bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and evaluation of uncertainty quantifying machine learning models to predict piperacillin plasma concentrations in critically ill patients
Authors: Verhaeghe Jarne , Dhaese Sofie A. M. , De Corte Thomas , Vander Mijnsbrugge David , Aardema Heleen , Zijlstra Jan G. , Verstraete Alain G. , Stove Veronique , Colin Pieter , Ongenae Femke , De Waele Jan J. , Van Hoecke Sofie
Published: August 2022

Background

Beta-lactam antimicrobial concentrations are frequently suboptimal in critically ill patients. Population pharmacokinetic (PopPK) modeling is the golden standard to predict drug concentrations. However, currently available PopPK models often lack predictive accuracy, making them less suited to guide dosing regimen adaptations. Furthermore, many currently developed models for clinical applications often lack uncertainty quantification. We, therefore, aimed to develop machine learning (ML) models for the prediction of piperacillin plasma concentrations while also providing uncertainty quantification with the aim of clinical practice.

Methods

Blood samples for piperacillin analysis were prospectively collected from critically ill patients receiving continuous infusion of piperacillin/tazobactam. Interpretable ML models for the prediction of piperacillin concentrations were designed using CatBoost and Gaussian processes. Distribution-based Uncertainty Quantification was added to the CatBoost model using a proposed Quantile Ensemble method, useable for any model optimizing a quantile function. These models are subsequently evaluated using the distribution coverage error, a proposed interpretable uncertainty quantification calibration metric. Development and internal evaluation of the ML models were performed on the Ghent University Hospital database (752 piperacillin concentrations from 282 patients). Ensuing, ML models were compared with a published PopPK model on a database from the University Medical Centre of Groningen where a different dosing regimen is used (46 piperacillin concentrations from 15 patients.).

Results

The best performing model was the Catboost model with an RMSE and $$R^2$$

R
2

of 31.94–0.64 and 33.53–0.60 for internal evaluation with and without previous concentration. Furthermore, the results prove the added value of the proposed Quantile Ensemble model in providing clinically useful individualized uncertainty predictions and show the limits of homoscedastic methods like Gaussian Processes in clinical applications.

Conclusions

Our results show that ML models can consistently estimate piperacillin concentrations with acceptable and high predictive accuracy when identical dosing regimens as in the training data are used while providing highly relevant uncertainty predictions. However, generalization capabilities to other dosing schemes are limited. Notwithstanding, incorporating ML models in therapeutic drug monitoring programs seems definitely promising and the current work provides a basis for validating the model in clinical practice.
Exploring nurse and nursing student experience of using an artist-produced photobook to learn about dementia
Authors: Dodd Savannah , Carter Gillian , Christie Andrena , Mitchell Gary
Published: August 2022

Background

Improving understanding about dementia in nursing is a priority area for educators and policymakers. This is due to poor professional understanding about dementia and suboptimal healthcare practice. While many educational interventions exist, there has been a paucity of research which has considered the use of artist-produced photobooks to improve knowledge and understanding about dementia. The aim of this study is to understand the impact of an artist-produced photobook on nurses’ attitudes and beliefs about dementia.

Results

Following a thematic analysis of four focus group interviews with 22 nurses and nursing students from Northern Ireland, three themes emerged. Theme one was about how the artist-produced photobook helped participants to humanise the person living with dementia. Theme two related to how the artist-produced photobook supported participants to actively construct their own meanings about dementia based on their previous professional and personal experiences. Theme three explored how an artist-produced photobook could be successfully used to complement existing dementia education in the future.

Conclusions

Using an artist-produced photobook was an innovative way to learn about dementia for nurses and nursing students. The photobook functioned as a tool underpinned by arts-based pedagogy (ABP), supporting nurses to understand the person behind the dementia disease. As such, an artist-produced photobook has the potential to be a useful complementary resource for supporting professional education about dementia.
Challenges experienced by newly qualified nurse-midwives transitioning to practice in selected midwifery settings in northern Malawi
Authors: Mtegha Mathews Brave , Chodzaza Elizabeth , Chirwa Ellen , Kalembo Fatch Welcome , Zgambo Maggie
Published: August 2022

Background

Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from education to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from education to practice. The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi.

Methodology

A qualitative descriptive approach was used. Data were collected through in-depth interviews using semi-structured interview guides from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). The researchers developed two interview guides; one for the newly qualified nurse-midwives and another one for the key informants. The interview guides had questions related to newly qualified nurse-midwives experiences of transitioning to practice and the support they received. Participants were from three selected hospitals in the Northern part of Malawi that have maternity units. Data were analysed manually using thematic analysis.

Findings

Five themes related to challenges faced by newly qualified nurse-midwives during their transition to practice in midwifery units emerged from the thematic analysis of the data. These included (1) Theory—practice gap, (2) Lack of confidence and skills, (3) Inadequate resources, (4) Transition support system, and (5) Workplace conflict.

Conclusion

Newly qualified nurse-midwives in Malawi encounter many challenges while transitioning from education to practice. The study findings underscore the need to develop a national framework support system that could not only help newly qualified midwives adjust positively to their new role but also create more opportunities for learning and developing and strengthening a collaborative partnership between colleges and hospitals.
Induction, decay, and determinants of functional antibodies following vaccination with the RTS,S malaria vaccine in young children
Authors: Feng Gaoqian , Kurtovic Liriye , Agius Paul A. , Aitken Elizabeth H. , Sacarlal Jahit , Wines Bruce D. , Hogarth P. Mark , Rogerson Stephen J. , Fowkes Freya J. I. , Dobaño Carlota , Beeson James G.
Published: August 2022

Background

RTS,S is the first malaria vaccine recommended for implementation among young children at risk. However, vaccine efficacy is modest and short-lived. Antibodies play the major role in vaccine-induced immunity, but knowledge on the induction, decay, and determinants of antibody function is limited, especially among children. Antibodies that promote opsonic phagocytosis and other cellular functions appear to be important contributors to RTS,S immunity.

Methods

We studied a phase IIb trial of RTS,S/AS02 conducted in young children in malaria-endemic regions of Mozambique. We evaluated the induction of antibodies targeting the circumsporozoite protein (CSP, vaccine antigen) that interact with Fcγ-receptors (FcRγs) and promote phagocytosis (neutrophils, monocytes, THP-1 cells), antibody-dependent respiratory burst (ADRB) by neutrophils, and natural killer (NK) cell activity, as well as the temporal kinetics of responses over 5 years of follow-up (ClinicalTrials.gov registry number NCT00197041).

Results

RTS,S vaccination induced CSP-specific IgG with FcγRIIa and FcγRIII binding activity and promoted phagocytosis by neutrophils, THP-1 monocytes, and primary human monocytes, neutrophil ADRB activity, and NK cell activation. Responses were highly heterogenous among children, and the magnitude of neutrophil phagocytosis by antibodies was relatively modest, which may reflect modest vaccine efficacy. Induction of functional antibodies was lower among children with higher malaria exposure. Functional antibody magnitude and the functional activity of antibodies largely declined within a year post-vaccination, and decay were highest in the first 6 months, consistent with the decline in vaccine efficacy over that time. Decay rates varied for different antibody parameters and decay was slower for neutrophil phagocytosis. Biostatistical modelling suggested IgG1 and IgG3 contribute in promoting FcγR binding and phagocytosis, and IgG targeting the NANP-repeat and C-terminal regions CSP were similarly important for functional activities.

Conclusions

Results provide new insights to understand the modest and time-limited efficacy of RTS,S in children and the induction of antibody functional activities. Improving the induction and maintenance of antibodies that promote phagocytosis and cellular functions, and combating the negative effect of malaria exposure on vaccine responses are potential strategies for improving RTS,S efficacy and longevity.
An epidemiological analysis of imported malaria in Shanghai during a COVID-19 outbreak
Authors: Zhu Min , Zhang Chengang , Zhang Yaoguang , Wang Zhenyu , Ma Xiaojiang , Dai Simin , Chen Jian
Published: August 2022

Background

The goal of this study was to understand the epidemiological characteristics of imported malaria in Shanghai specifically during the epidemic period of novel corona-virus pneumonia (COVID-19), to provide a reference for preventing the transmission of imported malaria after this disease had been previously eliminated.

Methods

The data of malaria cases reported in Shanghai from 2020 to 2021 were obtained from the China Information System for Disease Control and Prevention (CISDCP) and the Information System for Parasitic Disease Control and Prevention (ISPDCP). The characteristics of demographic and epidemiological distribution, travel-related information, diagnosis information, regions of infection acquisition and disposal information of epidemic situation were analysed with descriptive statistics.

Results

A total of 112 cases of malaria were reported in Shanghai from January 2020 to December 2021. There were 18 cases and 94 cases in 2020 and 2021, respectively, reaching the lowest and highest levels in the past 10 years. The incidence of malaria associated with seasons had an increasing trend (χ2 = 81.143, P < 0.05). These cases included Plasmodium falciparum (97, 86.61%), Plasmodium vivax (4, 3.57%), Plasmodium ovale (8, 7.14%) and Plasmodium malariae (3, 2.68%). The median age of patients with malaria was 38.0 years, the majority of these individuals were males (109, 97.32%), and most of them were labour personnel (93, 83.04%). Of the reported cases, 8 of these individuals (7.14%) reported experiencing malaria symptoms before their arrival in China after their stay overseas; 97 of these individuals (86.61%) reported experiencing symptoms within 14 days after their initial arrival from overseas; 15 of these individuals (13.39%) were diagnosed with ‘severe malaria’; and 4 of these individuals (3.57%) were also diagnosed with COVID-19. All cases were imported from Africa, and there were no indigenous cases and deaths.

Conclusion

Due to the impact of COVID-19, the number of imported malaria cases in Shanghai had greatly increased; however, prevention and control measures for imported malaria could be implemented to prevent re-transmission of this condition. Considering that the number of individuals returning from overseas labour is likely to increase in the next few years, it is necessary to strengthen the surveillance of imported malaria and to review the protocol for potential epidemic situations. Together, these measures could support the maintation of free-malaria status in Shanghai.
Surveillance of Russell body inflammation of the digestive tract: a case report and review of literature
Authors: Luo Shuai , Huang Xiang , Li Yao , Wang Jinjing
Published: August 2022

Introduction

Russell body inflammation of the digestive tract (RBIDT) is a rare chronic inflammation of the digestive tract mucosa that commonly presents as Russell body gastritis (RBG). This disease is usually associated with Helicobacter pylori (HP) infection. However, it can also occur in individuals without HP infection and with specific immune profiles, as seen in HIV and hepatitis C infections. The aetiology and pathogenesis of this disease remain controversial. Given the rarity of the disease and the diversity of the immunophenotypes, there is a high probability of misdiagnosis.

Case presentation

A male patient with RBG and HP infection was included in this study. The case of RBG with an unusual morphology of Mott cells that mimics stamped ring cells.Endoscopy performed during the follow-up revealed regression of the lesion 1 week after anti-HP treatment.

Conclusions

A case of RBG with a high likelihood of misdiagnosis of signet ring cell carcinoma (SRC) has been reported in this study along with a review of the relevant literature and an overview of RBIDT.
Association between low hemoglobin, clinical measures, and patient-reported outcomes in patients with rheumatoid arthritis: results from post hoc analyses of three phase III trials of sarilumab
Authors: Rubbert-Roth Andrea , Furst Daniel E. , Fiore Stefano , Praestgaard Amy , Bykerk Vivian , Bingham Clifton O. , Charles-Schoeman Christina , Burmester Gerd
Published: August 2022

Background

Anemia is common in patients with rheumatoid arthritis (RA). Higher hemoglobin (Hb) levels may be associated with better clinical outcomes and patient-reported outcomes (PROs). To assess this hypothesis, we conducted two post hoc analyses in three sarilumab phase III studies: TARGET, MOBILITY, and MONARCH.

Methods

Pooled data from combination therapy from placebo-controlled MOBILITY (sarilumab + methotrexate) and TARGET (sarilumab + conventional synthetic disease-modifying antirheumatic drugs [csDMARDs]) and monotherapy data from active-controlled MONARCH (sarilumab vs. adalimumab) studies were included. Associations between Hb levels and clinical measures and PROs were assessed over 24 weeks. The mean changes from baseline in clinical outcomes and PROs (to week 24) and radiographic outcomes (to week 52) were evaluated between low and normal Hb levels (based on the World Health Organization [WHO] criteria).

Results

From TARGET, MOBILITY, and MONARCH, 546, 1197, and 369 patients, respectively, were stratified according to Hb levels (low vs. normal). Over 24 weeks, higher Hb levels were found to be consistently associated with better clinical outcomes and PROs in combination therapy and monotherapy groups and were more pronounced among the patients treated with sarilumab than those treated with placebo and adalimumab. The mean change from baseline to week 24 in clinical efficacy measures and PROs was similar in patients with low vs. normal Hb at baseline. Differences between sarilumab and/or adalimumab, for all outcomes, were larger for low Hb subgroups. In MOBILITY, by week 52, the inhibition of progression of structural damage (assessed via Modified Total Sharp Score [mTSS]) was 84% (sarilumab 200 mg) and 68% (sarilumab 150 mg) vs. placebo in patients with low Hb and 97% (sarilumab 200 mg) and 68% (sarilumab 150 mg) vs. placebo in patients with normal Hb. Similar results were observed for other radiographic outcomes.

Conclusions

In these post hoc analyses, a consistent relationship was observed between higher Hb levels and better clinical outcomes and PROs in patients with RA. Irrespective of the baseline Hb levels, sarilumab treatment was associated with improvements in clinical measures and PROs over 24 weeks (improvements were more pronounced than those with adalimumab treatment) and mitigation of joint damage progression over 52 weeks.

Trial registration

ClinTrials.gov NCT01061736, NCT01709578, and NCT02332590
Manifestation of glucose-6-phosphate dehydrogenase deficiency in the wake of new-onset type 1 diabetes mellitus: a case report
Authors: Govindarajan Sandhya , Zamir Imran , Bagewadi Sunil , Moore Emily
Published: August 2022

Background

Diabetes mellitus is the most common metabolic disease globally, while glucose-6-phosphate dehydrogenase deficiency, an X-linked inherited disorder, is the most common erythrocyte enzyme defect. The association between the two in children has been infrequently reported.

Case presentation

We report the case of a 10-year-old boy of Iraqi descent who presented to our emergency department with new-onset type 1 diabetes mellitus without Diabetic Keto Acidosis. He was treated with subcutaneous insulin and discharged. Eleven days after hospitalization, he was found to be jaundiced during his home visit. Hence, he was referred to the pediatric unit, and his hemoglobin had declined from 130 g/L at the previous admission to 81 g/L. Blood tests revealed low haptoglobin, and his peripheral blood film showed anisocytosis, polychromasia, and occasional red cell fragments suggestive of acute hemolysis. His glucose-6-phosphate dehydrogenase activity was very low, and his subsequent genetic tests confirmed Mediterranean-type glucose-6-phosphate dehydrogenase deficiency.

Conclusion

Glucose-6-phosphate dehydrogenase deficiency in people with diabetes mellitus has been underreported in the literature so far, and screening of glucose-6-phosphate dehydrogenase deficiency should be considered on diagnosis of diabetes mellitus, especially in boys of African, Mediterranean, or Asian descent.
Documentation of adherence to infection prevention best practice in patient records: a mixed-methods investigation
Authors: Hascic Alen , Wolfensberger Aline , Clack Lauren , Schreiber Peter W. , Kuster Stefan P. , Sax Hugo
Published: August 2022

Background

Healthcare-associated infections remain a preventable cause of patient harm in healthcare. Full documentation of adherence to evidence-based best practices for each patient can support monitoring and promotion of infection prevention measures. Thus, we reviewed the extent, nature, and determinants of the documentation of infection prevention (IP) standards in patients with HAI.

Methods

We reviewed electronic patient records (EMRs) of patients included in four annual point-prevalence studies 2013–2016 who developed a device- or procedure-related HAI (surgical site infection (SSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated infection (VAP), catheter-related bloodstream infection (CRBSI)). We examined the documentation quality of mandatory preventive measures published as institutional IP standards. Additionally, we undertook semi-structured interviews with healthcare providers and a two-step inductive (grounded theory) and deductive (Theory of Planned Behaviour) content analysis.

Results

Of overall 2972 surveyed patients, 249 (8.4%) patients developed 272 healthcare-associated infections. Of these, 116 patients met the inclusion criteria, classified as patients with SSI, CAUTI, VAP, CRBSI in 78 (67%), 21 (18%), 10 (9%), 7 (6%), cases, respectively. We found documentation of IP measures in EMRs in 432/1308 (33%) cases. Documentation of execution existed in the study patients’ EMRs for SSI, CAUTI, VAP, CRBSI, and overall, in 261/931 (28%), 27/104 (26%), 46/122 (38%), 26/151 (17%), and 360/1308 (28%) cases, respectively, and documentation of non-execution in 67/931 (7%), 2/104 (2%), 0/122 (0%), 3/151 (2%), and 72/1308 (6%) cases, respectively. Healthcare provider attitudes, subjective norms, and perceived behavioural control indicated reluctance to document IP standards.

Conclusions

EMRs rarely included conclusive data about adherence to IP standards. Documentation had to be established indirectly through data captured for other reasons. Mandatory institutional documentation protocols or technically automated documentation may be necessary to address such shortcomings in patient safety documentation.
Dietary protein levels changed the hardness of muscle by acting on muscle fiber growth and the metabolism of collagen in sub-adult grass carp (Ctenopharyngodon idella)
Authors: Dong Min , Zhang Lu , Wu Pei , Feng Lin , Jiang Weidan , Liu Yang , Kuang Shengyao , Li Shuwei , Mi Haifeng , Tang Ling , Zhou Xiaoqiu
Published: August 2022

Background

Nutrient regulation has been proven to be an effective way to improve the flesh quality in fish. As a necessary nutrient for fish growth, protein accounts for the highest proportion in the fish diet and is expensive. Although our team found that the effect of protein on the muscle hardness of grass carp was probably related to an increased collagen content, the mechanism for this effect has not been deeply explored. Moreover, few studies have explored the protein requirements of sub-adult grass crap (Ctenopharyngodon idella). Therefore, the effects of different dietary protein levels on the growth performance, nutritional value, muscle hardness, muscle fiber growth, collagen metabolism and related molecule expression in grass carp were investigated.

Methods

A total of 450 healthy grass carp (721.16 ± 1.98 g) were selected and assigned randomly to six experimental groups with three replicates each (n = 25/replicate), and were fed six diets with 15.91%, 19.39%, 22.10%, 25.59%, 28.53% and 31.42% protein for 60 d.

Results

Appropriate levels of dietary protein increased the feed intake, percentage weight gain, specific growth rate, body composition, unsaturated fatty acid content in muscle, partial free amino acid content in muscle, and muscle hardness of grass carp. These protein levels also increased the muscle fiber density, the frequency of new muscle fibers, the contents of collagen and IGF-1, and the enzyme activities of prolyl 4-hydroxylases and lysyloxidase, and decreased the activity of matrix metalloproteinase-2. At the molecular level, the optimal dietary protein increased collagen type I α1 (Colα1), Colα2, PI3K, Akt, S6K1, La ribonucleoprotein domain family member 6a (LARP6a), TGF-β1, Smad2, Smad4, Smad3, tissue inhibitor of metalloproteinase-2, MyoD, Myf5, MyoG and MyHC relative mRNA levels. The levels of the myostatin-1 and myostatin-2 genes were downregulated, and the protein expression levels of p-Smad2, Smad2, Smad4, p-Akt, Akt, LARP6 and Smad3 were increased.

Conclusions

The appropriate levels of dietary protein promoted the growth of sub-adult grass carp and improved muscle hardness by promoting the growth of muscle fibers, improving collagen synthesis and depressing collagen degradation. In addition, the dietary protein requirements of sub-adult grass carp were 26.21% and 24.85% according to the quadratic regression analysis of growth performance (SGR) and the muscle hardness (collagen content), respectively.
Redefining germline predisposition in children with molecularly characterized ependymoma: a population-based 20-year cohort
Authors: Foss-Skiftesvik Jon , Stoltze Ulrik Kristoffer , van Overeem Hansen Thomas , Ahlborn Lise Barlebo , Sørensen Erik , Ostrowski Sisse Rye , Kullegaard Solvej Margrete Aldringer , Laspiur Adrian Otamendi , Melchior Linea Cecilie , Scheie David , Kristensen Bjarne Winther , Skjøth-Rasmussen Jane , Schmiegelow Kjeld , Wadt Karin , Mathiasen René
Published: August 2022

Ependymoma is the second most common malignant brain tumor in children. The etiology is largely unknown and germline DNA sequencing studies focusing on childhood ependymoma are limited. We therefore performed germline whole-genome sequencing on a population-based cohort of children diagnosed with ependymoma in Denmark over the past 20 years (n = 43). Single nucleotide and structural germline variants in 457 cancer related genes and 2986 highly evolutionarily constrained genes were assessed in 37 children with normal tissue available for sequencing. Molecular ependymoma classification was performed using DNA methylation profiling for 39 children with available tumor tissue. Pathogenic germline variants in known cancer predisposition genes were detected in 11% (4/37; NF2, LZTR1, NF1 & TP53). However, DNA methylation profiling resulted in revision of the histopathological ependymoma diagnosis to non-ependymoma tumor types in 8% (3/39). This included the two children with pathogenic germline variants in TP53 and NF1 whose tumors were reclassified to a diffuse midline glioma and a rosette-forming glioneuronal tumor, respectively. Consequently, 50% (2/4) of children with pathogenic germline variants in fact had other tumor types. A meta-analysis combining our findings with pediatric pan-cancer germline sequencing studies showed an overall frequency of pathogenic germline variants of 3.4% (7/207) in children with ependymoma. In summary, less than 4% of childhood ependymoma is explained by genetic predisposition, virtually restricted to pathogenic variants in NF2 and NF1. For children with other cancer predisposition syndromes, diagnostic reconsideration is recommended for ependymomas without molecular classification. Additionally, LZTR1 is suggested as a novel putative ependymoma predisposition gene.
The influence of digital competences, self-organization, and independent learning abilities on students’ acceptance of digital learning
Authors: Scheel Laura , Vladova Gergana , Ullrich André
Published: August 2022

Despite digital learning disrupting traditional learning concepts and activities in higher education, for the successful integration of digital learning, the use and acceptance of the students are essential. This acceptance depends in turn on students’ characteristics and dispositions, among other factors. In our study, we investigated the influence of digital competences, self-organization, and independent learning abilities on students’ acceptance of digital learning and the influence of their acceptance on the resistance to the change from face-to-face to digital learning. To do so, we surveyed 350 students and analyzed the impact of the different dispositions using ordinary least squares regression analysis. We could confirm a significant positive influence of all the tested dispositions on the acceptance of digital learning. With the results, we can contribute to further investigating the underlying factors that can lead to more positive student perceptions of digital learning and build a foundation for future strategies of implementing digital learning into higher education successfully.
COVID-19-related school closures and patterns of hospital admissions with stress-related presentations in secondary school-aged adolescents: weekly time series
Authors: Blackburn Ruth M. , Phillips Owen Jacquie , Downs Johnny , Gilbert Ruth
Published: August 2022

This study examines health service indicators of stress-related presentations (relating to pain, mental illness, psychosomatic symptoms and self-harm) in adolescents of secondary school age, using Hospital Episode Statistics data for England. We examined weekly time series data for three academic years spanning the time before (2018–2019) and during the COVID-19 pandemic (2019–2020 and 2020–2021), including the first lockdown when schools were closed to the majority of pupils. For all secondary school children, weekly stress presentations dropped following school closures. However, patterns of elevated stress during school terms re-established after reopening, with girls aged 11–15 showing an overall increase compared with pre-pandemic rates.
Associations between antipsychotic use, substance use and relapse risk in patients with schizophrenia: real-world evidence from two national cohorts
Authors: Lähteenvuo Markku , Luykx Jurjen J. , Taipale Heidi , Mittendorfer-Rutz Ellenor , Tanskanen Antti , Batalla Albert , Tiihonen Jari
Published: August 2022

Background

Research on the effectiveness of pharmacotherapies for schizophrenia and comorbid substance use disorder (SUD) is very sparse, and non-existent on the prevention of the development of SUDs in patients with schizophrenia.

Aims

To compare the real-world effectiveness of antipsychotics in schizophrenia in decreasing risk of developing an initial SUD, and psychiatric hospital admission and SUD-related hospital admission among patients with an SUD.

Method

Two independent national cohorts including all persons diagnosed with schizophrenia (N = 45 476) were followed up for 22 (Finland: 1996–2017) and 11 (Sweden: 2006–2016) years. Risk of developing an SUD was calculated with between-individual models, and risks of psychiatric and SUD-related hospital admission were calculated with within-individual models, using Cox regression and adjusted hazard ratios (aHRs) for using versus not using certain antipsychotics.

Results

For patients with schizophrenia without an SUD, clozapine use (Finland: aHR 0.20, 95% CI 0.16–0.24, P < 0.001; Sweden: aHR 0.35, 95% CI 0.24–0.50, P < 0.001) was associated with lowest risk of developing an initial SUD in both countries. Antipsychotic polytherapy was associated with second lowest risk (aHR 0.54, 95% CI 0.44–0.66) in Sweden, and third lowest risk (aHR 0.47, 95% CI 0.42–0.53) in Finland. Risk of relapse (psychiatric hospital admission and SUD-related hospital admission) were lowest for clozapine, antipsychotic polytherapy and long-acting injectables in both countries. Results were consistent across both countries.

Conclusions

Clozapine and antipsychotic polytherapy are most strongly associated with reduced risk of developing SUDs among patients with schizophrenia, and with lower relapse rates among patients with both diagnoses.
Clinical Outcomes of Operating an Acute Palliative Care Unit at a Comprehensive Cancer Center
Authors: Jung Eun Hee , Lee Si Won , Kim Yu Jung , Kang Beodeul , Suh Koung Jin , Lee Ju Hyun , Jeon Esther , Kim Dahee , Hur Sung Soun , Lee Ji Yun , Kim Ji-Won , Kim Se Hyun , Kim Jin Won , Lee Jeong-Ok , Lee Keun-Wook , Kim Jee Hyun , Bang Soo-Mee , Lee Jong Seok , Bruera Eduardo
Published: August 2022

PURPOSE:

Acute palliative care units (APCUs) are inpatient services in tertiary hospitals that provide intensive symptom management and assist in hospital discharge for transitions to hospice care. We aimed to analyze the clinical outcomes of operating an APCU at a comprehensive cancer center.

PATIENTS AND METHODS:

We retrospectively reviewed the medical records of 1,440 consecutive patients admitted to the APCU and analyzed demographic and clinical information, discharge outcomes, symptom assessments using the Edmonton Symptom Assessment System, spiritual distress, and financial distress.

RESULTS:

The median age of patients was 67.0 (range, 23-97) years, and 41% were female. The most common primary cancer types were lung (21.9%), hepatopancreatobiliary (14.1%), and colorectal cancers (12.9%). The median length of stay was 8.0 days (range, 1-60 days), and 31.0% of patients died in the APCU. Death in the APCU showed a significant decrease over time, and overall inpatient death in oncology wards did not increase after APCU opening. In total, 44.7% of patients were discharged to government-certified hospice centers. The proportion of patients discharged to certified hospice centers increased from 32.2% in 2015 to 62.4% in 2018. Among 715 patients with a follow-up evaluation 1 week after admission, Edmonton Symptom Assessment System symptom scores, spiritual distress, and financial distress showed statistically significant improvements compared with the baseline symptom scores ( P < .001). This improvement was limited to patients who did not die in the APCU.

CONCLUSION:

Patients with advanced cancer admitted to the APCU may experience significant improvements in distressing symptoms. The majority of patients requiring transition to hospice were successfully transferred to certified hospice centers. The percentage discharged alive improved over time.
Seasonal adjustments in body mass and basal thermogenesis in Chinese hwameis (Garrulax canorus): the roles of temperature and photoperiod
Authors: Li Chenxing , Liu Chenyu , Hu Pingxia , Zheng Xiyu , Li Ming , Liu Jinsong
Published: August 2022

For small birds to survive during seasonal acclimatization in temperate zones, regulation of body mass and thermogenesis is crucial. To determine the role of temperature and photoperiod in seasonal changes in body mass and thermogenesis in Chinese hwameis (Garrulax canorus), we compared body mass, basal metabolic rate (BMR), energy intake and cellular metabolic capacity of the tissue (muscle) and/or organs (liver, kidney, heart and small intestine) in seasonally acclimatized and laboratory-acclimated hwameis. A significant seasonal influence on body mass and BMR (which peaked in winter) was found, and these variations were mirrored by exposing the housed birds to cold temperatures or a short photoperiod. The level of dry matter intake, gross energy intake and digestible energy intake was higher during winter, and in housed animals that were exposed to cold temperatures. These results suggest that by increasing energy intake and thermogenesis, Chinese hwameis can overcome winter thermoregulatory challenges. When compared with warm-acclimated birds, cold-acclimated birds displayed higher mass-specific and whole-organ state 4 respiration in the muscle, liver and kidney, and higher mass-specific and whole-organ cytochrome c oxidase activity in the liver. These data demonstrate that cellular thermogenesis partly underpins basal thermoregulation in Chinese hwameis. Cold temperature and short photoperiod can be used as helpful environmental cues during seasonal acclimatization. However, the role of temperature is more significant compared with that of photoperiod in Chinese hwameis; the changes in energy metabolism and thermoregulation induced by temperature appear to be intensified by photoperiod.
Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland
Authors: Junttila Anna , Helminen Olli , Helmiö Mika , Huhta Heikki , Kallio Raija , Koivukangas Vesa , Kokkola Arto , Laine Simo , Lietzen Elina , Meriläinen Sanna , Pohjanen Vesa-Matti , Rantanen Tuomo , Ristimäki Ari , Räsänen Jari V. , Saarnio Juha , Sihvo Eero , Toikkanen Vesa , Tyrväinen Tuula , Valtola Antti , Kauppila Joonas H. ,   the FINEGO Group
Published: August 2022

Background

No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting.

Methods

This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987–2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage.

Results

A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82–1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72–1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45–1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996–2016 mirrored the main analysis.

Conclusions

This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.
O mercado do ouro como porto seguro quando os mercados de ações apresentam níveis de risco acentuado: evidência nas crises da China e da pandemia da COVID-19
Authors: Texeira Nuno , Dias Rui , Pardal Pedro
Published: August 2022

Este artigo tem como objetivo analisar se o mercado do ouro representa um porto seguro quando os principais mercados financeiros sofrem quebras significativas. Para tal, e efetuada uma análise sobre a integração e os comovimentos nos mercados de ações de Franca (CAC 40), Alemanha (DAX 30), Estados Unidos (Dow Jones), Reino Unido (FTSE 100), Itália (FTSE MIB), Hong Kong (Hang Seng), além do mercado do ouro (XAU), no período entre maio de 2015 e maio de 2020, o qual compreende dois subperíodos complexos: o crash na China (2015/2016) e o início da pandemia da COVID-19, em 2020. Na análise de integração, utilizou-se a metodologia de Gregory e Hansen (1996), e, para avaliar os choques (comovimentos) entre mercados, a de funções impulso-resposta (IRF), com simulações de Monte Carlo. Os resultados evidenciam que os mercados de ações de Franca, Alemanha e Estados Unidos mostram os níveis mais elevados de integração, não integrando, contudo, com o mercado do ouro. Relativamente a este, não se observou uma integração com nenhum dos mercados de ações em análise, demonstrando que, quando estes apresentam níveis elevados de risco, o índice XAU poderá representar um porto seguro para a diversificação de carteiras e mitigação desse risco. Tal conclusão e reforçada pela análise da relação entre os mercados de ações e do ouro em curto prazo, por meio das funções de impulso-resposta, e onde se obtém evidência de comovimentos positivos/negativos, com significância estatística, entre todos os mercados, com exceção do ouro.
The use of cannabinoids in the treatment of attention deficit hyperactivity disorder - a review of the latest literature.
Authors: Skubel Tomasz , Czarnota Jakub , Dobrzyński Michał , Kopystecka Agnieszka , Kozioł Ilona , Drozd Małgorzata , Rybak Natalia , Patryn Rafał
Published: August 2022

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a common problem in adolescents and adults around the world. ADHD is particularly characterized by inattention, impulsiveness and hyperactivity, and in order to deal with these problems, patients often resort to other methods of treatment in addition to classic pharmacotherapy. Increasing numbers of ADHD patients are self-medicating with cannabis, despite the lack of specific evidence on its efficacy and safety.

Aim of the study: The purpose of this study was to review the most recent available literature on the use of cannabidiol in the treatment of ADHD. For this purpose, PubMed and scopus databases were reviewed. The phrase "cannabidiol and ADHD" was used in the database search. After reviewing the titles and abstracts, 15 articles and articles cited in them were obtained and analyzed in detail.

Results: Cannabinoids are reported to have pharmacological anxiolytic, neuroprotective, antidepressant, antipsychotic and hypnotic effects. Single-case studies of patients treated with them show that cannabinoids reduced hyperactivity, improved focus and control of impulsive behavior. Patients also reported side effects of cannabis use, the most common being mild short-term memory problems, dry mouth, sleepiness, and occasional experiences of constant thirst and greater forgetfulness. Most of the acute side effects were related to neuropsychiatric symptoms and were associated with cardiac sympathomimetic effects

 Conclusion:  There is evidence for the effects of cannabinoids on ADHD symptoms as well as the influence of the cannabinoid system on involvement in neurological and psychiatric disorders. However, more controlled clinical trials are needed to determine the effect of cannabis use on ADHD symptoms and the norms of its use in this indication.

 Keywords

cannabidiol, ADHD, literature review
Multiobjective Line Balancing Game: Collaboration and Peer Evaluation
Authors: Ahmadi Taher , van der Rhee Bo
Published: August 2022

We introduce a spreadsheet-based game, the multiobjective line balancing (MOLB) game, to teach assembly line balancing as a common topic of discussion in operations research, operations management, supply chain management, or management science courses at the undergraduate or graduate level. The MOLB game was designed based on the triple bottom line framework, in which the economic, social, and environmental aspects of line balancing decisions are simultaneously taken into account. The MOLB game can be played in teams of three or four students. First, each team receives unique information for balancing an assembly line. Each team should find as many feasible balances as possible in a collaborative form and then send the Pareto solution set and the best found solution to a peer team. In the second round of the game, the teams assess the results of a peer team first by trying to find infeasible or non-Pareto solutions and second by attempting to improve on the provided solutions. Finally, the reviewer team presents the results of the peer-review process to the entire class.

Supplemental Material: The Teaching Note, instruction video, and MOLB game master file is available at https://www.informs.org/Publications/Subscribe/Access-Restricted-Materials .
"Não é um ano perdido graças à resistência das professoras": temporalidades e invenções em cotidianos escolares pandêmicos
Authors: Ferreira Sabrina Mendonça , Emilião Soymara Vieira
Published: August 2022

Este ensaio tematiza a resistência docente, enfatizando a questão do tempo, objetivando relacioná-la a invenções nos cotidianos escolares a partir de questões importantes que emergiram no tecer de conversas de professoras, refletindo sobre sentidos que os tempos pandêmicos têm provocado nos cotidianos escolares. Uma questão relaciona os tempos gregos com o tempo próprio da escola e o que outras dimensões temporais podem dar a conhecer, em processos formativos docentes. Em seguida, discute-se o entendimento de tempo de aula como espaçotempo possível de invenção e expansão do presente nos cotidianos escolares. Finalmente, considerando o distanciamento físico dos espaços escolares habituais por conta da pandemia causada pela Covid-19, mas em insubmissão ao tempo do medo e com inspiração em pesquisas e estudos com os cotidianos, defende-se, conclusivamente, o esforço coletivo de se operar com outras lógicas temporais no campo curricular contemporâneo.
A linha tênue entre mulher negra, educação escolar e profissão (Rio Grande do Norte, 1931-1963)
Authors: De Araujo Marta Maria , De Alcântara Paulo Basílio
Published: August 2022

Com a intenção de prosseguir na discussão sobre a escolarização das mulheres no Brasil, este estudo reflete acerca do alcance do direito à educação primária, principalmente de dez mulheres negras que estudaram no Rio Grande do Norte entre 1931 e 1963, em intersecção com a teia humana da origem social da família, os estudos escolares e as profissões. Metodologicamente, para análise do corpus documental (entrevistas semiestruturadas e documentos oficiais), faz-se uso do entendimento de direito à educação de Cury (2002), Chizzotti (2020) e Anísio Teixeira (2009), essencialmente por concebê-lo na amplitude da dimensão humana e social de cada pessoa. Em termos de conclusão, o corpus documental pesquisado revela que o direito à educação escolar das dez mulheres negras estudadas foi resultante da sociedade da escolarização, embora com oportunidades socioeducacionais limitadas e desiguais: uma parte delas (três), que estudou o ensino primário em fazendas, sítios e povoações, não prosseguiu os estudos para os níveis secundários seguintes, além de ter exercido profissões diferenciadas daquelas das sete mulheres que tiveram o direito à continuidade dos estudos em nível secundário (quatro) e universitário (três) no período em pauta.
Yara Lúcia Brayner Mattos: entre a política, a educação e a nutrição
Authors: Barreto Raylane Andreza Dias Navarro , Lima Gabrielly Cavalcanti de
Published: August 2022

Neste artigo, analisa-se a trajetória formativa e profissional da educadora, nutricionista e militante política pernambucana Yara Lúcia Brayner Mattos (1941–2005). A partir de pesquisa bibliográfica e documental, e com vistas a uma compreensão crítica do processo formativo que desembocou em sua militância no Partido Comunista Brasileiro (PCB) e na sua prisão durante o regime civil-militar, o que se buscou foi contribuir para o tecimento de uma história que reflete a atuação das mulheres a partir de sua relação com a política. A investigação, pautada por aspectos familiar, escolar, cultural e político, permitiu entender que sua participação em agremiações como a União dos Estudantes de Pernambuco, o Movimento de Cultura Popular e as Ligas Camponesas na década de 1960 a levou à militância no PCB como forma de resistência, de reivindicação dos direitos civis e de enfrentamento de um regime político autoritário e ditatorial.
Violência e o crime em legítima defesa: resistência e transgressão de Amélia dos Santos (1921)
Authors: Silva Araújo Alves Laura Maria , Da Silva Araújo Telmo Renato , Barreto Sabino Elianne
Published: August 2022

Este artigo analisa os autos do processo judicial de Amélia Moreira dos Santos, ocorrido em 1921, na cidade de Inhangapy, no estado do Pará. Amélia  ̶  mãe de dois filhos, pobre, sem instrução  ̶, foi acusada de matar seu companheiro Manoel Duarte Gomes. Vivendo uma relação abusiva e de violência, Amélia era considerada pelas testemunhas mulher trabalhadora, boa esposa, dedicada ao lar e aos filhos; já para a justiça uma pessoa desqualificada e sem índole para criar seus filhos. Amélia, a ré, vai a júri popular por três ocasiões sendo absolvida por legítima defesa. Amélia viveu em um contexto social que, apesar de estabelecer um discurso de moralidade a respeito da figura feminina, ainda reverberava o poder masculino. Além disso, um judiciário reprodutor de um discurso impositivo de conceitos e estereótipos de gênero. O caso criminal de Amélia acaba por revelar, de um lado, à violência sofrida por muitas mulheres na capital do Pará no início do século XX e, de outro lado, que elas não tinham chances de defesa e nenhuma política social de amparo contra a violência. Contudo, embora diante do patriarcalismo e uma justiça machista, Amélia resistiu e transgrediu as normas vigentes dando final a uma relação conjugal abusiva.
AS VÁRIAS FACES DA “GUERRA SANTA”: UMA ANÁLISE COMPARADA DA CONCEPÇÃO DE JIHAD DO ISLÃ POLÍTICO AO JIHADISMO
Authors: Maynard Dilton C.S , Sá Katty Cristina Lima
Published: August 2022

O presente artigo tem por objetivo analisar, através da perspectiva comparada, as concepções de jihad formuladas ao longo do século XX pelos islamitas Hassan al- Banna, Abul Ala Mawdudi, Sayyid Qutb, Abdullah Azzam e Osama Bin Laden. Nossas fontes para tanto serão os escritos produzidos por esses autores, a exemplo do folheto Jihad in Islam de Mawdudi, do livro Milestones de Qutb e das fatwas de Bin Laden. Como aporte teórico, utilizaremos a História dos Conceitos conforme proposto por Reinhart Koselleck, ao passo que nossa metodologia comparada seguirá os preceitos de Marc Bloch.  Ao final, exporemos a semelhanças e diferenças entre as concepções analisadas e como o conceito da ética muçulmana jihad foi transformado em um instrumento político,