bluuebunny/crossref_metadata_2025 huggingface dataset:
How do patients with secondary progressive multiple sclerosis enrolled in the EXPAND randomized controlled trial compare with those seen in German clinical practice in the NeuroTransData multiple sclerosis registry?
Authors: Braune Stefan , Bergmann Arnfin , Bezlyak Vladimir , Adlard Nicholas
Published: August 2022

Background

In EXPAND (NCT01665144), a phase 3 randomized clinical trial, siponimod reduced disability progression versus placebo in patients with secondary progressive multiple sclerosis (SPMS).

Aim

To understand how a real-world population with SPMS relates to that in EXPAND, we conducted a retrospective, observational cohort study using the German NeuroTransData (NTD) multiple sclerosis (MS) registry.

Methods

The NTD MS registry is run by a Germany-wide network of physicians. Two cross-sectional analyses were performed using the NTD MS registry. The first included patients with SPMS, as recorded in the registry, and compared their characteristics between 1 January 2018 and 31 December 2018 with patients in EXPAND. The second described the characteristics of patients in the registry at the time of diagnosis of SPMS between 1 January 2010 and 31 December 2018.

Results

The first analysis included 773 patients: patients were older in the NTD MS registry than in EXPAND (mean age, 57.9 vs 48.0 years) and had a longer duration of SPMS (mean, 6.2 vs 3.8 years). In the NTD MS registry, median Expanded Disability Status Scale (EDSS) scores were comparable to EXPAND (6.0 versus 6.0), although fewer patients had relapses in the previous 24 months (16% vs 36% [siponimod] and 37% [placebo]). Data on gadolinium-enhancing lesions were only available for 5.8% of patients in the NTD MS registry. The second analysis included 916 patients: at the time of SPMS diagnosis, the mean age was 53.2 years and the median EDSS score was 5.0.

Conclusion

The population in the NTD MS registry was older to that in EXPAND, but were similar in terms of disability. Differences likely reflect the inclusion criteria of EXPAND but also highlight that real-world populations encompass a wider range of patient characteristics.
Bodies in Balance: Tracking Type 1 Diabetes
Authors: Mialet Hélène
Published: August 2022

This article explores through the lens of Type 1 Diabetes what a body in fluctuation feels, and what kind of ecosystem has to be recreated to be able to survive, an ecosystem made of sensations, senses, sensors and more. It investigates the complexity of relying on sensations that appear or disappear, on other beings that have their own agendas, or on machines that could help or kill. It describes the fear of feeling estranged from one’s ‘extended body’ when it functions alone, it tracks the experience of low blood sugar through the memory of the body or the instruments left in its surroundings. It is a story about the fiction of bodily integrity, of the combat between life and death, and of the impossibility of controlling the texture of life.
Redefining engineering for early childhood educators through professional development
Authors: Xu Tingting , Jack Lexa
Published: August 2022

This study examined the impact of an intensive professional development series on early childhood educators’ content knowledge of engineering and their self-efficacy towards teaching engineering. Seventeen early childhood teachers participated and responded to questionnaires, surveys, and focus-group interviews before and after the professional development. The results show that these early childhood educators significantly (1) increased their knowledge of engineering; (2) improved their engineering teaching self-efficacy; and (3) enhanced their confidence level towards teaching engineering for young children. This study is important because it provides an example of an effective approach to enhance early childhood teachers’ preparation in teaching engineering activities for young children. It also sheds light on the urgency to improve overall teacher preparation and continuous education in science, technology, engineering, and mathematics for young children.
Characterization of the microstructure and mechanical properties of activated tungsten inert gas welded and hot-wire tungsten inert gas welded super austenitic stainless steel AISI 904L
Authors: Sunny Kora T , Korra Nanda Naik , Muthukumaran Vasudevan , Arivazhagan Baksha
Published: August 2022

Super austenitic stainless steel AISI 904L is a premium stainless steel variant known for its superior properties and ability to retain the same in highly challenging conditions. This study investigates the feasibility of welding 10-mm thick plates of AISI 904L through activated tungsten inert gas welding and hot-wire tungsten inert gas welding methods. The fabricated joints are then subjected to solidification mode study, ferrite number analysis, microstructural characterization, and mechanical tests. Results of the solidification mode study indicated primary austenitic solidification in both the weld joints. The ferrite number measurement revealed that the hot-wire tungsten inert gas weld joint had a higher δ-ferrite content of 1.58 over 0.99 of the activated tungsten inert gas weld joint. A microstructure study confirmed the presence of refined equiaxed grains in the fusion zone of the hot-wire tungsten inert gas weld joint, while the activated tungsten inert gas weld joint displayed equiaxed grains crammed between the columnar grains and dendrites. Liquid penetrant inspection of bend-tested samples proved the soundness and quality of both weld joints. The hot-wire tungsten inert gas weld joint excelled over the activated tungsten inert gas weld joint with a higher microhardness value. During tensile tests, activated tungsten inert gas and hot-wire tungsten inert gas weld joints displayed average ultimate tensile strength values of 521 and 514 MPa, respectively. The impact toughness of the activated tungsten inert gas weld joint was 248 J, while it was 220 J for the hot-wire tungsten inert gas weld joint. Field emission scanning electron microscope analysis equipped with energy-dispersive spectroscopy and elemental color mapping provided details about weld microstructure and the reasons for the material's failure. The study proved the efficiency and soundness of the 10-mm thick joints of AISI 904L fabricated by activated tungsten inert gas and hot-wire tungsten inert gas welding techniques.
Multi-material printing of PVDF composites: A customized solution for maintenance of heritage structures
Authors: Kumar Vinay , Singh Rupinder , Ahuja Inderpreet Singh
Published: August 2022

In the past three decades, 3D printing technologies have emerged as a convenient tool for the repair and maintenance of heritage structures. But hitherto little has been reported on multi-material 3D printed composites with 4D properties for the repair and maintenance of heritage structures. The present study reports the investigations on multi-material 3D printing of conducting and non-conducting polyvinylidene fluoride (PVDF) composite layers with self-actuating and self-healing properties to repair non-structural cracks in heritage buildings. The non-conducting (PVDF-CaCO3) and conducting (PVDF-graphene-Mn doped ZnO) composites were 3D printed and tested for electrostriction-based strain measurement for 4D analysis. The thermo-mechanical properties of the composite solution were obtained from dynamic mechanical analysis (DMA). The electrical, bonding, and morphological properties were investigated by current-voltage (I-V), x-ray diffraction (XRD), Fourier transformed infrared (FTIR), and scanning electron microscopy (SEM)-energy dispersive spectroscopy (EDS) analysis. Results of the self-elongation and contraction by electrostriction in PVDF composite demonstrate the feasibility of 3D printing technology as a novel tool to fabricate cost-effective smart solutions for the repair and maintenance of heritage structures.
A novel adaptive fault diagnosis algorithm for multi-machine equipment: application in bearing and diesel engine
Authors: Liu Yangshuo , Kang Jianshe , Bai Yunjie , Guo Chiming
Published: August 2022

This paper proposes an adaptive fault diagnosis algorithm based on vibration signals for fault diagnosis of bearings and diesel engines. First, the improved nonlinear gray wolf optimization algorithm (NGWO) is adopted to optimize the key parameter for variational mode decomposition (VMD) with the power spectral entropy as the fitness value. Meanwhile, adaptive noise reduction of the signal is realized. Then, sensitive fault features of bearings and diesel engines are selected through a feature sensitivity analysis on the vibration signals. Also, a single-layer sparse autoencoder is used to align the feature dimensions of each type of data to construct feature matrix samples. Subsequently, a deep neural network (DNN) consisting of a two-layer stacked sparse autoencoder (SSAE) and a Softmax classification layer is constructed to realize failure mode recognition. During the training process of DNN, a surrogate model formed by NGWO and a back propagation neural network is employed to optimize the hyperparameters of SSAE. Finally, to verify the effectiveness of the proposed fault diagnosis algorithm, fault diagnosis experiments are conducted on the fault data set of bearings and diesel engines. The diagnosis results show that the proposed method achieves high-precision fault diagnosis for bearings and diesel engines and performs stably for small samples.
Flicker: A review of temporal light modulation stimulus, responses, and measures
Authors: Miller NJ , Leon FA , Tan J , Irvin L
Published: August 2022

Flicker has been an important lighting system consideration for over a century. More precise terms are temporal light modulation (TLM) as the stimulus, and responses to TLM as the unwanted visual, cognitive, or physiological consequences. As lighting technology evolved, different forms of TLM emerged, and so did responses to them. Today, some LED systems – encompassing the LED, driver, and control – can result in TLM causing severe unwanted effects, while other LED systems produce no unwanted effects at all. LED systems can deliver a much wider range of luminous waveforms than conventional lighting systems, some exhibiting very high modulation depths. More than any light source before, they can elicit perceptions of the phantom array. Direct flicker effects at modulation frequencies less than about 80 Hz and the stroboscopic effect at frequencies greater than 80 Hz are fairly well understood, but the phantom array effect needs more exploration and characterisation. This review focuses on the technology and research history that led to current metrics for quantifying TLM and human responses to TLM. Visually impaired individuals may exhibit alterations in their response to TLM, but such a discussion is beyond the intent of this review. Thus, the focus is on individuals with normal visual function.
Financial incentives and moral distress in Australian audiologists and audiometrists
Authors: Simpson Andrea , Fawcett Meg , McLeod Lily , Lin Jennifer , Tuncer Selda , Sarkic Bojana
Published: August 2022

Introduction

Financial incentive schemes have been commonly used by the hearing aid industry as a way of encouraging device sales. These schemes can lead to a conflict of interest as the hearing device dispenser is torn between personal reward over the best interests of their client. This conflict of interest has the potential for the dispenser to develop “moral distress”, a negative state of mind when an individual’s ethical values contrast with those of the employing organization. The purpose of this study was to investigate if there was a relationship between financial incentives and moral distress in Australian audiologists and audiometrists.

Methods

An online survey was distributed to all members of Audiology Australia and the Australian College of Audiology via email. Participants rated their perceived moral distress from 0 to 10 on the Moral Distress Thermometer and answered four questions about financial incentives in their respective workplace.

Results

A total of 65 participants, 42 females and 23 males, completed the online survey. A quarter of participants rated their moral distress corresponding to levels of uncomfortable or above. A statistically significant association was found between financial incentives, sales target setting, and higher perceived moral distress in participants.

Conclusions

For our sample, the implementation of financial incentives created ethical challenges for practicing audiologists and audiometrists. Modifications to employee rewards programs as well as a regulation of device sales are recommended.
“Invisible in the Most Tragic of Ways”: Exploring Internalized Transphobia and Coping Through Photovoice
Authors: Owens Trenton K. , Mizock Lauren , Ormerod Alayne J. , Nelson Annabelle , St. Amand Colt , Paces-Wiles Diane , Judd Terrence D.
Published: August 2022

Transgender and gender diverse (TGD) individuals experience minority stress that includes internalizing the negative attitudes that exist in society about those whose identities rest outside of the gender binary. The purpose of this study was to gain a better understanding of the experience of internalized stigma and associated coping methods among six TGD adults utilizing photovoice. Thematic and iconographic analysis of 35 works produced by the participants revealed themes involving metaphors for internalized transphobia, internalized social messages, the psychological debt or emotional cost of internalized transphobia, and a range of coping strategies. Specifically, invisibility was a common metaphor used to suggest that a TGD person’s experience may be associated with actively hiding, masking their identity, or failing to be seen as their true self. Participants expressed concern with being accepted by others and noted anxiety about outward expressions of their gender and personal characteristics. The results also revealed that participants experienced loneliness, fear of rejection, and low self-esteem related to internalized transphobia and their TGD identities. Participants reported receiving messages that TGD individuals are often viewed negatively and generally lack support from society and close relations. Coping strategies utilized by participants included withdrawing from others, hiding their TGD identity to avoid rejection or violence, self-exploration, accepting self and others, and connecting to a community of TGD persons and/or allies. Focus group feedback revealed benefits to participants, including an enhanced sense of community and self-esteem, as well as recommendations for future group structure. Implications and future research directions are discussed.
Relationships Among Environmental Variables, Physical Capacity, Balance Self-Efficacy, and Real-World Walking Activity Post-Stroke
Authors: Miller Allison , Pohlig Ryan T. , Reisman Darcy S.
Published: August 2022

Background:

Social and physical environmental factors affect real-world walking activity in individuals with stroke. However, environmental factors are often non-modifiable, presenting a challenge for clinicians working with individuals with stroke whose real-world walking is limited due to environmental barriers.

Objective:

The purpose of this work was to test a model hypothesizing the relationships among environmental factors (specifically, living situation and area deprivation), modifiable factors, and real-world walking activity to understand opportunities for intervention. We hypothesized that balance self-efficacy would mediate the relationship between the environment and real-world walking and that physical capacity would moderate this mediation.

Methods:

This was a cross-sectional study of 282 individuals with chronic (≥6 months) stroke. We tested the indirect effect to determine if mediation was present. Multiple group structural equation modeling was used to test if physical capacity moderated this mediation. A χ2 difference test was used to compare the moderation model against the null (no moderation) model.

Results:

Balance self-efficacy mediated the relationship between area deprivation and real-world walking (indirect effect: β = −0.04, P = .04). Both the moderation and null models fit the data equally well statistically (χ2(5) = 6.9, P = .23). We therefore accepted the simpler (null) model and concluded that the mediation was not moderated.

Conclusions:

Targeting balance self-efficacy may be an effective approach to improving real-world walking in persons with stroke who experience barriers within the physical environment. A stroke survivor’s physical capacity may not impact this approach. Future work should consider utilizing more specific measures of the social and physical environment to better understand their influences on real-world walking activity in individuals with stroke. However, the results of this work provide excellent targets for future longitudinal studies targeting real-world walking activity in stroke.
Open-set low-shot classification leveraging the power of instance discrimination
Authors: Kasapis Spiridon , Zhang Geng , Smereka Jonathon M , Vlahopoulos Nickolas
Published: August 2022

In search, exploration, and reconnaissance operations of autonomous ground vehicles, an image recognition capability is needed for specifically classifying targeted objects (relevant classes) and at the same time identifying as unknown (irrelevant and unseen) objects that do not belong to any known classes, as opposed to falsely classifying them in one of the relevant classes. This paper integrates an unsupervised learning feature extraction framework based on the Instance Discrimination method with an Open-Set Low-Shot (IDLS) classifier for creating the desired new capability. Unlabeled images from the vehicle’s operating environment are used for training the feature extractor while a modest number (less than 40) images for each relevant class and unlabeled irrelevant images are used for training the Open-Set Low-Shot (OSLS) classifier in a manner that enables recognition of images unseen during training as irrelevant. The value and the accuracy of the new IDLS approach are demonstrated through a thorough comparison with alternative unsupervised and fully supervised methods.
Is epilepsy related to psychiatric disorders in people with intellectual disability? A systematic review
Authors: Peña-Salazar Carlos , Alfonso-Ramos Miqueu , Arroyo-Uriarte Paula , Serrano-Blanco Antoni , Aznar-Lou Ignacio
Published: August 2022

The prevalence of psychiatric disorders in people with Intellectual Disability (ID) is statistically higher than in the general population. There is a lack of consensus on the role that epilepsy plays in psychiatric disorders in people with ID. We carried out a systematic review of articles published between 1960 and 2022, focusing on high-quality, case-control original research studies that only included adult populations. The primary outcome was the prevalence of psychiatric disorders in people with intellectual disability with and without epilepsy. Six articles were finally included. Results were varied; some reported a statistical increase, whereas others did not find any statistical difference. Due to the current controversy on the role of epilepsy in psychiatric disorders in people with ID and the small number of publications on the topic, we cannot affirm a relationship between epilepsy and psychiatric disorders in people with ID.
Epidemiology of shoulder instability procedures: A comprehensive analysis of complications and costs
Authors: Best Matthew J , Wang Kevin Y , Nayar Suresh K , Agarwal Amil R , Kreulen R Timothy , Sharma Sribava , McFarland Edward G , Srikumaran Uma
Published: August 2022

Background

Recurrent shoulder instability is a debilitating condition that can lead to chronic pain, decreased function, and inability to return to activities or sport. This retrospective epidemiology study was performed to report 90-day postoperative complications and costs of Latarjet, anterior bone block reconstruction, arthroscopic, and open Bankart repair for shoulder instability.

Methods

Patients 18 years and older who underwent four primary shoulder surgeries from 2010 to 2019 were identified using national claims data. Patient demographics, comorbidities, and 90-day postoperative complications were analyzed using univariate analysis and multivariable logistic regression. Total and itemized 90-day reimbursements were determined for each procedure.

Results

The 90-day medical and surgery-specific complication rates were highest for anterior bone block reconstruction, followed by Latarjet. Arthroscopic Bankart repair had the highest 90-day costs and primary procedure costs compared to other procedures.

Conclusion

Anterior bone block reconstruction and Latarjet procedures were associated with the highest rates of 90-day medical and surgery-specific complications, while arthroscopic Bankart repair was associated with the highest costs.
Utterance chains: A dialogic route to speculative thinking-with toddlers in the Chthulucene
Authors: White E. Jayne
Published: August 2022

Sustained shared thinking dialogues which focus on teacher talk with preschool learners have long been considered an important route to learning progression. Toddlers, however, seldom engage in dialogues through talk alone, and their encounters are often fleeting. As a consequence, they are often positioned on the periphery of learning dialogues that are granted primacy in the Capitalocene, because they must first acquire adult forms of communication and their meanings before thought becomes possible. Viewed from a dialogic standpoint, however, toddlers offer important clues to co-constituted meaning-making through subtle, fleeting, embodied and interconnected language acts. When stitched together across time and space and in speculative, apperceptive, contemplation of their strategic orientation, these seemingly random utterances can act as a source of shared thinking through interanimating chains of thought that implicate teachers as well as toddlers. In the paper that follows, utterance chains are brought to life through curated video and dialogue with Aotearoa New Zealand teachers who, sought to ‘think with’ toddlers in ECE settings. Paying attention to interconnecting links in meaning across language acts over time and space, utterance chains invoked apperceptive engagement with language and thought. These discoveries invite teachers to expand communicative repertoires to ‘think with’ young learners as optimistic encounters of ‘making-with’ bestowals in and for the Chthulucene.
Patient and clinician experiences of remote consultation during the SARS-CoV-2 pandemic: A service evaluation
Authors: Schutz Sue , Walthall Helen , Snowball Joanna , Vagner Raluca , Fernandez Nicola , Bartram Emilia , Merriman Clair
Published: August 2022

Objectives

During the SARS-CoV-2 pandemic, clinicians were instructed to move all but emergency consultations to remote means to reduce the spread of the virus. The aim of this study was to evaluate patients’ and clinicians’ experiences of moving to remote means of consultation with their health care professionals during the SARS-CoV-2 pandemic.

Methods

The study design was a qualitative service evaluation. Twenty-six clinicians and forty-eight patients who met the inclusion criteria consented to be interviewed. Clinician participants were from either medical, nursing, or allied health professional backgrounds. Patients were recruited from diabetes, acute care, and haematology and cancer areas. Data analysis was conducted using a thematic analysis framework.

Results

Following coding and thematic analysis of the data collected from clinicians, five themes were identified: personal and professional well-being; providing a safe and high-quality experience; adapting to a new way of working; making remote consultations fit for purpose and an awareness of altered dynamics during consultation. Patient data was coded into 3 themes: remote consultation adds value; remote consultation brings challenges and concerns about remote consultation.

Conclusions

Clinician and patient experiences reported here are reflected in the literature. The study indicates that remote consultation is not suitable for all patients and in all contexts. Whilst maintaining the benefits to patients, remote means of consultation needs organisational support and preparation. A way forward that maintains the benefits whilst addressing concerns seems urgent.
Overall and patient-level comparative effectiveness of dimethyl fumarate and fingolimod: A precision medicine application to the Observatoire Français de la Sclérose en Plaques registry
Authors: Simoneau Gabrielle , Jiang Xiaotong , Rollot Fabien , Tian Lu , Copetti Massimiliano , Guéry Matthieu , Ruiz Marta , Vukusic Sandra , de Moor Carl , Pellegrini Fabio ,   on behalf of OFSEP investigators
Published: August 2022

Background

Comparing real-world effectiveness and tolerability of therapies for relapsing-remitting multiple sclerosis is increasingly important, though average treatment effects fail to capture possible treatment effect heterogeneity. With the clinical course of the disease being highly heterogeneous across patients, precision medicine methods enable treatment response heterogeneity investigations.

Objective

To compare real-world effectiveness and discontinuation profiles between dimethyl fumarate and fingolimod while investigating treatment effect heterogeneity with precision medicine methods.

Methods

Adults initiating dimethyl fumarate or fingolimod as a second-line therapy were selected from a French registry. The primary outcome was annualized relapse rate at 12 months. Seven secondary outcomes relative to discontinuation and disease progression were considered. A precision medicine framework was used to characterize treatment effect heterogeneity.

Results

Annualized relapse rates at 12 months were similar for dimethyl fumarate and fingolimod. The odd of treatment persistence was 47% lower for patients treated with dimethyl fumarate relative to those treated with fingolimod (odds ratio: 0.53, 95% confidence interval: 0.39, 0.70). None of the five precision medicine scoring approaches identified treatment heterogeneity.

Conclusion

These findings substantiated the similar effectiveness and different discontinuation profiles for dimethyl fumarate and fingolimod as a second-line therapy for relapsing-remitting multiple sclerosis, with no significant effect heterogeneity observed.
“We Are the Heartbeat of the School”: How School Counselors Supported Student Mental Health During the COVID-19 Pandemic
Authors: Alexander Emily R. , Savitz-Romer Mandy , Nicola Tara P. , Rowan-Kenyon Heather T. , Carroll Stephanie
Published: August 2022

The COVID-19 pandemic and the shift to online learning exacerbated the mental health needs of children and adolescents, especially among minoritized students who were disproportionately impacted by the virus. Although the pandemic has increased the demand for counseling, research finds that school counselors are often hindered by organizational constraints. Using organizational role theory, this study examined school counselors’ perceptions of their role delivering mental health supports during the pandemic. Findings indicate that school counselors reported an increased need for counseling, but faced multiple barriers to supporting students, leaving those who most needed the support particularly vulnerable.
An Investigation of How School Counselors Adapted Their Delivery Due to COVID-Induced Disparities
Authors: Limberg Dodie , Villares Elizabeth , Gonzales Shelby , Starrett Angie , Rosen Nadiya
Published: August 2022

We utilized a mixed-methods design to understand how a national sample of 589 school counselors adapted their approach to address K–12 students’ academic, social/emotional, and career development during the COVID-19 pandemic. More specifically, we examined how COVID-19–induced disparities influenced school counselors’ delivery of services. We identified six themes using thematic analysis and conducted a t test to further understand what services and strategies counselors were actively using 6 months after the onset of COVID-19. Our findings suggest that school counselors continued to adjust their comprehensive school counseling programs to address pandemic-induced disparities.
Tiered Supports for the Class of 2021 in Unprecedented Times: A High School Counseling Department’s Journey
Authors: Tillery Christina A. , Crane Erin , Goodman-Scott Emily
Published: August 2022

The impact of COVID-19 and the racial awakening of the United States intensified the inequities already present in many K–12 schools. Authors report a practitioner-focused case study of a high school counseling department integrating multitiered systems of support (MTSS) into their comprehensive school counseling program during the 2020–2021 school year, in response to both a global pandemic and the racial justice movement. Authors describe school counselors’ passionate commitment to supporting the school and department goal of increased graduation rate for the graduating class of 2021 in the midst of navigating virtual learning, racial and ethnic disparities, and lack of resources.
Parentification as a Social Determinant of Health: Implications for School Counselors
Authors: Higdon Kathryn L. , Rumsey Amanda D. , Swisher Sierra C.
Published: August 2022

Parentification has been found to impact both the short- and long-term physical, mental, and social/emotional well-being of children and adolescents and can be viewed as a social determinant of health. The COVID-19 pandemic has only compounded these effects. We demonstrate how school counselors are uniquely positioned to identify and assist parentified students. Using a multitiered approach, we suggest school counseling strategies and interventions that support this vulnerable group of students.
Exploring COVID-19-Related Educational Disruption of Early Elementary Students and Their Families: A School Counselor Case Example
Authors: Randolph Amber L. , Wirth Kirsten J.
Published: August 2022

The COVID-19 pandemic has caused myriad issues for early elementary students and their families. Those early in their educational careers, particularly pre-K–2 students, are especially vulnerable developmentally to abrupt disruptions. School counselors, in turn, are being called upon to respond to crises and provide trauma-informed care for these students and their families, often virtually. This article explores COVID-19-related educational disruption of early elementary students, their families, and school counselors through the use of a case example.
Two faces of discontent in Italy: One looking to the North and one to the South
Authors: Chaykina Maria , Cuccu Liliana , Pontarollo Nicola
Published: August 2022

In this paper, we analyse the spatial distribution of anti-EU and populist vote across Italian municipalities. A clear geographical divide is found, with northern municipalities supporting anti-EU parties and southern ones the populist parties. This knowledge is fundamental for the development of effective place-specific policies.
Endoscopic Treatment of Anastomotic Complications
Authors: Durrani Hamza , White Peter T
Published: August 2022

Anastomotic complications following esophagectomy can be challenging to manage with increased morbidity and mortality. Endoscopic interventions can play a key role in controlling extra-esophageal soilage and promoting anastomotic leak healing. Endoscopic stenting, endoluminal vacuum therapy and clipping are all viable options in appropriately selected patients, and should be included alongside re-operative surgical intervention as an important tool in the armamentarium of an esophageal surgeon. Similarly, endoscopic dilation via balloon or bougie dilators, as well as stent placement in the appropriate setting, are useful tools for providers who manage patients with post-anastomotic leak esophageal strictures.
What If Endoscopic Eradication Therapy for Esophageal Neoplasia Is Not Good Enough?
Authors: Watson Thomas J.
Published: August 2022

Endoscopic eradication therapies have become the standard of care for most cases of Barrett’s esophagus with high-grade dysplasia or intramucosal adenocarcinoma, largely replacing esophagectomy. While associated with high rates of complete elimination of dysplastic mucosa and superficially invasive esophageal cancer, as well as an excellent complication profile, endoscopic eradication requires strict adherence to established diagnostic and treatment protocols as well as disciplined follow-up. Even with appropriate attention to detail, esophageal neoplasia can persist or recur following endoscopic resection or ablation. The managing physician must remain cognizant of the limitations of endoscopic approaches and consider surgical alternatives to treatment when they fail or are exceeded. Esophagectomy, performed at experienced centers on appropriately selected patients with early-stage neoplasia, can be undertaken with the expectation of cure, low perioperative mortality, acceptable morbidity, and good long-term quality of life. Prompt surgical referral should occur when endoscopic eradication has been ineffective so as not to deprive the patient with early esophageal neoplasia the chance of cure.
Single-cell analysis of acute lymphoblastic and lineage-ambiguous leukemia: approaches and molecular insights
Authors: Iacobucci Ilaria , Witkowski Matthew T. , Mullighan Charles G.
Published: August 2022

Despite recent progress in identifying the genetic drivers of acute lymphoblastic leukemia (ALL), prognosis remains poor for those individuals who experience disease recurrence. Moreover, acute leukemias of ambiguous lineage lack a biologically informed framework to guide classification and therapy. These needs have driven the adoption of multiple complementary single-cell sequencing approaches to explore key issues in the biology of these leukemias, including cell of origin, developmental hierarchy and ontogeny, and the molecular heterogeneity driving pathogenesis, progression, and therapeutic responsiveness. There are multiple single-cell techniques for profiling a specific modality, including RNA, DNA, chromatin accessibility and methylation; and an expanding range of approaches for simultaneous analysis of multiple modalities. Single-cell sequencing approaches have also enabled characterization of cell-intrinsic and -extrinsic features of ALL biology. In this review we describe these approaches and highlight the extensive heterogeneity that underpins ALL gene expression, cellular differentiation, and clonal architecture throughout disease pathogenesis and treatment resistance. In addition, we discuss the importance of the dynamic interactions that occur between leukemia cells and the nonleukemia microenvironment. We discuss potential opportunities and limitations of single-cell sequencing for the study of ALL biology and treatment responsiveness.
Development of the International Classification of Diseases Ontology (ICDO) and its application for COVID-19 diagnostic data analysis
Authors: Wan Ling , Song Justin , He Virginia , Roman Jennifer , Whah Grace , Peng Suyuan , Zhang Luxia , He Yongqun
Published: August 2022

Background

The 10th and 9th revisions of the International Statistical Classification of Diseases and Related Health Problems (ICD10 and ICD9) have been adopted worldwide as a well-recognized norm to share codes for diseases, signs and symptoms, abnormal findings, etc. The international Consortium for Clinical Characterization of COVID-19 by EHR (4CE) website stores diagnosis COVID-19 disease data using ICD10 and ICD9 codes. However, the ICD systems are difficult to decode due to their many shortcomings, which can be addressed using ontology.

Methods

An ICD ontology (ICDO) was developed to logically and scientifically represent ICD terms and their relations among different ICD terms. ICDO is also aligned with the Basic Formal Ontology (BFO) and reuses terms from existing ontologies. As a use case, the ICD10 and ICD9 diagnosis data from the 4CE website were extracted, mapped to ICDO, and analyzed using ICDO.

Results

We have developed the ICDO to ontologize the ICD terms and relations. Different from existing disease ontologies, all ICD diseases in ICDO are defined as disease processes to describe their occurrence with other properties. The ICDO decomposes each disease term into different components, including anatomic entities, process profiles, etiological causes, output phenotype, etc. Over 900 ICD terms have been represented in ICDO. Many ICDO terms are presented in both English and Chinese. The ICD10/ICD9-based diagnosis data of over 27,000 COVID-19 patients from 5 countries were extracted from the 4CE. A total of 917 COVID-19-related disease codes, each of which were associated with 1 or more cases in the 4CE dataset, were mapped to ICDO and further analyzed using the ICDO logical annotations. Our study showed that COVID-19 targeted multiple systems and organs such as the lung, heart, and kidney. Different acute and chronic kidney phenotypes were identified. Some kidney diseases appeared to result from other diseases, such as diabetes. Some of the findings could only be easily found using ICDO instead of ICD9/10.

Conclusions

ICDO was developed to ontologize ICD10/10 codes and applied to study COVID-19 patient diagnosis data. Our findings showed that ICDO provides a semantic platform for more accurate detection of disease profiles.
SEMplMe: a tool for integrating DNA methylation effects in transcription factor binding affinity predictions
Authors: Nishizaki Sierra S. , Boyle Alan P.
Published: August 2022

Motivation

Aberrant DNA methylation in transcription factor binding sites has been shown to lead to anomalous gene regulation that is strongly associated with human disease. However, the majority of methylation-sensitive positions within transcription factor binding sites remain unknown. Here we introduce SEMplMe, a computational tool to generate predictions of the effect of methylation on transcription factor binding strength in every position within a transcription factor’s motif.

Results

SEMplMe uses ChIP-seq and whole genome bisulfite sequencing to predict effects of methylation within binding sites. SEMplMe validates known methylation sensitive and insensitive positions within a binding motif, identifies cell type specific transcription factor binding driven by methylation, and outperforms SELEX-based predictions for CTCF. These predictions can be used to identify aberrant sites of DNA methylation contributing to human disease.

Availability and Implementation

SEMplMe is available from https://github.com/Boyle-Lab/SEMplMe.
Effects of silicon application on leaf structure and physiological characteristics of Glycyrrhiza uralensis Fisch. and Glycyrrhiza inflata Bat. under salt treatment
Authors: Shen Zihui , Cheng Xiaojiao , Li Xiao , Deng Xianya , Dong Xiuxiu , Wang Shaoming , Pu Xiaozhen
Published: August 2022

Background

Soil salinization leads to a significant decline in crop yield and quality, including licorice, an important medicinal cash crop. Studies have proofed that the application of exogenous silicon can significantly improve the ability of licorice to resist salt stress, however, few studies concentrated on the effects of foliar silicon application on the morphology, physiological characteristics, and anatomical structure of licorice leaves under salt stress. In this study, the effects of Si (K2SiO3) on the structural and physiological characteristics of Glycyrrhiza uralensis Fisch. and G. inflata Bat. leaves under different salt concentrations (medium- and high-salt) were studied.

Results

Compared with the control (without salt), the plant height, total dry weight, leaf area, leaf number, relative water content, xylem area, phloem area, ratio of palisade to spongy tissue, gas exchange parameters, and photosynthetic pigment content of both licorice varieties were significantly reduced under high-salt (12S) conditions. However, the thickness of the leaf, palisade tissue, and spongy tissue increased significantly. Applying Si to the leaf surface increased the area of the vascular bundle, xylem, and parenchyma of the leaf’s main vein, promoted water transportation, enhanced the relative leaf water content, and reduced the decomposition of photosynthetic pigments. These changes extended the area of photosynthesis and promoted the production and transportation of organic matter. G. uralensis had a better response to Si application than did G. inflata.

Conclusions

In conclusion, foliar application of Si can improve water absorption, enhance photosynthesis, improve photosynthetic capacity and transpiration efficiency, promote growth and yield, and alleviate the adverse effects of salt stress on the leaf structure of the two kinds of licorice investigated.
A comparison of statistical methods for modeling count data with an application to hospital length of stay
Authors: Fernandez Gustavo A. , Vatcheva Kristina P.
Published: August 2022

Background

Hospital length of stay (LOS) is a key indicator of hospital care management efficiency, cost of care, and hospital planning. Hospital LOS is often used as a measure of a post-medical procedure outcome, as a guide to the benefit of a treatment of interest, or as an important risk factor for adverse events. Therefore, understanding hospital LOS variability is always an important healthcare focus. Hospital LOS data can be treated as count data, with discrete and non-negative values, typically right skewed, and often exhibiting excessive zeros. In this study, we compared the performance of the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) regression models using simulated and empirical data.

Methods

Data were generated under different simulation scenarios with varying sample sizes, proportions of zeros, and levels of overdispersion. Analysis of hospital LOS was conducted using empirical data from the Medical Information Mart for Intensive Care database.

Results

Results showed that Poisson and ZIP models performed poorly in overdispersed data. ZIP outperformed the rest of the regression models when the overdispersion is due to zero-inflation only. NB and ZINB regression models faced substantial convergence issues when incorrectly used to model equidispersed data. NB model provided the best fit in overdispersed data and outperformed the ZINB model in many simulation scenarios with combinations of zero-inflation and overdispersion, regardless of the sample size. In the empirical data analysis, we demonstrated that fitting incorrect models to overdispersed data leaded to incorrect regression coefficients estimates and overstated significance of some of the predictors.

Conclusions

Based on this study, we recommend to the researchers that they consider the ZIP models for count data with zero-inflation only and NB models for overdispersed data or data with combinations of zero-inflation and overdispersion. If the researcher believes there are two different data generating mechanisms producing zeros, then the ZINB regression model may provide greater flexibility when modeling the zero-inflation and overdispersion.
What next for the polyclinic? New models of primary health care are required in many former Soviet Union countries
Authors: Edwards Nigel , Sheiman Igor
Published: August 2022

Background

There is unfinished reform in primary care in Russia and other former Soviet Union (FSU) countries. The traditional ‘Semashko’ multi-specialty polyclinic model has been retained, while its major characteristics are increasingly questioned. The search for a new model is on a health policy agenda. It is relevant for many other countries.

Objectives

In this paper, we explore the strengths and weaknesses of the multi-specialty polyclinic model currently found in Russia and other FSU countries, as well as the features of the emerging multi-disciplinary and large-scale primary care models internationally. The comparison of the two is a major research question. Health policy implications are discussed.

Methods

We use data from two physicians’ surveys and recent literature to identify the characteristics of multi-specialty polyclinics, indicators of their performance and the evaluation in the specific country context. The review of the literature is used to describe new primary care models internationally.

Results

The Semashko polyclinic model has lost some of its original strengths due to the excessive specialization of service delivery. We demonstrate the strengths of extended practices in Western countries and conclude that FSU countries should “leapfrog” the phase of developing solo practices and build a multi-disciplinary model similar to the extended practices model in Europe. The latter may act as a ‘golden mean’ between the administrative dominance of the polyclinic model and the limited capacity of solo practices. The new model requires a separation of primary care and outpatient specialty care, with the transformation of polyclinics into centers of outpatient diagnostic and specialty services that become part of hospital services while working closely with primary care.

Conclusion

The comprehensiveness of care in a big setting and potential economies of scale, which are major strengths of the polyclinic model, should be retained in the provision of specialty care rather than primary care. Internationally, there are lessons about the risks associated with models based on narrow specialization in caring for patients who increasingly have multiple conditions.
Co-infection and enterovirus B: post EV-A71 mass vaccination scenario in China
Authors: Guo Wei , Xu Danhan , Cong Shanri , Du Zengqing , Li Li , Zhang Ming , Feng Changzeng , Bao Guohong , Sun Hao , Yang Zhaoqing , Ma Shaohui
Published: August 2022

Background

Hand, foot, and mouth disease (HFMD) is a common child infectious disease caused by more than 20 enterovirus (EV) serotypes. In recent years, enterovirus A71 (EV-A71) has been replaced by Coxsackievirus A6 (CV-A6) to become the predominant serotype. Multiple EV serotypes co-circulate in HFMD epidemics, and this study aimed to investigate the etiological epidemic characteristics of an HFMD outbreak in Kunming, China in 2019.

Methods

The clinical samples of 459 EV-associated HFMD patients in 2019 were used to amplify the VP1 gene region by the three sets of primers and identify serotypes using the molecular biology method. Phylogenetic analyses were performed based on the VP1 gene.

Results

Three hundred and forty-eight cases out of 459 HFMD patients were confirmed as EV infection. Of these 191 (41.61%) were single EV infections and 34.20% had co-infections. The EVs were assigned to 18 EV serotypes, of which CV-A6 was predominant (11.33%), followed by CV-B1 (8.93%), CV-A4 (5.23%), CV-A9 (4.58%), CV-A 16 (3.49%) and CV-A10 and CVA5 both 1.96%. Co-infection of CV-A6 with other EVs was present in 15.25% of these cases, followed by co-infection with CV-A16 and other EVs. The VP1 sequences used in the phylogenetic analyses showed that the CV-A6, CV-B1 and CV-A4 sequences belonged to the sub-genogroup D3 and genogroups F and E, respectively.

Conclusion

Co-circulation and co-infection of multiple serotypes were the etiological characteristic of the HFMD epidemic in Kunming China in 2019 with CV-A-6, CV-B1 and CV-A4 as the predominant serotypes. This is the first report of CV-B1 as a predominant serotype in China and may provide valuable information for the diagnosis, prevention and control of HFMD.