unbalanced covariates in the raw data. After PSM, the patients who had received postoperative radiotherapy were found to have a better survival prognosis and disease-specific survival prognosis than those who had not received radiotherapy [HR = 0.809, 95% CI (0.731–0.894), P < 0.001 and HR = 0.814, 95% CI (0.732–0.904), P < 0.001; respectively]. A similar result was observed for the patients who had received postoperative chemotherapy versus those who had not [HR = 0.703, 95% CI (0.633–0.78), P < 0.001 and HR = 0.736, 95% CI (0.658–0.822), P < 0.001, for survival and disease-specific survival prognoses, respectively]. Finally, the β coefficients of the Cox proportional risk regression were used to establish a nomogram.

Conclusion

Age, insurance status, gender, histological type, degree of differentiation, T and N stages, tumor size, regional lymph node dissection, and postoperative radiotherapy or chemotherapy are factors affecting the prognosis in pancreatic head cancer after pancreaticoduodenectomy. Postoperative radiotherapy and chemotherapy can improve patient survival. These still need to be further validated in the future.
Is There a Neuropathic-Like Component to Endometriosis-Associated Pain? Results From a Large Cohort Questionnaire Study
Authors: Coxon Lydia , Wiech Katja , Vincent Katy
Published: November 2021

Background: Pain is one of the primary symptoms of endometriosis, a chronic inflammatory condition characterised by the presence of endometrial tissue outside the uterus. Endometriosis-associated pain is commonly considered as nociceptive in nature, but its clinical presentation suggests that it might have neuropathic-like properties in a subgroup of patients.

Methods: This is a cross sectional study using an online survey. The survey was distributed by patient support websites. The survey was composed of validated questionnaires assessing pain symptoms, psychological measures and questions about number of surgeries.

Main Results: We had 1,417 responses which met the inclusion criteria. Using standard painDETECT cut-off scores, we found that pain was classified as neuropathic in 40% of patients and as mixed neuropathic/nociceptive in a further 35%. In line with observations in other neuropathic conditions, the neuropathic subgroup reported higher pain intensities, greater psychological distress and cognitive impairment. Neuropathic pain was also more likely in those with more surgeries to the abdomen and a longer history of pain. As revealed by a cluster analysis, those with a neuropathic pain component could further be divided into two subgroups based on their sensory profile.

Conclusions: The data presented here indicate that endometriosis-associated pain includes a neuropathic-like component in a substantial proportion of women. Although further investigation is required, our finding challenges the current conceptualisation of endometriosis-associated pain as nociceptive and advocates for a new perspective on this type of pain, which is so debilitating to a large number of women.
The Efficacy of Acupuncture on Tic Disorders in Children: A Retrospective and Propensity Score-Matched Study
Authors: You Hai-Zhen , Zhou Yi-Fang , Yu Ping-Bo , Xie Jing , Chen Jia , Li Ji-Jun , Wang Guang-Hai , Sun Ke-Xing
Published: November 2021

Background : Acupuncture has been considered as a complementary or alternative therapy for children with tic disorders (TD), but its efficacy remains largely unknown. This study retrospectively examined the efficacy of acupuncture treatment for TD in children over the course of 12 weeks.

Methods: Data were collected from Traditional Chinese Medicine clinics in a public pediatric hospital in Shanghai between June 2020 and March 2021. A total of 250 patients with TD were included in the study, with 122 patients exposed to acupuncture therapy combined with conventional treatment (observation group), and 128 patients exposed to conventional treatment alone (control group). Propensity score matching analyses were used to balance baseline characteristics, resulting in 78 matched patients for each group. Reductions in the Yale Global Tic Severity Scale (YGTSS) total score were analyzed in the two groups after 12 weeks of treatment.

Results: The two groups reached equilibrium in terms of baseline demographic characteristics and YGTSS total score after the propensity score matching (P > 0.05). Compared to the control group, the reduction in the YGTSS total score after 12 weeks of treatment was greater for the observation group (OR = 2.94, 95% CI: 1.03, 8.39, P = 0.04), and this association was stronger for patients who had significant vocal tics (β = 0.29, 95% CI: 0.88, 2.68, P = 0.001). The clinical efficacy for the observation group was significantly better than the control group.

Conclusions: We provided preliminary evidence supporting the therapeutic effect of acupuncture for TD in children. Hence, our findings indicate that acupuncture could be an adjuvant treatment efficacious for TD in children, especially for vocal tics.
Short-Term Efficacy and Safety Outcomes of Brolucizumab in the Real-Life Clinical Practice
Authors: Montesel Andrea , Bucolo Claudio , Sallo Ferenc B. , Eandi Chiara M.
Published: November 2021

To report the early efficacy and safety outcomes of treatment with intravitreal injections of brolucizumab (IVT-B) in patients presenting neovascular age-related macular degeneration (nAMD) in a tertiary clinical setting. A retrospective case series of patients that received IVT-B with a minimum of two injections performed and at least 4 weeks of follow-up after last injection. Nineteen eyes of 19 patients were included. The number of IVT-B performed for the whole cohort was 58 injections; the mean number of IVT-B per patient was 3.0 ± 1.0 (range 2–6); the mean follow-up time was 14.4 ± 9.0 weeks. Mean baseline best-corrected visual acuity was 0.4 ± 0.4 logMAR and at the last follow-up was 0.4 ± 0.6 logMAR (p = 0.778). All eyes showed a reduction in retinal thickness, with the central macular thickness being 470 ± 151 μm at baseline and 360 ± 144 μm at the last follow-up (p = 0.001). Intra-retinal fluid was present at baseline in 12 eyes (63%) and in three eyes (16%) at the last follow-up (p = 0.065). Sub-retinal fluid was present at baseline in 17 eyes (89%) and at the last follow-up in three eyes (16%, p = 0.011). Pigment epithelium detachment was apparent in the 16 eyes (84%) at baseline and was still present in 14 eyes (73%, p = 0.811). One adverse event of intraocular inflammation was reported. In conclusion, our short-term experience showed that brolucizumab was highly effective in restoring the anatomy and in stabilizing the visual acuity of eyes with nAMD. Its safety profile should be evaluated carefully and needs further investigations.
Paeoniflorin Suppresses TBHP-Induced Oxidative Stress and Apoptosis in Human Umbilical Vein Endothelial Cells via the Nrf2/HO-1 Signaling Pathway and Improves Skin Flap Survival
Authors: Jiang Jingtao , Dong Chengji , Zhai Liang , Lou Junsheng , Jin Jie , Cheng Sheng , Chen Zhuliu , Guo Xiaoshan , Lin Damu , Ding Jian , Gao Weiyang
Published: November 2021

Random-pattern skin flap is a vital technique frequently applied in reconstruction surgeries for its convenience and effectiveness in solving skin defects. However, ischemic necrosis, especially in the distal areas of the flap, still needs extra attention after surgery. Earlier evidence has suggested that paeoniflorin (PF) could stimulate angiogenesis and suppress ischemic cardiovascular disease. However, few studies have focused on the role of PF in flap survival. In this study, we have demonstrated that the human umbilical vein endothelial cells (HUVECs) treated with PF can alleviate tert-butyl hydroperoxide (TBHP)-stimulated cellular dysfunction and apoptosis. To better evaluate, HUVECs’ physiology, cell tube formation, migration, and adhesion were assessed. Mechanistically, PF protects HUVECs against apoptosis via stimulating the nuclear factor (erythroid-derived 2)-like 2 (Nrf2)/heme oxygenase 1 (HO-1) pathway. PF also downregulates mitochondrial ROS production to reduce excessive intracellular ROS production induced by TBHP and restore TBHP-induced mitochondrial depolarization. As a result, silencing Nrf2 partially abolishes the protective effect of PF exposure on HUVECs. In in vivo experiments, the oral administration of PF was shown to have enhanced the vascularization of regenerated tissues and promote flap survival. However, the PF-mediated protection was partially lost after co-treatment with ML385, a selective Nrf2 inhibitor, suggesting that PF is a crucial modulator regulating the Nrf2/HO-1 signaling pathway. In summary, our data have provided a new insight into PF as a potential therapy for enhancing random-pattern flap viability.
Alhagi pseudalhagi Extract Exerts Protective Effects Against Intestinal Inflammation in Ulcerative Colitis by Affecting TLR4-Dependent NF-κB Signaling Pathways
Authors: Xu Xiaoqin , Zhang Juan , Chen Liang , Sun Yu , Qing Degang , Xin Xuelei , Yan Chunyan
Published: November 2021

Alhagi pseudalhagi Desv. Extract (APE) is the major active fraction extracted from the aerial part of Alhagi pseudalhagi Desv. In view of its application in Uyghur medicine, it may be beneficial for the treatment of ulcerative colitis (UC). The aim of the present study was to investigate the possible beneficial effects of APE on UC mice and detect the possible mechanisms underlying these effects.

Methods: An acute UC model was established in mice using dextran sulfate sodium. Sixty mice were randomly divided into six groups: normal, UC model, sulfasalazine (200 mg/kg), high-dose APE (APE-H, 2.82 g/kg), middle-dose APE (APE-M, 1.41 g/kg), and low-dose APE (APE-L, 0.70 g/kg) groups. Drugs were administered by gavage for 10 days after the induction of colitis. Serum and colon tissue samples were collected from the mice during the experiment, and survival signs, body weight changes, disease activity index (DAI), colon length, and colon wet weight in mice were determined after the treatment. UC-induced damage, including inflammation and ulceration of colon mucosa, were observed by the naked eye as well as using hematoxylin and eosin staining (H&E) and scanning electron microscopy and scored according to Wallace and Keean’s criteria. We measured the levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 in the serum and colon tissues using ELISA. Additionally, the relative protein levels of toll-like receptor 4 (TLR4), nuclear factor-kappa B p65 (NF-κB p65), phosphorylated NF-κB p65 at Ser536 (p-p65 Ser536), inhibitor kappa B-kinase ß (IK-Kβ), and phosphorylated IK-Kβ (Ser176/180) (p-IK-Kβ) in colonic mucosal epithelial tissues were detected using western blotting. The main functional components of APE were analyzed and confirmed by UPLC-MS/MS.

Results: APE treatment repaired the UC-induced colon mucosa injury, reduced the weight loss, attenuated DAI, colon macroscopic damage index, and histological inflammation, and significantly downregulated the levels of inflammatory markers, including TNF-α, IL-1β, and IL-6, in the serum and colon tissues. Additionally, APE treatment reduced the levels of TLR4 and phosphorylation of p-NF-κB and p-IK-Kβ. The main components of APE are taxifolin, 3,5-dihydroxy-2-(4-hydroxyphenyl)-7-[(2R,3R,4S,5S,6R)-3,4,5-trihydroxy-6-(hydroxymethyl) oxan-2-yl] oxychromen-4-one, hyperoside, rutin, kaempferol, isorhamnetin, 7,8-dihydroxyflavone, and kaempferide.

Conclusions: To the best of our knowledge, the present study is first to demonstrate that APE exerts a protective effect against intestinal inflammation in UC by affecting TLR4-dependent NF-κB signaling pathways.
Postural Adjustments and Biomechanics During Gait Initiation and Obstacle Negotiation: A Comparison Between Akinetic-Rigid and Hyperkinetic Parkinson’s Disease
Authors: Casal Marcela Zimmermann , Peyré-Tartaruga Leonardo Alexandre , Zanardi Ana Paula Janner , Ivaniski-Mello André , Alves Lucas de Liz , Haas Aline Nogueira , Martinez Flávia Gomes
Published: November 2021

Background: Individuals with Parkinson’s disease (PD) exhibit different combinations of motor symptoms. The most frequent subtypes are akinetic-rigid (AK-R) and hyperkinetic (HYP). Motor symptoms, such as rigidity and bradykinesia, can directly affect postural adjustments and performance in daily tasks, like gait initiation and obstacles negotiation, increasing the risk of falls and functional dependence.

Objective: To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls.

Methods: Cross-sectional study. Thirty-three volunteers with PD were divided into two groups according to clinical motor manifestations: AK-R (n = 16) and HYP (n = 17). We assessed the anticipatory (APA), compensatory (CPA) postural adjustments analyzing kinematic, kinetic and, electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent T-tests and Pearson correlation tests for comparisons and correlations, respectively (α = 0.05).

Results: In the APA phase of the gait initiation test, compared to the functional HYP group, the AK-R group showed shorter time for single support (p = 0.01), longer time for double support (p = 0.01) accompanied by a smaller first step (size, p = 0.05; height, p = 0.04), and reduced muscle activation of obliquus internus (p = 0.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height (p = 0.01) and hip excursion (p = 0.02), accompanied by a reduced mediolateral displacement of the center of pressure (p = 0.02) during APA, and activation of the gluteus medius (p = 0.02) and the anterior tibialis (p = 0.04) during CPA in comparison with HYP group.

Conclusion: The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacles negotiation compared to hyperkinetic PD. Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights onto PD motor evaluation and neurorehabilitation.
Inspiratory Muscle Training for Obstructive Sleep Apnea: Protocol Development and Feasibility of Home Practice by Sedentary Adults
Authors: Krause-Sorio Beatrix , An Eunjoo , Aguila Andrea P. , Martinez Fernando , Aysola Ravi S. , Macey Paul M.
Published: November 2021

Background: Inspiratory muscle training (IMT) may improve respiratory and cardiovascular functions in obstructive sleep apnea (OSA) and is a potential alternative or adjunct treatment to continuous positive airway pressure (CPAP). IMT protocols were originally designed for athletes, however, we found some OSA patients could not perform the exercise, so we aimed for a more OSA-friendly protocol. Our feasibility criteria included (1) participants successfully managing the technique at home; (2) participants completing daily practice sessions and recording data logs; and (3) capturing performance plateaus to determine an optimal length of the intervention.

Methods: Five sedentary OSA patients participated in this feasibility study (three men, mean age = 61.6 years, SD = 10.2). Using a digital POWERbreathe K4 or K5 device, participants performed 30 daily inhalations against a resistance set at a percentage of maximum, recalculated weekly. Participants were willing to perform one but not two daily practice sessions. Intervention parameters from common IMT protocols were adapted according to ability and subjective feedback. Some were unable to perform the typically used 75% of maximum inspiratory resistance so we lowered the target to 65%. The technique required some practice; therefore, we introduced a practice week with a 50% target. After an initial 8 weeks, the intervention was open-ended and training continued until all participants demonstrated at least one plateau of inspiratory strength (2 weeks without strength gain). Weekly email and phone reminders ensured that participants completed all daily sessions and logged data in their online surveys. Weekly measures of inspiratory resistance, strength, volume, and flow were recorded.

Results: Participants successfully completed the practice and subsequent 65% IMT resistance targets daily for 13 weeks. Inspiratory strength gains showed plateaus in all subjects by the end of 10 weeks of training, suggesting 12 weeks plus practice would be sufficient to achieve and capture maximum gains. Participants reported no adverse effects.

Conclusion: We developed and tested a 13-week IMT protocol in a small group of sedentary, untreated OSA patients. Relative to other IMT protocols, we successfully implemented reduced performance requirements, a practice week, and an extended timeframe. This feasibility study provides the basis for a protocol for clinical trials on IMT in OSA.
High-Elevation Populations of Montane Grasshoppers Exhibit Greater Developmental Plasticity in Response to Seasonal Cues
Authors: Smith Julia M. , Telemeco Rory S. , Briones Ortiz Bryan A. , Nufio César R. , Buckley Lauren B.
Published: November 2021

Populations of insects can differ in how sensitive their development, growth, and performance are to environmental conditions such as temperature and daylength. The environmental sensitivity of development can alter phenology (seasonal timing) and ecology. Warming accelerates development of most populations. However, high-elevation and season-limited populations can exhibit developmental plasticity to either advance or prolong development depending on conditions. We examine how diurnal temperature variation and daylength interact to shape growth, development, and performance of several populations of the montane grasshopper, Melanoplus boulderensis, along an elevation gradient. We then compare these experimental results to observed patterns of development in the field. Although populations exhibited similar thermal sensitivities of development under long-day conditions, development of high-elevation populations was more sensitive to temperature under short-day conditions. This developmental plasticity resulted in rapid development of high elevation populations in short-day conditions with high temperature variability, consistent with their observed capacity for rapid development in the field when conditions are permissive early in the season. Notably, accelerated development generally did not decrease body size or alter body shape. Developmental conditions did not strongly influence thermal tolerance but altered the temperature dependence of performance in difficult-to-predict ways. In sum, the high-elevation and season-limited populations exhibited developmental plasticity that enables advancing or prolonging development consistent with field phenology. Our results suggest these patterns are driven by the thermal sensitivity of development increasing when days are short early in the season compared to when days are long later in the season. Developmental plasticity will shape phenological responses to climate change with potential implications for community and ecosystem structure.
Revisiting Why Plants Become N Deficient Under Elevated CO2: Importance to Meet N Demand Regardless of the Fed-Form
Authors: Igarashi Maaya , Yi Yan , Yano Katsuya
Published: November 2021

An increase in plant biomass under elevated CO2 (eCO2) is usually lower than expected. N-deficiency induced by eCO2 is often considered to be a reason for this. Several hypotheses explain the induced N-deficiency: (1) eCO2 inhibits nitrate assimilation, (2) eCO2 lowers nitrate acquisition due to reduced transpiration, or (3) eCO2 reduces plant N concentration with increased biomass. We tested them using C3 (wheat, rice, and potato) and C4 plants (guinea grass, and Amaranthus) grown in chambers at 400 (ambient CO2, aCO2) or 800 (eCO2) μL L−1 CO2. In most species, we could not confirm hypothesis (1) with the measurements of plant nitrate accumulation in each organ. The exception was rice showing a slight inhibition of nitrate assimilation at eCO2, but the biomass was similar between the nitrate and urea-fed plants. Contrary to hypothesis (2), eCO2 did not decrease plant nitrate acquisition despite reduced transpiration because of enhanced nitrate acquisition per unit transpiration in all species. Comparing to aCO2, eCO2 remarkably enhanced water-use efficiency, especially in C3 plants, decreasing water demand for CO2 acquisition. As our results supported hypothesis (3) without any exception, we then examined if lowered N concentration at eCO2 indeed limits the growth using C3 wheat and C4 guinea grass under various levels of nitrate-N supply. While eCO2 significantly increased relative growth rate (RGR) in wheat but not in guinea grass, each species increased RGR with higher N supply and then reached a maximum as no longer N was limited. To achieve the maximum RGR, wheat required a 1.3-fold N supply at eCO2 than aCO2 with 2.2-fold biomass. However, the N requirement by guinea grass was less affected by the eCO2 treatment. The results reveal that accelerated RGR by eCO2 could create a demand for more N, especially in the leaf sheath rather than the leaf blade in wheat, causing N-limitation unless the additional N was supplied. We concluded that eCO2 amplifies N-limitation due to accelerated growth rate rather than inhibited nitrate assimilation or acquisition. Our results suggest that plant growth under higher CO2 will become more dependent on N but less dependent on water to acquire both CO2 and N.
Mask, Train, Repeat! Artificial Intelligence for Quantitative Wood Anatomy
Authors: Resente Giulia , Gillert Alexander , Trouillier Mario , Anadon-Rosell Alba , Peters Richard L. , von Arx Georg , von Lukas Uwe , Wilmking Martin
Published: November 2021

The recent developments in artificial intelligence have the potential to facilitate new research methods in ecology. Especially Deep Convolutional Neural Networks (DCNNs) have been shown to outperform other approaches in automatic image analyses. Here we apply a DCNN to facilitate quantitative wood anatomical (QWA) analyses, where the main challenges reside in the detection of a high number of cells, in the intrinsic variability of wood anatomical features, and in the sample quality. To properly classify and interpret features within the images, DCNNs need to undergo a training stage. We performed the training with images from transversal wood anatomical sections, together with manually created optimal outputs of the target cell areas. The target species included an example for the most common wood anatomical structures: four conifer species; a diffuse-porous species, black alder (Alnus glutinosa L.); a diffuse to semi-diffuse-porous species, European beech (Fagus sylvatica L.); and a ring-porous species, sessile oak (Quercus petraea Liebl.). The DCNN was created in Python with Pytorch, and relies on a Mask-RCNN architecture. The developed algorithm detects and segments cells, and provides information on the measurement accuracy. To evaluate the performance of this tool we compared our Mask-RCNN outputs with U-Net, a model architecture employed in a similar study, and with ROXAS, a program based on traditional image analysis techniques. First, we evaluated how many target cells were correctly recognized. Next, we assessed the cell measurement accuracy by evaluating the number of pixels that were correctly assigned to each target cell. Overall, the “learning process” defining artificial intelligence plays a key role in overcoming the issues that are usually manually solved in QWA analyses. Mask-RCNN is the model that better detects which are the features characterizing a target cell when these issues occur. In general, U-Net did not attain the other algorithms’ performance, while ROXAS performed best for conifers, and Mask-RCNN showed the highest accuracy in detecting target cells and segmenting lumen areas of angiosperms. Our research demonstrates that future software tools for QWA analyses would greatly benefit from using DCNNs, saving time during the analysis phase, and providing a flexible approach that allows model retraining.
Team Coping: Cross-Level Influence of Team Member Coping Activities on Individual Burnout
Authors: Kamphuis Wim , Delahaij Roos , de Vries Thomas A.
Published: November 2021

Coping with stress has been primarily investigated as an individual-level phenomenon. In work settings, however, an individual’s exposure to demands is often shared with co-workers, and the process of dealing with these demands takes place in the interaction with them. Coping, therefore, may be conceptualized as a multilevel construct. This paper introduces the team coping concept and shows that including coping as a higher-level team property may help explain individual-level outcomes. Specifically, we investigated the effects of exposure to danger during deployment on burnout symptoms in military service members and examined to what extent this relationship was moderated by individual-level and team-level functional coping. We hypothesized that the relationship between individuals’ exposure to danger and burnout is contingent on both. In line with our predictions, we found that service members who were highly exposed to danger, and did not engage in much functional coping, suffered most from burnout symptoms, but only when their teammates did not engage in much functional coping either. When their teammates did engage in much functional coping, the effect of exposure to danger on burnout was buffered. Hence, team members’ coping efforts functioned as a resilience resource for these service members.
Gender Differences in Peer Influence on Autistic Traits in Special Needs Schools—Evidence From Staff Reports
Authors: Nenniger Gina , Hofmann Verena , Müller Christoph M.
Published: November 2021

Children and adolescents with an intellectual disability (ID) and autistic traits often attend special needs schools where they are surrounded by peers with diverse characteristics. Given the role that peers can play in social development, we examined whether autistic traits development in students with ID and high levels of such characteristics are influenced by the level of autistic traits among the schoolmates they like most. Furthermore, we investigated the degree to which this peer influence susceptibility depends on students’ gender. A longitudinal design, with data collection points at the beginning and the end of a school year, was used. Staff reported on 330 students with high levels of autistic traits (20.6% girls; age 10.17 years, SD = 3.74) who attended 142 classrooms in 16 Swiss special needs schools. Results showed that students’ future individual level of autistic traits (T2) was not predicted by the autistic traits level of preferred peers (T1), controlling for individual autistic traits at T1, level of general functioning, gender, and age. However, the peer effect was significantly moderated by students’ gender, indicating that girls but not boys were susceptible to peer influence. These findings are discussed in terms of implications for understanding autistic traits development and directions of support for children and adolescents in their peer context.
Temporal Assessment of Self-Regulated Learning by Mining Students’ Think-Aloud Protocols
Authors: Lim Lyn , Bannert Maria , van der Graaf Joep , Molenaar Inge , Fan Yizhou , Kilgour Jonathan , Moore Johanna , Gašević Dragan
Published: November 2021

It has been widely theorized and empirically proven that self-regulated learning (SRL) is related to more desired learning outcomes, e.g., higher performance in transfer tests. Research has shifted to understanding the role of SRL during learning, such as the strategies and learning activities, learners employ and engage in the different SRL phases, which contribute to learning achievement. From a methodological perspective, measuring SRL using think-aloud data has been shown to be more insightful than self-report surveys as it helps better in determining the link between SRL activities and learning achievements. Educational process mining on the basis of think-aloud data enables a deeper understanding and more fine-grained analyses of SRL processes. Although students’ SRL is highly contextualized, there are consistent findings of the link between SRL activities and learning outcomes pointing to some consistency of the processes that support learning. However, past studies have utilized differing approaches which make generalization of findings between studies investigating the unfolding of SRL processes during learning a challenge. In the present study with 29 university students, we measured SRLviaconcurrent think-aloud protocols in a pre-post design using a similar approach from a previous study in an online learning environment during a 45-min learning session, where students learned about three topics and wrote an essay. Results revealed significant learning gain and replication of links between SRL activities and transfer performance, similar to past research. Additionally, temporal structures of successful and less successful students indicated meaningful differences associated with both theoretical assumptions and past research findings. In conclusion, extending prior research by exploring SRL patterns in an online learning setting provides insights to the replicability of previous findings from online learning settings and new findings show that it is important not only to focus on the repertoire of SRL strategies but also on how and when they are used.
Exploring L2 Listening Instruction, Self-Efficacy, and Strategy Use: A Mediation Analysis
Authors: Xu Jian , Fan Jason , Luo Kaizhou
Published: November 2021

This study aims to investigate different types of English listening instruction, listening self-efficacy, and listening strategy use, particularly the mediating role of self-efficacy between listening instruction and strategy use. We first examined the types of L2 instruction being employed in English as a Foreign Language (EFL) listening classrooms and then we looked into the relationships between L2 listening instruction, listening self-efficacy, and listening strategy use. The results of exploratory factor analysis demonstrated four types of English listening instruction: process-based instruction, comprehension-based instruction, self-regulation-based instruction, and strategy-based instruction. The results of structural equation modeling showed that listening self-efficacy mediated the relationship between strategy-based instruction and listening strategy use, and self-regulation-based instruction and listening strategy use. This study has implications for understanding the effectiveness of different listening teaching practices in enhancing self-efficacy and strategy use.
A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol
Authors: Lane Rebecca , D'Souza Sophie , Livanou Maria , Jacob Jenna , Riches Wendy , Ullman Roz , Rashid Anisatu , Singleton Rosie , Wheeler James , Fuggle Peter , Bevington Dickon , Deighton Jessica , Law Duncan , Fonagy Peter , Hindley Nick , White Oliver , Edbrooke-Childs Julian
Published: November 2021

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS).

Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service.

Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.
Psychedelic Experiences During the Early COVID-19 Pandemic: Findings From an International Online Survey
Authors: Evens Ricarda , Reiche Simon , Marek Roman M. , Moon Daa Un , Groß Rosa Elisa , Romanello Amy , Jalilzadeh Masah Dario , Scicchitano Böckheler Matteo , Gutwinski Stefan , Montag Christiane , Mick Inge , Majić Tomislav
Published: November 2021

Introduction: The current corona virus disease (COVID-19) pandemic has caused a serious global health crisis that has affected large parts of the public and private life worldwide, including the use of psychoactive substances. In this study, we investigated the effect of the COVID-19 pandemic on the use of serotonergic psychedelics, i.e., the settings in which people use psychedelics, the motives of usage, and the subjective quality of psychedelic experiences.

Methods: The study was part of an international, cross-sectional, internet-based survey (N = 5,049) available in five languages (English, German, Spanish, Italian, and Korean) carried out during the early phase of the pandemic from April to August 2020. Participants were asked to retrospectively rate settings and motives of psychedelic substance use before the pandemic and in the last 4 weeks during the pandemic, as well as changes in psychedelic experiences.

Results: Of n = 1,375 participants that reported the use psychedelics in 2019 or 2020, n = 642 (46.6%) also took psychedelics during the pandemic. During the pandemic, participants used psychedelics significantly less often in settings that were outside their home. Top motives to use psychedelics were comparable before and during the pandemic, but participants consumed less out of curiosity, to celebrate, or because friends took it, and more out of boredom. An increase in positively connoted, often pro-social experiences was observed. Two thirds of participants who used psychedelics during the pandemic claimed that psychedelics had helped them to deal better with the corona pandemic at least slightly.

Discussion: Changes in setting and motives were mostly in line with restrictions caused by control measures to contain the spread of the virus. The unexpected increase in positively connoted experiences possibly reflects a favorable interaction of environmental macro- and individual micro-contexts during the pandemic (e.g., by reducing the use in more uncontrolled recreational settings or by encouraging a strong self-selection of substance users due to the expectation of “bad trips”). Increased pro-social feelings under psychedelics might reflect a desire for social interactions in times of social distancing and pandemic-related stress and anxiety.
Contextual Barriers and Enablers to Safewards Implementation in Victoria, Australia: Application of the Consolidated Framework for Implementation Research
Authors: Fletcher Justine , Brophy Lisa , Pirkis Jane , Hamilton Bridget
Published: November 2021

Background: Safewards is a complex psychosocial intervention designed to reduce conflict and containment on inpatient mental health units. There is mounting international evidence of the effectiveness and acceptability of Safewards. However, a significant challenge exists in promising interventions, such as Safewards, being translated into routine practice. The Consolidated Framework for Implementation Research (CFIR) provides a framework through which to understand implementation in complex health service environments. The aim was to inform more effective implementation of Safewards using the CFIR domains and constructs, capitalizing on developing an understanding of variations across wards.

Method: Seven Safewards Leads completed the Training and Implementation Diary for 18 wards that opted in to a trial of Safewards. Fidelity Checklist scores were used to categorize low, medium and high implementers of Safewards at the end of the 12-week implementation period.

Results: Qualitative data from the diaries were analyzed thematically and coded according to the five CFIR domains which included 39 constructs. Twenty-six constructs across the five domains were highlighted within the data to have acted as a barrier or enabler. Further analysis revealed that six constructs distinguished between low, medium, and high implementing wards.

Discussion: Our findings suggest that for implementation of Safewards to succeed, particular attention needs to be paid to engagement of key staff including managers, making training a priority for all ward staff, adequate planning of the process of implementation and creating an environment on each inpatient unit that prioritize and enables Safewards interventions to be undertaken by staff regularly.
The Role of Melanocortin Plasticity in Pain-Related Outcomes After Alcohol Exposure
Authors: Sharfman Nathan , Gilpin Nicholas W.
Published: November 2021

The global COVID-19 pandemic has shone a light on the rates and dangers of alcohol misuse in adults and adolescents in the US and globally. Alcohol exposure during adolescence causes persistent molecular, cellular, and behavioral changes that increase the risk of alcohol use disorder (AUD) into adulthood. It is established that alcohol abuse in adulthood increases the likelihood of pain hypersensitivity and the genesis of chronic pain, and humans report drinking alcohol to relieve pain symptoms. However, the longitudinal effects of alcohol exposure on pain and the underlying CNS signaling that mediates it are understudied. Specific brain regions mediate pain effects, alcohol effects, and pain-alcohol interactions, and neural signaling in those brain regions is modulated by neuropeptides. The CNS melanocortin system is sensitive to alcohol and modulates pain sensitivity, but this system is understudied in the context of pain-alcohol interactions. In this review, we focus on the role of melanocortin signaling in brain regions sensitive to alcohol and pain, in particular the amygdala. We also discuss interactions of melanocortins with other peptide systems, including the opioid system, as potential mediators of pain-alcohol interactions. Therapeutic strategies that target the melanocortin system may mitigate the negative consequences of alcohol misuse during adolescence and/or adulthood, including effects on pain-related outcomes.
Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study
Authors: Bock Nynke W. , Wouters Hans , Lammers Anne J. , Blanker Marco H.
Published: November 2021

Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines.

Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases.

Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31–60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0–14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely “type of question,” “cases in relation to current clinical guidelines,” “case complexity” and “the doctor being pressured.” Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients.

Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.
Short Practical Regimen of Acupuncture for Melasma: A Prospective Cohort Study in a Tertiary Hospital in Thailand
Authors: Supasiri Thanan , Salakshna Nuntida , Pongpirul Krit
Published: November 2021

Background: Acupuncture shows benefits for patients with melasma, although no optimal number of sessions have been determined.

Methods: The prospective observational study was conducted in melasma patients who were treated with acupuncture procedures two times a week and were evaluated after the 5th and the 10th sessions of acupuncture, with a 1-week follow-up after the last session. Participants Groups A and B received five and 10 acupuncture sessions, respectively. Melasma was assessed by using the melanin index (MI), melasma area and severity index (MASI), patient-reported improvement scores, and acupuncture-related adverse events.

Results: Out of 113 participants, 67 received five sessions of acupuncture treatment while 39 received 10 sessions. At 1 week after five sessions of acupuncture in Group A, the mean MI decreased by 28.7 (95% CI −38.5 to −18.8, p < 0.001), whereas the median MASI decreased by 3.4 (95% CI −6.9 to −1.2, p < 0.001) points. At 1 week after ten sessions of acupuncture in Group B, the mean MI decreased by 31.3 (95% CI −45 to −17.6, p < 0.001), whereas the median MASI decreased by 5.4 (95%CI −9.9 to −3, p < 0.001) points. The first five sessions of acupuncture had a higher incremental effect than the last five sessions, although there was no statistically significant difference. Twenty-nine participants reported minor side effects. Group B had a risk ratio (RR) of having adverse events 1.8 times (95% CI 1.0–3.4, p = 0.05) compared with Group A.

Conclusion: Short acupuncture regimens of 5–10 sessions in melasma seem to be effective and practical with minor side effects.
Effects of Social Mobility and Stringency Measures on the COVID-19 Outcomes: Evidence From the United States
Authors: Sun Jianmin , Kwek Keh , Li Min , Shen Hongzhou
Published: November 2021

This paper examines the effects of stringency measures (provided by the Oxford Coronavirus Government Response Tracker) and total time spent away from home (provided by the Google COVID-19 Community Mobility Reports) on the COVID-19 outcomes (measured by total COVID-19 cases and total deaths related to the COVID-19) in the United States. The paper focuses on the daily data from March 11, 2020 to August 13, 2021. The ordinary least squares and the machine learning estimators show that stringency measures are negatively related to the COVID-19 outcomes. A higher time spent away from home is positively associated with the COVID-19 outcomes. The paper also discusses the potential economic implications for the United States.
Considerations on Acoustic Mapping Velocimetry (AMV) Application for in-situ Measurement of Bedform Dynamics
Authors: You H. , Muste M. , Kim D. , Baranya S.
Published: November 2021

Non-intrusive technologies for the in-situ measurement of river morphological features are increasingly popular in the scientific and practice communities due to their efficient and productive data acquisition. While the measurement of suspended load with optical and acoustic technologies is currently an active area of research, the measurement of bedform dynamics has not experienced similar progress. We have successfully demonstrated through laboratory experiments that, by combining acoustic mapping with image velocimetry concepts, we can characterize the planar dynamics of the bedform migration. The technique, labeled Acoustic Mapping Velocimetry (AMV), is currently transferred to field conditions using multiple-beam echo-sounders (MBES) for producing acoustic maps. During this transfer, new questions emerged because, in field conditions, many of the morphologic features targeted by AMV measurements are not a priori known. Moreover, the image velocimetry processing can be approached with several alternatives, each of them characterized by strength and limitations. This paper assembles guidelines for establishing optimal parameters for the acquisition of the acoustic maps based on analytical considerations, and for selecting essential features of the processing for image velocimetry. We test these guidelines using MBES data acquired in the Mississippi River.