bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors driving the exposure to information sources: Pakistani farmers' information behavior
Authors: Maqbool Rashid , Soroya Saira Hanif , Mahmood Khalid
Published: October 2021

The purpose of the present study is to examine the factors behind the selection and exposure of information sources by Pakistani farmers. This study is based on a quantitative research approach that involved survey design for the collection of data. The population of the present investigation was the farmers who have involved in any type of farming in District Okara province Punjab, Pakistan. A convenient sampling technique was used to select a sample from the different three tehsils of District Okara. A survey questionnaire was employed to collect data. Results proved that characteristics of information i.e. accessibility, usefulness, and credibility have a significant impact on the frequency of information sources/channels exposure, however, convenience proved an insignificant factor to farmers’ information sources exposure. Results further confirm that farming experience has a negative association with information exposure among Pakistani farmers. Since the usefulness and credibility of information sources trigger their use among farmers, therefore, farmers’ societies, agents, and government officials should work on developing credible content and highlighting the usefulness of different available information sources and channels.
‘It feels it’s wasting whatever time I’ve got left’: A qualitative study of living with treatable but not curable cancer during the COVID-19 pandemic
Authors: Radcliffe Eloise , Khan Aysha , Wright David , Berman Richard , Demain Sara , Foster Claire , Restorick-Banks Susan , Richardson Alison , Wagland Richard , Calman Lynn
Published: October 2021

Background:

People living with cancer that is treatable but not curable have complex needs, often managing health at home, supported by those close to them. Challenges are likely to be exacerbated during the COVID-19 pandemic and the risk-reducing measures introduced in response. The impact of COVID-19 on those living with incurable, life-threatening conditions is little understood.

Aim:

To investigate the experiences and identify the impact of the COVID-19 pandemic for people living with treatable not curable cancer and their informal carers.

Design:

Qualitative semi-structured phone interviews were conducted with 21 patients living with cancer that is treatable but not curable and 14 carers.

Setting/ participants:

Participants were part of a larger longitudinal qualitative study (ENABLE) on supported self-management for people living with cancer that is treatable but not curable.

Results:

The COVID-19 pandemic magnified uncertainty and anxiety and led to loss of opportunities to do things important to patients in the limited time they have left to live. Lack of face-to-face contact with loved ones had a significant impact on patients’ and carers’ emotional wellbeing. Carers experienced increased responsibilities but less access to formal and informal support and respite. While changes to treatment led to some concern about longer-term impact on health, most patients felt well-supported by healthcare teams.

Conclusion:

The study provides rich insights into the nature of challenges, uncertainty and lost opportunities resulting from the COVID-19 pandemic for patients and carers living with cancer that is treatable but not curable, which has wider resonance for people living with other life-limiting conditions.
Inverted urothelial papilloma in a cat
Authors: Brunetti Barbara , Foglia Armando , Savini Federica , Dondi Francesco , Abbate Jessica Maria
Published: October 2021

A 12-year-old neutered female cat was referred with clinical signs referable to lower urinary tract disease. Clinical examination revealed a tense, painful urinary bladder, and proximal urethral thickening. Endoscopic studies showed a pedunculated mass with polypoid projections. Multiple full-thickness mucosal biopsies were obtained, and the mass was almost completely excised. The neoplasm was confined to the mucosa and consisted of epithelial cells arranged in anastomosing trabeculae and nests, growing downward into the lamina propria. Neoplastic cells showed minimal atypia and low mitotic activity. Histological findings were consistent with inverted urothelial papilloma. Feline papillomavirus DNA was not amplified from biopsies. One year later, the cat had no urological signs, and urinary bladder was normal at ultrasound. To the authors’ knowledge, this is the first report of a case of inverted urothelial papilloma in a cat and is a differential diagnosis for low-grade urothelial carcinoma and other lesions with inverted growth pattern.
Neoliberal disease: COVID-19, co-pathogenesis and global health insecurities
Authors: Sparke Matthew , Williams Owain David
Published: October 2021

The COVID-19 pandemic has at once exposed, exploited and exacerbated the health-damaging transformations in world order tied to neoliberal globalization. Our central argument is that the same neoliberal plans, policies and practices advanced globally in the name of promoting wealth have proved disastrous in terms of protecting health in the context of the pandemic. To explain why, we point to a combinatory cascade of socio-viral co-pathogenesis that we call neoliberal disease. From the vectors of vulnerability created by unequal and unstable market societies, to the reduced response capacities of market states and health systems, to the constrained ability of official global health security agencies and regulations to offer effective global health governance, we show how the virus has found weaknesses in a market-transformed global body politic that it has used to viral advantage. By thereby turning the inequalities and inadequacies of neoliberal societies and states into global health insecurities the pandemic also raises questions about whether we now face an inflection point when political dis-ease with neoliberal norms will lead to new kinds of post-neoliberal policy-making. We conclude, nevertheless, that the prospects for such political-economic transformation on a global scale remain quite limited despite all the extraordinary damage of neoliberal disease described in the article.
Introduction to Rivera’s Gender Affirming Nursing Care Model: A Middle-Range Theory
Authors: Rivera Denise , Jukkala Angela , Rohini T
Published: October 2021

Purpose: Currently, standards for transgender care guide surgical, hormonal, cosmetic and psychological care, yet do not include the domain of nursing care and nursing sensitive care outcomes. In response, the purpose of this project was to create a middle-range nursing theory to guide transgender nursing care. Methods: Rivera’s Gender Affirming Nursing Care (GANC) Model was developed using a community informed iterative process, combining and modifying two existing theories. Each theory was evaluated, construct templates were created, modified, and expanded to create the proposed gender transcendent model. Face validity was established through expert and community review. Findings: Concepts identified include: Relationship (Join With), Knowledge (Learn With) and Engagement (Partner With). Action within the model is propelled by drivers, including ongoing learning, ongoing research, ongoing self-assessment, and leadership. The model operates within the recognized domains of nursing, to support gender affirming nursing care. Conclusions: The middle-range theory was tested and found to stimulate gender neutral thinking; however, the model would benefit from additional testing to determine impact on nursing and patient outcomes. The model allows the nurse, through self-reflection and other internal growth mechanisms, to identify personal implicit and explicit bias. It is through these actions and shifting paradigms that nurses develop a personal gender affirming nursing practice.
Adolescent Neglect and Health Risk
Authors: Kobulsky Julia M. , Villodas Miguel , Yoon Dalhee , Wildfeuer Rachel , Steinberg Laurence , Dubowitz Howard
Published: October 2021

This study examined relationships between adolescent neglect and abuse and later health risk in a sample of 1050 youth (53% female, 56% Black, and 24% White) from the Longitudinal Studies of Child Abuse and Neglect. At age 16, the youth reported any adolescent exposure to neglect and physical, sexual, and emotional abuse. At age 18, they reported risk behaviors (delinquency, substance use, and sexual behavior) and emotional and behavioral problems (externalizing and internalizing problems, suicidality). Control variables were childhood maltreatment (self-reports and early childhood child protective services reports), risk behaviors and emotional and behavioral problems at age 16, and demographics. Analysis confirmed a 5-factor model of adolescent neglect (Exposure to Risk, Inadequate Monitoring, Inattention to Basic Needs, Permitting Misbehavior, and Inadequate Support). Inadequate Support and Exposure to Risk were associated with more substances used; Exposure to Risk was also associated with delinquency and suicidality. Adolescent emotional abuse was associated with not using a condom use and internalizing and externalizing problems. Findings underscore the importance of preventing or addressing neglect during adolescence.
Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review
Authors: Tan Apphia JQ , Rusli Khairul DB , McKenna Lisa , Tan Laurence LC , Liaw Sok Ying
Published: October 2021

Objective

To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care.

Methods

A scoping review was conducted. A systematic search for articles published in 2000–2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included ‘telemedicine’, ‘telehealth’ and ‘nursing homes’.

Results

Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks.

Conclusion and implications

Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers’ perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.
When Cotard's syndrome fits the sociocultural context: The singular case of Per “Dead” Ohlin and the Norwegian black metal music scene
Authors: Sanches Hugo , Villaverde Buback Ferreira Leonardo , Gonçalves Pacheco João Pedro , Schenberg Luiz Carlos , Sampaio Meireles Marcos
Published: October 2021

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per “Dead” Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment.
The cerebrofacial metameric syndromes: An embryological review and proposal of a novel classification scheme
Authors: Larson Anthony S. , Brinjikji Waleed , Krings Timo , Guerin Julie B.
Published: October 2021

The cerebrofacial metameric syndromes are a group of congenital syndromes that result in vascular malformations throughout specific anatomical distributions of the brain, cranium and face. Multiple reports of patients with high-flow or low-flow vascular malformations following a metameric distribution have supported this idea. There has been much advancement in understanding of segmental organization and cell migration since the concept of metameric vascular syndromes was first proposed. We aim to give an updated review of these embryological considerations and then propose a more detailed classification system for these syndromes, predominately incorporating the contribution of neural crest cells and somitomeres to the pharyngeal arches.
Systematic review evaluating the efficacy of the cerebroplacental ratio (CPR) in saving babies lives
Authors: Elmes Catherine , Phillips Rita
Published: October 2021

Introduction

The aim of this systematic review is to critically assess the efficacy of the cerebroplacental ratio performed in the third trimester at predicting adverse perinatal outcomes and reducing stillbirth rates.

Method

The literature search was performed using CINAHL, EMBASE, EMCARE, MEDLINE and PubMed including systematic reviews, retrospective and prospective studies from inception until July 2020 utilising the PRISMA checklist and flowchart. Data displaying sensitivities, specificity and odds ratios (OR) to include 95% confidence interval (CI) were extracted and synthesised.

Findings

Initially, 1226 studies were identified, and nine studies met the inclusion criteria. Sample sizes ranged from 491 to 9772 pregnancies. The cerebroplacental ratio had the strongest diagnostic accuracy of all of the independent variables for detecting fetal demise (mean sensitivity and specificity; 79% and 78%). The cerebroplacental ratio, however, did not perform as favourably at predicting operative delivery (mean sensitivity and specificity; 59% and 82%) or anticipating admission to the neonatal intensive care unit (mean sensitivity and specificity; 55% and 74%).

Discussion

The results from this study showed that the cerebroplacental ratio within third trimester pregnancies has been proven to have moderate to high diagnostic value when detecting adverse perinatal outcomes, in particular fetal demise.

Conclusion

Cerebroplacental ratio has the potential as a diagnostic tool to reduce adverse perinatal outcomes, in particular fetal demise and help reduce stillbirth rates. The main study limitation involved heterogeneity within the included studies, in particular with a regard to blinding.
An exploration of the effects of social media on youth online and offline sociopolitical engagement
Authors: Zyad Hicham
Published: October 2021

On April 20th, 2018, Moroccan youths launched a boycott campaign on social media targeting three commercial brands. This incident has reinvigorated the debate on youth engagement in civic activism. Thus, this article compares Moroccan college-level students’ civic engagement through formal processes and online social networking as well as predicting students’ levels of engagement based on their demographic characteristics and political orientation variables. The analysis revealed that social media use was significantly correlated with youth virtual civic activities. Political interest and self-efficacy also had a significant impact on youth civic engagement. However, of the five demographic variables involved, only two were found to be significantly correlated with youth online civic activities. The study therefore identifies evidence corroborating other researchers’ finding that Moroccan youth play a role in influencing policy and decision-making through informal channels of civic engagement.
A framework for modeling fault propagation paths in air turbine starter based on Bayesian network
Authors: Guo Runxia , Wang Zihang
Published: October 2021

Any minor fault may spread, accumulate and enlarge through the causal link of fault in a closed-loop complex system of civil aircraft, and eventually result in unplanned downtime. In this paper, the fault propagation path model (FPPM) is proposed for system-level decomposition and simplifying the process of fault propagation analysis by combining the improved ant colony optimization algorithm (I-ACO) with the Bayesian network (BN). In FPPM, the modeling of the fault propagation path consists of three models, namely shrinking model (SM), ant colony optimization model (ACOM), and assessment model (AM). Firstly, the state space is shrunk by the most weight supported tree algorithm (MWST) at the initial establishment stage of BN. Next, I-ACO is designed to improve the structure of BN in order to study the fault propagation path accurately. Finally, the experiment is conducted from two different perspectives for the rationality of the well-trained BN’s structure. An example of practical application for the propagation path model of typical faults on the A320 air turbine starter is given to verify the validity and feasibility of the proposed method.
Simulation of the flapping wing aerial vehicle using flexible multibody dynamics
Authors: Choi JaeWon , Gong DuHyun , Lee Junhee , Kim Chongam , Shin SangJoon
Published: October 2021

An insect-type flapping wing micro aerial vehicle offers high aerodynamic efficiency and maneuverability in confined spaces. The complicated aerodynamic/structural behavior of flapping wing micro aerial vehicle, however, causes difficulties regarding the dynamic control and parametric design. This paper develops a moderately accurate numerical framework taking into account the passive motion of the main wings. Finite-element-based multibody dynamics and two-dimensional unsteady aerodynamics are combined to simulate the hover of a flapping wing micro aerial vehicle. In addition, flexible and rigid wings are compared through numerical simulation considering the flexibility. In terms of the average thrust, numerical simulation by fluid–structure interaction shows good agreements against the experimental results within 5% discrepancy.
Efficacy and Safety of Subcutaneous Immunotherapy for Local Allergic Rhinitis: A Meta-Analysis of Randomized Controlled Trials
Authors: Zhu Wanting , Gao Pei , Zhang Qidi , Chen Jianjun
Published: October 2021

Background

Subcutaneous immunotherapy (SCIT) has been used for treating local allergic rhinitis (LAR) patients. However, the clinical efficacy and safety were still questioned.

Objective

This study was designed to estimate the efficacy and safety of SCIT for treating LAR patients through meta-analysis.

Methods

We systemically searched MEDLINE, Cochrane Library, and Embase publications. Randomized, double-blind, clinical trials for the efficacy and safety of Allergen Immunotherapy (AIT) for LAR were included. A meta-analysis of 4 clinical endpoints (combined symptom and medication scores [CSMS], symptom scores [SS], medication scores [MS] and rhinoconjunctivitis quality of life questionnaire [RQLQ]) and adverse events (AEs)) was performed after bias and heterogeneity assessments. The immunologic response results were summarized.

Results

Four RCTs with 134 patients were included. Four studies for analyzing primary outcomes (CSMS, SS, MS) and AEs, three for RQLQ results. The results indicated an important significant difference between SCIT and placebo groups, list as follows: CSMS (SMD = −2.42, 95% CI: −3.60 to −1.25, P < .0001), SS (SMD = −2.08, 95% CI −3.68 to −0.48, P = .01), MS (SMD = −1.43, 95% CI: −2.65 to −0.21, P = 0.02), RQLQ (SMD = −0.70, 95% CI −1.29 to −0.12, P = .02), Local AEs (RR = 4.13, 95% CI 1.08 to 15.77, P = .04). For immunologic response, significantly increased serum sIgG4 levels and improvements of allergen tolerance was observed after SCIT.

Conclusions

Our meta-analysis suggests that SCIT has a significant effect on improving symptoms and reducing medicine consumption for LAR patients. Larger and multicenter clinical trials are needed to clarify the safety and long-term efficacy.
Tyrosine phosphatases regulate resistance to ALK inhibitors in ALK+ anaplastic large cell lymphoma
Authors: Karaca Atabay Elif , Mecca Carmen , Wang Qi , Ambrogio Chiara , Mota Ines , Prokoph Nina , Mura Giulia , Martinengo Cinzia , Patrucco Enrico , Leonardi Giulia , Hossa Jessica , Pich Achille , Mologni Luca , Gambacorti-Passerini Carlo , Brugières Laurence , Geoerger Birgit , Turner Suzanne D. , Voena Claudia , Cheong Taek-Chin , Chiarle Roberto
Published: October 2021

Anaplastic large cell lymphomas (ALCLs) frequently carry oncogenic fusions involving the anaplastic lymphoma kinase (ALK) gene. Targeting ALK using tyrosine kinase inhibitors (TKIs) is a therapeutic option in cases relapsed after chemotherapy, but TKI resistance may develop. By applying genomic loss-of-function screens, we identified PTPN1 and PTPN2 phosphatases as consistent top hits driving resistance to ALK TKIs in ALK+ ALCL. Loss of either PTPN1 or PTPN2 induced resistance to ALK TKIs in vitro and in vivo. Mechanistically, we demonstrated that PTPN1 and PTPN2 are phosphatases that bind to and regulate ALK phosphorylation and activity. In turn, oncogenic ALK and STAT3 repress PTPN1 transcription. We found that PTPN1 is also a phosphatase for SHP2, a key mediator of oncogenic ALK signaling. Downstream signaling analysis showed that deletion of PTPN1 or PTPN2 induces resistance to crizotinib by hyperactivating SHP2, the MAPK, and JAK/STAT pathways. RNA sequencing of patient samples that developed resistance to ALK TKIs showed downregulation of PTPN1 and PTPN2 associated with upregulation of SHP2 expression. Combination of crizotinib with a SHP2 inhibitor synergistically inhibited the growth of wild-type or PTPN1/PTPN2 knock-out ALCL, where it reverted TKI resistance. Thus, we identified PTPN1 and PTPN2 as ALK phosphatases that control sensitivity to ALK TKIs in ALCL and demonstrated that a combined blockade of SHP2 potentiates the efficacy of ALK inhibition in TKI-sensitive and -resistant ALK+ ALCL.
Evaluation of vecabrutinib as a model for noncovalent BTK/ITK inhibition for treatment of chronic lymphocytic leukemia
Authors: Jebaraj Billy Michael Chelliah , Müller Annika , Dheenadayalan Rashmi Priyadharshini , Endres Sascha , Roessner Philipp M. , Seyfried Felix , Walliser Claudia , Wist Martin , Qi Jialei , Tausch Eugen , Mertens Daniel , Fox Judith A. , Debatin Klaus-Michael , Meyer Lüder Hinrich , Taverna Pietro , Seiffert Martina , Gierschik Peter , Stilgenbauer Stephan
Published: October 2021

Covalent Bruton tyrosine kinase (BTK) inhibitors, such as ibrutinib, have proven to be highly beneficial in the treatment of chronic lymphocytic leukemia (CLL). Interestingly, the off-target inhibition of IL-2-inducible T-cell kinase (ITK) by ibrutinib may also play a role in modulating the tumor microenvironment, potentially enhancing the treatment benefit. However, resistance to covalently binding BTK inhibitors can develop as the result of a mutation in cysteine 481 of BTK (C481S), which prevents irreversible binding of the drugs. In the present study we performed preclinical characterization of vecabrutinib, a next-generation noncovalent BTK inhibitor that has ITK-inhibitory properties similar to those of ibrutinib. Unlike ibrutinib and other covalent BTK inhibitors, vecabrutinib showed retention of the inhibitory effect on C481S BTK mutants in vitro, similar to that of wild-type BTK. In the murine Eμ-TCL1 adoptive transfer model, vecabrutinib reduced tumor burden and significantly improved survival. Vecabrutinib treatment led to a decrease in CD8+ effector and memory T-cell populations, whereas the naive populations were increased. Of importance, vecabrutinib treatment significantly reduced the frequency of regulatory CD4+ T cells in vivo. Unlike ibrutinib, vecabrutinib treatment showed minimal adverse impact on the activation and proliferation of isolated T cells. Lastly, combination treatment with vecabrutinib and venetoclax augmented treatment efficacy, significantly improved survival, and led to favorable reprogramming of the microenvironment in the murine Eμ-TCL1 model. Thus, noncovalent BTK/ITK inhibitors, such as vecabrutinib, may be efficacious in C481S BTK mutant CLL while preserving the T-cell immunomodulatory function of ibrutinib.
All-trans retinoic acid plus low-dose rituximab vs low-dose rituximab in corticosteroid-resistant or relapsed ITP
Authors: Wu Ye-Jun , Liu Hui , Zeng Qiao-Zhu , Liu Yi , Wang Jing-Wen , Wang Wen-Sheng , Jia-Feng  , Zhou He-Bing , Huang Qiu-Sha , He Yun , Fu Hai-Xia , Zhu Xiao-Lu , Jiang Qian , Jiang Hao , Chang Ying-Jun , Xu Lan-Ping , Huang Xiao-Jun , Zhang Xiao-Hui
Published: October 2021

The study aimed to compare the efficacy and safety of all-trans retinoic acid (ATRA) plus low-dose rituximab (LD-RTX) with LD-RTX monotherapy in corticosteroid-resistant or relapsed immune thrombocytopenia (ITP) patients. Recruited patients were randomized at a ratio of 2:1 into 2 groups: 112 patients received LD-RTX plus ATRA, and 56 patients received LD-RTX monotherapy. Overall response (OR), defined as achieving a platelet count of ≥30 × 109/L confirmed on ≥2 separate occasions (≥7 days apart), at least a doubling of the baseline platelet count without any other ITP-specific treatment, and the absence of bleeding within 1 year after enrollment, was observed in more patients in the LD-RTX plus ATRA group (80%) than in the LD-RTX monotherapy group (59%) (between-group difference, 0.22; 95% CI, 0.07-0.36). Sustained response (SR), defined as maintenance of a platelet count >30 × 109/L, an absence of bleeding, and no requirement for any other ITP-specific treatment for 6 consecutive months after achievement of OR during 1 year following enrollment, was achieved by 68 (61%) patients in the combination group and 23 (41%) patients in the monotherapy group (between-group difference, 0.20; 95% CI, 0.04-0.35). The 2 most common adverse events (AEs) for the combination group were dry skin and headache or dizziness. Our findings demonstrated that ATRA plus LD-RTX significantly increased the overall and sustained response, indicating a promising treatment option for corticosteroid-resistant or relapsed adult ITP. This study is registered at www.clinicaltrials.gov as #NCT03304288.
Fast activation maximization for molecular sequence design
Authors: Linder Johannes , Seelig Georg
Published: October 2021

Background

Optimization of DNA and protein sequences based on Machine Learning models is becoming a powerful tool for molecular design. Activation maximization offers a simple design strategy for differentiable models: one-hot coded sequences are first approximated by a continuous representation, which is then iteratively optimized with respect to the predictor oracle by gradient ascent. While elegant, the current version of the method suffers from vanishing gradients and may cause predictor pathologies leading to poor convergence.

Results

Here, we introduce Fast SeqProp, an improved activation maximization method that combines straight-through approximation with normalization across the parameters of the input sequence distribution. Fast SeqProp overcomes bottlenecks in earlier methods arising from input parameters becoming skewed during optimization. Compared to prior methods, Fast SeqProp results in up to 100-fold faster convergence while also finding improved fitness optima for many applications. We demonstrate Fast SeqProp’s capabilities by designing DNA and protein sequences for six deep learning predictors, including a protein structure predictor.

Conclusions

Fast SeqProp offers a reliable and efficient method for general-purpose sequence optimization through a differentiable fitness predictor. As demonstrated on a variety of deep learning models, the method is widely applicable, and can incorporate various regularization techniques to maintain confidence in the sequence designs. As a design tool, Fast SeqProp may aid in the development of novel molecules, drug therapies and vaccines.
Predictive scoring systems for in-hospital mortality due to acutely decompensated liver cirrhosis in Indonesia
Authors: Nababan Saut Horas H. , Mansjoer Arif , Fauzi Achmad , Gani Rino A.
Published: October 2021

Background

Acutely decompensated liver cirrhosis is associated with high medical costs and negatively affects productivity and quality of life. Data on factors associated with in-hospital mortality due to acutely decompensated liver cirrhosis in Indonesia are scarce. This study aims to identify predictors of in-hospital mortality and develop predictive scoring systems for clinical application in acutely decompensated liver cirrhosis patients.

Methods

This was a retrospective cohort study using a hospital database of acutely decompensated liver cirrhosis data at Cipto Mangunkusumo National General Hospital, Jakarta (2016–2019). Bivariate and multivariate logistic regression analyses were performed to identify the predictors of in-hospital mortality. Two scoring systems were developed based on the identified predictors.

Results

A total of 241 patients were analysed; patients were predominantly male (74.3%), had hepatitis B (38.6%), and had Child–Pugh class B or C cirrhosis (40% and 38%, respectively). Gastrointestinal bleeding was observed in 171 patients (70.9%), and 29 patients (12.03%) died during hospitalization. The independent predictors of in-hospital mortality were age (adjusted OR: 1.09 [1.03–1.14]; p = 0.001), bacterial infection (adjusted OR: 6.25 [2.31–16.92]; p < 0.001), total bilirubin level (adjusted OR: 3.01 [1.85–4.89]; p < 0.001) and creatinine level (adjusted OR: 2.70 [1.20–6.05]; p = 0.016). The logistic and additive scoring systems, which were developed based on the identified predictors, had AUROC values of 0.899 and 0.868, respectively.

Conclusion

The in-hospital mortality rate of acutely decompensated liver cirrhosis in Indonesia is high. We have developed two predictive scoring systems for in-hospital mortality in acutely decompensated liver cirrhosis patients.
Do older people with cardiovascular-metabolic multimorbidity prefer to sign contracts for family doctor services? Evidence from a cross-sectional study in rural Shandong, China
Authors: Yang Shijun , Li Jie , Fu Peipei , Chen Yan , Wang Yi , Zhao Dan , Li Zhixian , Li Wenjuan , Li Jie , Yan Chen , Gui Zhen , Zhou Chengchao
Published: October 2021

Background

Family doctor policy is an important part of deepening healthcare reform in China. The study aimed to explore the association between cardiovascular-metabolic multimorbidity and the status of signing a contract for family doctor services among the older people in rural Shandong, China.

Methods

A cross-sectional study was conducted in 3 cities of Shandong province, China. A total of 1395 rural residents over 60 years of age were included in this study using a multistage stratified random sampling method. Covariates included demographic and socioeconomic characteristics, health-related characteristics, health service utilization, and awareness of family doctor contract services. The univariate and multivariate regression logistic analysis was used to analyze the data.

Results

There were 28.2% of the rural older people contracted for the family doctor contract services. The contract rate of seniors with cardiovascular-metabolic multimorbidity was statistically higher than those without cardiovascular-metabolic multimorbidity (OR = 1.67, 95%CI, 1.21-2.32) after controlling for confounding factors. In addition, occupation, physical activities, self-rated health status, distance from the village clinic, the awareness of family doctor contract services were found to be associated with the signing behavior among the rural older adults.

Conclusion

This study demonstrated that the rural older people with cardiovascular-metabolic multimorbidity had a higher family doctor contract rate than those without cardiovascular-metabolic multimorbidity, and there was a gap between the current signing rate and the policy goal. To increase the rate of signing for family doctor contract services, the government should take joint efforts to expand the publicity and coverage, and give priority to meeting the healthcare demands of rural older adults with cardiovascular-metabolic multimorbidity.
The COVID-19 pandemic as experienced by the spouses of home-dwelling people with dementia – a qualitative study
Authors: Rokstad Anne Marie Mork , Røsvik Janne , Fossberg Marit , Eriksen Siren
Published: October 2021

Background

Worldwide, restrictive measures have been taken to manage the spread of the COVID-19 pandemic. Social distancing and self-isolation have considerably affected the lives of people with dementia and their informal caregivers. The purpose of the study was to explore the consequences of the COVID-19 pandemic as experienced by the spouses of home-dwelling people with dementia in Norway.

Methods

The study had a qualitative descriptive design using individual telephone interviews for data collection. A total sample of 17 spouses of people with dementia were included, 14 women and three men ages 52 to 82 years. A qualitative content analysis following six steps inspired by Graneheim and Lundman was used to identify the categories presented.

Results

The participants emphasized four main perspectives: 1) Radical changes in available services, 2) Restrictions changed everyday life, 3) Impacts on health and well-being, and 4) Actions that made life easier. The participants also described how positive activities and easily accessible services helped them in this situation.

Conclusions

The governmental restrictions of the COVID-19 pandemic resulted in radical changes in available services with severe consequences for the lives and well-being of home-dwelling people with dementia and their spouses. Examples of coping strategies and possible psychosocial interventions compatible with virus precautions were identified. The potential of such interventions should be further explored to meet the needs of vulnerable groups in situations like a pandemic.
Disparity of perception of quality of life between head and neck cancer patients and caregivers
Authors: Kassir Zachary M. , Li Jinhong , Harrison Christine , Johnson Jonas T. , Nilsen Marci L.
Published: October 2021

Background

Caregivers are invaluable sources of support for individuals recovering from head and neck cancer (HNC). Accordingly, minimizing caregiver distress is essential to promote the well-being of both caregivers and their patients. This study assessed if psychosocial distress (i.e., anxiety and depression) among HNC caregivers is associated with a difference in how caregivers and their patients perceive patients’ quality of life (QOL) after treatment completion.

Methods

Caregivers’ and patients’ perceptions of patient QOL were assessed using the University of Washington QOL Questionaire (UWQOL), a validated HNC-specific health-related QOL questionnaire. The survey is interpreted in terms of its two composite scores: a physical QOL score and a social-emotional QOL score with higher scores indicating better QOL. Caregiver anxiety was assessed using the Generalized Anxiety Questionaire-7 (GAD-7) and caregiver depression was assessed using the Patient Health Questionaire 8 (PHQ-8). Patients completed the UWQOL as part of clinic intake while caregivers were asked to complete the UWQOL for their patients in addition to the PHQ-8 and GAD-7 in private. Linear regression was used to analyze the association between differences in caregivers’ and patients’ QOL scores (both social-emotional and physical QOL subscale scores) and GAD-7 and PHQ-8 scores.

Results

Of 47 caregivers recruited, 42.6% (n = 20) viewed patients’ social-emotional QOL more negatively than patients themselves, while 31.9% viewed patients’ physical QOL more negatively. After controlling for covariates, differences in perception of social-emotional QOL (p = .01) and differences in perception of physical QOL (p = .007) were significantly associated with caregiver depression, but not anxiety. Caregivers who disagreed with patients regarding patients’ social-emotional QOL scored 6.80 points higher on the PHQ8 than agreeing caregivers. Caregivers who disagreed regarding patients’ physical QOL scored 6.09 points higher.

Conclusion

Caregivers commonly view patients’ QOL more negatively than patients themselves. These caregivers tend to have greater psychosocial distress than caregivers who agree with their patients. Interventions designed to identify and aid at-risk caregivers are critically needed. We propose screening for differences in perception of patient QOL as a way of identifying distressed caregivers as well as provider-facilitated communication between patients and caregivers as possible interventions that should be examined in future research.
Artificial neural network application for identifying risk of depression in high school students: a cross-sectional study
Authors: Zhao Fang-Fang
Published: October 2021

Background

Identifying important factors contributing to depression is necessary for interrupting risk pathways to minimize adolescent depression. The study aimed to assess the prevalence of depression in high school students and develop a model for identifying risk of depression among adolescents.

Methods

Cross-sectional study was conducted. A total of 1190 adolescents from two high schools in eastern China participated in the study. Artificial neurol network (ANN) was used to establish the identification model.

Results

The prevalence of depression was 29.9% among the students. The model showed the top five protective and risk factors including perceived stress, life events, optimism, self-compassion and resilience. ANN model accuracy was 81.06%, with sensitivity 65.3%, specificity 88.4%, and area under the receiver operating characteristic (ROC) curves 0.846 in testing dataset.

Conclusion

The ANN showed the good performance in identifying risk of depression. Promoting the protective factors and reducing the level of risk factors facilitate preventing and relieving depression.
Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function
Authors: Zhou Junfeng , Lin Sheng , Sun Sida , Zheng Chengying , Wang Jiaxing , He Qingliang
Published: October 2021

Background

To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS).

Methods

A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery.

Results

The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P < 0.05). There were no significant differences in preoperative CD3+, CD4+, CD8+, natural killer (NK) cells, CD4+/CD8+, IgA, IgM and IgG levels between two groups (P < 0.05). Three days after surgery, the immune function indices were decreased in both groups, but with no significant difference between two groups (P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P < 0.05). The 3-year survival rate were 96.7% in group A and 91.7% in group B, respectively, with no statistically significant difference.

Conclusion

Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.
Plasma Proneurotensin and Prediction of Cause-Specific Mortality in a Middle-aged Cohort During Long-term Follow-up
Authors: Fawad Ayesha , Bergmann Andreas , Schulte Janin , Butt Zahra A , Nilsson Peter M , Bennet Louise , Orho-Melander Marju , Melander Olle
Published: October 2021

Context

Neurotensin is associated with cardiometabolic diseases but its role with mortality risk in humans is unknown.

Objective

This work aims to examine the prediction of proneurotensin (Pro-NT) with respect to total and cause-specific mortality in a middle-aged cohort.

Methods

In the population-based middle-aged cohort (n = 4632; mean age, 57 years) of the Malmö Diet and Cancer Study, Pro-NT was assessed and total as well as cause-specific mortality was studied. Main cause of death was based on the International Classification of Diseases.

Results

During a mean follow-up of 20 ± 3 years, 950 men and 956 women died. There was significantly increased mortality risk in individuals belonging to the highest quartile (Q) of Pro-NT (Q4, Pro-NT ≥ 149 pmol/L) compared with Qs 1 to 3 (Pro-NT < 149 pmol/L), hazard ratio (HR), 95% CI of 1.29 (1.17-1.42; P < .001). Data were adjusted for sex and age. No significant interaction was observed between Pro-NT and sex on mortality risk. Individuals within Q4 vs Qs 1 to 3 had an HR of 1.41 (95% CI, 1.18-1.68; P < .001) for death due to cardiovascular disease (n = 595/4632); 2.53 (95% CI, 1.37-4.67; P = .003), due to digestive tract disease (n = 42/4632), 1.62 (95% CI, 1.04-2.52; P = .032) due to mental and behavioral disease (n = 90/4632); and 1.91 (95% CI, 1.15-3.19; P = .013) due to unspecific causes (n = 64/4632). There was no significant relationship between Pro-NT and deaths due to cancer, infections, neurological, or other causes. Adjustment for cardiovascular risk factors only marginally changed these results.

Conclusion

The relationship between Pro-NT and total mortality risk was mainly driven by cardiovascular mortality, but high Pro-NT also predicts death from digestive, mental, and behavioral disease and deaths attributed to unspecific causes.
Expression Profile of the GLP-1 Receptor in the Gastrointestinal Tract and Pancreas in Adult Female Mice
Authors: Grunddal Kaare V , Jensen Elisa P , Ørskov Cathrine , Andersen Daniel B , Windeløv Johanne A , Poulsen Steen Seier , Rosenkilde Mette M , Knudsen Lotte Bjerre , Pyke Charles , Holst Jens J
Published: October 2021

Therapies based on glucagon-like peptide-1 receptor (GLP-1R) agonism are highly effective in treating type-2 diabetes and obesity, but the localization of GLP-1 receptors mediating the antidiabetic and other possible actions of GLP-1 is still debated. The purpose with this study was to identify sites of GLP-1R mRNA and protein expression in the mouse gastrointestinal system by means of GLP-1R antibody immunohistochemistry, Glp-1r mRNA fluorescence in situ hybridization (FISH) and 125I-exendin (9-39) autoradiography. As expected GLP-1R staining was observed in almost all β cells in the pancreatic islets, but more rarely in α and δ cells. In the stomach, GLP-1R staining was found exclusively in the gastric corpus mucous neck cells, known to protect the stomach mucosa. The Brunner’s glands were strongly stained for GLP-1R, and pretreatment with GLP-1 agonist exendin-4 caused internalization of the receptor and mucin secretion, while pretreatment with PBS or antagonist exendin (9–39) did not. In the intestinal mucosa, GLP-1R staining was observed in intraepithelial lymphocytes, lamina propria lymphocytes, and enteroendocrine cells containing secretin, peptide YY, and somatostatin, but not cholecystokinin. GLP-1R staining was seen in nerve fibers within the CHAT- and NO-positive myenteric plexuses from the gastric corpus to the distal large intestine being strongest in the mid- and hindgut area. Finally, intraperitoneal administration of radiolabeled exendin (9–39) strongly labeled myenteric fibers. In conclusion, this study expands our knowledge of GLP-1 receptor localization and suggests that GLP-1 may serve an important role in modulating gastrointestinal health and mucosal protection.
Inside North Korean Literature: The Hidden Meaning of Narratives
Authors: Minsun Kim
Published: October 2021

This study examines the grammar of tension and appropriation in North Korean literature, thereby shedding light on the complex meaning and metaphors hidden within the external (literal) narratives of North Korean literary texts. The true meaning of North Korean literature is situated between the political reality and the tension created by its narratives. This tension, concealed within the constraints of custom and form, permeates the text and the spaces between the lines. Accordingly, when reading North Korean literature, in addition to considering the social and literary contexts of the text, one needs to be careful not to miss the hidden meanings held within. This study reads between the lines to examine the critical view of the current reality that North Korean literature is a metaphor for and the desires that are symptomatically expressed therein. Specifically, the focus is on North Korean science fiction, which uses a grammar of appropriation to discuss the realities of the present through narratives of the future.
Depth and Death
Authors: Trüper Henning
Published: October 2021

This article proposes a re-reading of what inclusion into the sphere of the historical actually means in modern European historical discourse. It argues that this re-reading permits challenging a powerful but problematic norm of ontological homogeneity as something to be achieved in and by historical discourse. At least some of the more conceptually profound challenges that accounts of “deep history”—of very distant pasts—pose to historical discourse have to do with pursuits of this norm. Historical theory has the potential of responding to some of these challenges and actually reverting them back to the practice of accounting for deep times in historical writing. The argument proceeds, in a first step, by analyzing the ties between modern European mortuary cultures and historical writing. In a second step, the history of humanitarian moralities is brought to bear on the analysis to make visible, thirdly, the fractured presences of deep time in modern-era and contemporary historical writing. The fractures in question emerge, the article argues, from the ontological heterogeneity of historical knowledge. Thus, in the end, a position beyond ontological homogeneity is adumbrated.