bluuebunny/crossref_metadata_2025 huggingface dataset:
The practice of breast self-examination and associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda: A Cross Section Study
Authors: Wolde Mulugeta Tenna , Okova Rosemary , Habtu Michael , Wondafrash Mekitie , Bekele Abebe
Published: April 2023

Background Breast self-examination is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years since globally breast cancer among women contributed to 685,000 deaths in 2020. However, the practice of breast self-examination among healthcare professionals is low in many developing countries. Therefore, this research was intended to measure the level of breast self-examination practice and determine associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda.Methods A cross-sectional study was conducted among 221 randomly selected female healthcare professionals in four district hospitals in Kigali, Rwanda. A self-administered structured questionnaire was used as data collection instrument. The predictor variables were socio-demographic and obstetrics variables, knowledge on breast cancer and breast self-examination, attitude towards breast cancer and breast self-examination. Sample statistics such as frequencies, proportions and mean were used to recapitulate the findings in univariate analysis. Multiple logistic regression analysis was employed to identify statistically significant variables that predict breast self-examination practice. Adjusted odds ratio and 95% confidence level were reported. P-value < 0.05 was used to declare statistical significance.Results Breast self-examination was practiced by 43.5% of female healthcare professionals. This prevalence is low compared to other studies. Attitude towards breast self-examination and breast cancer was the only predictor variable that was significantly associated with breast self-examination practice [AOR = 1.032; 95% CI (1.001, 1.065), p-value = 0.042]. However, number of pregnancy and number of children were not significantly associated with BSE practice in the multi-variate analysis. In addition, knowledge and attitude were linearly correlated with r = 0.186, p = 0.005.Conclusions The breast self-examination practice was found to be low. Attitude toward breast cancer and breast self-examination was positively associated with BSE practice. Moreover, attitude and knowledge were linearly associated. This suggests the need for continuous medical education on breast self-examination and breast cancer to increase the knowledge & BSE practice level of female healthcare professionals.
Native T1, T2 mapping and strain analysis to assess myocardial viability in the subacute phase of MI: comparison with late gadolinium enhancement
Authors: Mohammadzadeh Ali , Salehabadi Ghazaleh , Ranjbar Abdolmohammad , Meshgi Shahla , Azimi Amir , Dastmardi Maedeh , Tabrizi Zhaleh
Published: April 2023

This study aims to assess the potential of myocardial strain, T1 and T2 mapping in evaluating myocardial damage severity, thereby discriminating viable from non-viable myocardium without utilizing contrast agents in the subacute phase of myocardial infarction. Fourty three patients (mean age 56.05±10 years, 86% male) and eight sex and age-matched healthy volunteers underwent 1.5 T CMR with viability protocol. The global values were compared between patients and controls, and segmental values were compared in viable and non-viable myocardium determined by late gadolinium enhancement (LGE) as gold standard for viability assessment. The mean value of global myocardial strain parameters, including global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) in the patient's group, was significantly lower than controls. In contrast, the mean value of Global T1 and T2 in the patient's group was significantly higher than in controls. Global infarcted zone size (IZS) and grey zone size (GZS) positively correlate with the T1 and T2 mapping and negatively with strain mapping global values. A comparison of segmental parameters based on viability demonstrated a significant decrease in the values of strains and a significant increase in the T1 and T2 mapping values in non-viable segments. ROC analysis demonstrated that circumferential strain (AUC 0.827, p<0.001, 95%CI 0.792–0.861) had the highest diagnostic accuracy in differentiating viable and non-viable myocardium among segmental parameters. A cut-off of a circumferential strain of -8.809 differentiated viable from non-viable segments with 81% sensitivity and 71% specificity. The good accuracy in predicting myocardial viability, the significant mean difference between viable and non-viable parametric values, and the significant correlation between global values and enhanced and grey zone size, holds promises for using strain, T1, and T2 mapping for viability assessment without gadolinium contrast agents.
Analysis of inter-joint coordination during the sit-to-stand and stand-to-sit tasks in stroke patients with hemiplegia
Authors: He Jian , Liu Dongwei , Hou Meijin , Luo Anhua , Wang Shuhao , Ma Ye
Published: April 2023

BackgroundInter-joint coordination is an important factor affecting postural stability, and its variability increases after fatigue. This study aimed to investigate the coordination pattern of lower limb joints during the sit-to-stand (Si-St) and stand-to-sit (St-Si) tasks in stroke patients and explore the influence of duration on inter-joint coordination.MethodsThirteen stroke hemiplegia patients (five with left paretic and eight right paretic) and thirteen age-matched healthy subjects were recruited. The Si-St and St-Si tasks were performed while each subject’s joint kinematics were recorded using a three-dimensional motion capture system. Sagittal joint angles of the bilateral hip, knee and ankle joints as well as the movement duration were extracted. The angle-angle diagrams for the hip-knee, hip-ankle and knee-ankle joint were plotted to assess the inter-joint coordination. The inter-joint coordination was quantified using geometric characteristics of the angle-angle diagrams, including perimeter, area and dimensionless ratio. The coefficient of variation (CV) was performed to compare variability of the coordination parameters.ResultsThere were no significant differences in the perimeter, area and dimensionless ratio values of the bilateral hip-knee, hip-ankle and knee-ankle inter-joints during Si-St and St-Si tasks in the stroke group. The perimeter values of bilateral hip-knee and knee-ankle inter-joints in the stroke group were lower (P<0.05) than in the healthy group during Si-St and St-Si tasks. Although no significant bilateral differences were found, the inter-joint coordination in stroke patients decreased with the increased movement duration of both Si-St and St-Si tasks. Additionally, the CV of the hip-knee inter-joint area during the Si-St task in the stroke group was less than (P<0.05) that in the healthy group.ConclusionStroke patients exhibit different inter-joint coordination patterns than healthy controls during the Si-St and St-Si tasks. The duration affects joint coordination, and inter-joint coordination is limited on the hemiplegic side joint pairs, which may lead to inconsistency in the rhythm of the left and right leg inter-joint movements and increase the risk of falls. These findings provide new insights into motor control rehabilitation strategies and may help planning targeted interventions for stoke patients with hemiplegia.
Serum Apelin-12 as a Novel Marker of Metabolic Inflammatory Syndrome in elderly Chinese: a cross-sectional study
Authors: Wang Xinru , Wang Jiantao , Ren Jiaoqi , Zhang Xiaoming , Wang Jinxiu , Wang Yin , Hu Yue , Zhang Yutu , He Chengfeng , Xue Wenjiao , Xiang Lvxuan , Tao Yinghong , Guo Jingchun , Zhou Houguang
Published: April 2023

Background: Apelin-12 has been proposed as a novel adipocytokine with vital roles in metabolic disorders. In this study, we aimed to explore the relationship between serum apelin-12 and metabolic inflammatory syndrome (MIS) in the elderly.
Methods: The cross-sectional study involved 224 subjects aged over 60. According to their diagnoses of the four components of MIS (type 2 diabetes, non-alcoholic fatty liver disease, atherosclerosis, and obesity/overweight), they were divided into two groups: the control group (0 or 1 component n=63) and the MIS group (≥2 components, n=161). Serum levels of apelin-12, adiponectin and C-reactive protein were measured by ELISA.
Results: Serum apelin-12 was significantly higher in the MIS group than in the control group (1.83 ng/mL (1.59-2.07) vs 1.66 ng/mL (1.45-1.92), P=0.001). Partial correlation analysis showed that apelin-12 levels were positively correlated with fasting insulin (ra=0.169), HOMA-IR (ra=0.183), ALT (ra=0.180), AST (ra=0.145) and CRP (ra=0.140, all Pa<0.05) and negatively associated with adiponectin (ra=-0.211) and HDL-C (ra=-0.156) after controlling age, sex and body mass index. Besides, after adjustment for age, sex, fasting blood glucose, diastolic blood pressure and total triglyceride, apelin-12 was still determined as an independent predictor for MIS.
Conclusion: Serum apelin-12 can be an independent risk factor predicting metabolic inflammatory syndrome and may serve as a useful potential marker for the diagnosis of MIS in elderly Chinese.
Stimulated Thyroglobulin and Pre-ablation Antithyroglobulin Antibody Product Can Predict the Response to Radioiodine Therapy in TgAb-positive Differentiated Thyroid Cancer Pa-tients: A Retrospective Study
Authors: Han Na , Lu Chenghui , Li Jiao , Wang Congcong , Zhao Zilong , Zhang Yingying , Liu Xinfeng , Si Zengmei , Wang Guoqiang , Wang Zenghua , Li Fengqi , Wang Xufu
Published: April 2023

Objective We aimed to explore the predictive value of stimulated thyroglobulin(sTg) and pre-ablation antithyroglobulin (paTgAb) product to the effect of radioiodine therapy (RAIT) in TgAb-positive DTC patients.Methods We totally enrolled 265 patients with TgAb-positive DTC who underwent RAIT after total thyroidectomy (TT) in this study. Based on the last follow-up result, patients were divided into two groups, which were excellent response (ER) group and non-excellent response (NER) group. We analyzed the factors related to the effect of RAIT.Results The ER group was consisted of 197 cases. NER group was consisted of 68 cases. For the univariate analysis, we found that maximal tumor diameter, whether with extrathyroidal extension (ETE), bilateral or unilateral primary lesion, preop-TgAb, paTgAb, sTg×paTgAb and N stage showed significantly differently in ER group and NER group. ROC curves showed the cut-off value was 724.25 IU/ml, 424.00 IU/ml, and 59.73 for preop-TgAb, paTgAb, sTg×paTgAb, respectively. The multivariate logistic regression analysis results indicated that paTgAb, sTg×paTgAb and N stage were independent risk factors for NER. For the Kaplan-Meier analysis of DFS, the median DFS of patients with sTg×paTgAb<59.73 was significantly longer than patients with sTg×paTgAb ≥ 59.73 (48.59months vs. 50.27months, p = 0.041).Conclusion We found that sTg and paTgAb conduct is a good predictor of efficacy to RAIT in TgAb-positive DTC patients. It can play a very positive and important role in optimizing treatment, improving prognosis and reducing the burden of patients.
Changes in Salivary Flow in the Elderly: A Quantitative Cross-Sectional Study
Authors: Lima Patrícia O. , Barroso Heloisa H. , Silva Larissa D. A. , Almeida Herlon F. , Rocha Ricardo L. , Canuto Marcus H. , Pinheiro Marcos L. P.
Published: April 2023

Purpose: To evaluate the association of alcoholism, smoking habits, and daily practices on the salivary flow of 220 elderly Brazilians, between 65 and 74 years of age.
Materials and methods: This is an exploratory, analytical, quantitative study. Subjects were selected through proportional stratified sampling. The stimulated salivary flow was measured by the Navazesh method. To assess alcohol dependence and smoking, the Alcohol Use Disorders Identification Test (AUDIT) and Questionnaire of Smoking Urges Brief (QSU-B) questionnaires were used, respectively. Data were analyzed using STATA software, using Pearson's chi-square test, and logistic regression.
Results: The mean age was 69.9, the majority were women (59%), of brown ethnicity (55.9%), with up to 8 years of schooling (62.7%), income of up to a minimum wage (46.4%) and married (62.3%). There was a prevalence of 43.2% of individuals with hyposalivation, mostly aged 70 to 74 years old. There was an association between reduced salivary flow and elderly people who ingested less liquid and with those who brushed their teeth less frequently. The variables age, sex, fluid intake and craving for smoking explained, on average, 43% of the occurrences of hyposalivation in the studied population.
Conclusion: Elderly women, aged 70 and over, who drink a small amount of liquids during the day, are more susceptible to hyposalivation and need to be monitored more closely by the health team involved.
Clinical relevance: Hyposalivation in the elderly can impact their quality of life, therefore the present study is important to understand some factors that may worsen this condition.
Inclusive environmental decision-making in Sub-Saharan Africa: Insights from the Ogoni remediation project, Niger Delta, Nigeria
Authors: Sam Kabari , Zibima Tubodenyefa
Published: April 2023

Greater involvement of women is globally believed to enhance environmental management outcomes. However, despite being disproportionately affected by environmental degradation primarily caused by oil spills in the Niger Delta region of Nigeria, women in the region are often excluded in environmental decision-making processes. Women involved in farming and fishing face increased vulnerability to contaminated land, food insecurity and conflicts driven by environmental degradation. Using a mixed approach, women, lawmakers, policymakers, regulators, civil society organizations, environmental management practitioners, and government agents responsible for environmental remediation were engaged through interviews, focus group discussions and questionnaires to examine women inclusion in environmental decision-making and governance in the Ogoni contaminated land remediation project in the Niger Delta region of Nigeria. The results indicate that lack of trust and confidence in drivers of environmental decision-making process could affect women participation and involvement in environmental management. Although cultural beliefs and practices impede women participation in the region, women participation in itself does not translate to inclusion in environmental decision-making due to limited capacity, confidence and trust in the process. Creating platforms for capacity building, developing gender policy, adapting appropriate communication strategy, initiating women networks and strengthening social cohesion could enhance women involvement in environmental decision-making in regions with similar cultural context to the Niger Delta region.
Why may consider rainfall space-time variability in Precision Agriculture?
Authors: Pilau Felipe Gustavo , Santos Thais Letícia , Battisti Rafael , Reichardt Klaus , Gonçalves Ivo Zution
Published: April 2023

Brazil is one of the largest soybean producers in the world, however, there are still yield gaps in crops, mainly linked to weather conditions. Based on it, this paper quantifies the spatial variability of rainfall based on two dense networks of rain gauges and analyzes the influence on the attainable productivity (Ya) of the soybean crop. The study was carried out in Piracicaba, SP. For the first rain gauge network a measuring campaign was conducted from 1993 to 1994, with 10 gauges distributed in 1,000.0 ha. The second rain gauge network measuring campaign was conducted from 2016 to 2018, with 9 gauges sampling 36.0 ha. To evaluate the influence of rainfall spatial variability on soybean yield a multi-model (FAO, DSSAT, and MONICA) simulation was used. The relative production loss (Ygrel) caused by water deficiency was simulated for 3 sowing dates and each rainfall sampling point. The results showed that the spatial variability of precipitation has a direct influence on attainable productivity (Ya). However, the magnitude of rainfall variability is not directly replicated in yield. The temporal variability, between the different sowing times, had a major influence on soybean yield.
Exclusive breastfeeding in health personnel; incidence and barriers
Authors: Nanthakomol Tonga , Nukaw Sonthaya , Kositamongkol Sudatip
Published: April 2023

Objective Exclusive breastfeeding 6 months (EBF) in health care personnel are challenges due to work schedule, high workload or separation issues. This study was aimed to evaluate the incidence and factors related to EBF in our hospital personnel.Material and Methods This was a cross-sectional study. Female employees who took maternity leave within 2 years were approached. A set of questions regarding baseline characteristics, breastfeeding attitude, perception of breastfeeding obstacles, breastfeeding behavior and support from the health care system. Factors associated with EBF were analyzed using logistic regression analysis.Results There were 110 mothers who participated in the study. Mean maternal age was 32.5 ± 4.21 years, 66.36% came from the nursing department, infant’s age were 6–24 months, 46.4% of mothers had previous breastfeeding experience. Our EBF rate was 63.6%. From univariable analysis, previous breastfeeding experience, work schedule, family type, support from colleagues and workplace was not significantly associated with EBF. But breastfeeding attitude (OR = 1.12, 95%CI 1.08–1.38), perception of breastfeeding obstacle (OR = 1.45, 95%CI 1.26–1.66), breastfeeding behavior (OR = 1.17, 95%CI 1.08–1.26), and support form health system (OR = 1.09, 95%CI 1.01–1.19) were significantly associated with EBF (p-value < 0.05). From multiple logistic regression model, perception of breastfeeding obstacles (aOR 1.55, 95%CI 1.27–1.90), breastfeeding behavior (aOR 1.12, 95%CI 1.01–1.24) and support form health care system (aOR 0.84, 95%CI 0.72–0.97) remains the significant factors associated with successful EBF (p-value < 0.05).Conclusion Successful EBF were prevalent in mothers who had good attitudes to breastfeeding, perceived low levels of obstacles, and who had support from the health care system.
Role of heparin-binding protein, glycocalyx in Sepsis-induced coagulopathy
Authors: Zhang Shaokang , Ma Shaolin , Liu Yang
Published: April 2023

BackgroundTo explore the role of heparin-binding proteins released from glycocalyx and neutrophils in the mechanism of Sepsis-induced coagulopathy development. The therapeutic mechanism of Heparin in septic coagulation caused by Hparin-binding Protein and glycocalyx was studied by comparing the changes of Hparin-binding Protein and glycocalyx metabolites before and after heparin administration.MethodsPatients diagnosed with sepsis from November 2021 to November 2022 were selected and prospectively studied. Basic clinical data were collected and main indicators were detected for enrolled patients. Hparin-binding Protein and glycocalyx metabolites(HA、HS、SDC-1) were determined by ELISA kit. The main observation indexes were the changes of Hparin-binding Protein and glycocalyx metabolites in two groups before and after heparin administration.ResultsA total of 148 subjects were screened, and 80 met inclusion and exclusion criteria. Of these, 24 were in the SIC( Sepsis-induced coagulopathy) group and 56 were in the non-SIC group. The levels of HBP(Hparin-binding Protein) and glycocalyx metabolites in SIC group were higher than those in non-SIC group. After heparin treatment, the levels of HBP in SIC and non-sic groups were increased, and the levels of glycocalyx metabolites were decreased. Compared with the non-SIC group, patients in the SCI group had more significant increase in HBP level and decrease in glycocalyx metabolites.ConclusionPlasma HBP may affect blood coagulation and endothelial function on glycocalyx. Heparin may indirectly protects the glycocalyx by replacing the HBP that binds to the glycocalyx.
A Retrospective Chart Review Demonstrates that Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration
Authors: Woodruff Kary , Joy Elizabeth , Burns Ryan D. , Summers Scott A. , Metos Julie M. , Jordan Kristine C.
Published: April 2023

Background: Insufficient evidence exists to support the recommendation for coordinated, multidisciplinary care for the outpatient treatment of patients with anorexia nervosa. The objective of this study was to conduct a pragmatic assessment of care delivered through a retrospective comparative examination of patients who received a coordinated, multidisciplinary approach (medical provider, registered dietitian, and mental health professional collaborating to coordinate patient care) on clinical outcomes for treatment of anorexia nervosa (AN).Methods: Historical electronic medical record data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes (body mass index for adults, body mass index percentile for pediatric patients) defined AN severity and weight restoration. Electronic medical record data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively.Results: Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54],p= 0.042). Additionally, patients receiving care from 1-2 providers (OR = 1.006, 95% CI [1.003, 1.010],p= 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011],p= 0.021) had significantly higher odds of weight restoration per provider visit day.Conclusions: This retrospective chart review supports the coordinated, multidisciplinary care model for the outpatient treatment of AN.
Occupational burnout, job satisfaction and flourishing among healthcare workers in western China: a network analysis
Authors: Jia Siyan , Yu Bin , Feng Chuanteng , Jia Peng , Xu Peng , Yang Shujuan
Published: April 2023

BackgroundHealthcare workers suffered with high prevalence of occupational burnout, which might be related with their job satisfaction and well-being. This study aimed to provide evidence of complex interrelations among occupational burnout, job satisfaction, and flourishing, and identify key variables from the perspective of network structure among healthcare workers.MethodsA cross-sectional study was conducted between July and October 2021, and 922 healthcare workers were recruited to report their sociodemographic characteristics, occupational burnout, job satisfaction, and flourishing. Network analysis was conducted to investigate the interrelations of dimensions in occupational burnout, job satisfaction, and flourishing communities, and identify central variables and bridges connecting different dimensions with different bridge strength thresholds in the network structure. The Network Comparison Test (NCT) was conducted to examine the gender differences in networks.ResultsIn the network, feeling exhausted at work (strength: 1.42) and feeling frustrated at work (1.27) in occupational burnout community, and interested in daily activities (1.32) in flourishing community were central variables. Bridges in the network were job reward satisfaction (bridge strength: 0.31), satisfaction with job itself (0.25), and job environment satisfaction (0.19) in job satisfaction community, as well as interested in daily activities (0.29) and feeling respectable (0.18) in flourishing community, with bridges selected with top 20% bridge strengths. Feeling frustrated at work (0.14) in occupational burnout community and leading a purposeful and meaningful life (0.11) in flourishing community became bridges when using thresholds of top 25% and 30% bridge strengths, respectively. We also observed higher network densities in females (network density: 0.37) than that in males (0.34) and gender differences in the distribution of partial correlation coefficients (M = 0.27, P = 0.017).ConclusionsIn the network structure of occupational burnout-job satisfaction-flourishing, feeling frustrated at work in occupational burnout community and interested in daily activities in flourishing community were both central variables and bridges, which may be targeted variables to intervene to alleviate the overall level of symptoms in the network and therefore prevent poor health outcomes in healthcare workers.
Does Resilience and Social Support Moderate the Association between Race-Related Stress Black Women’s Reports of Trauma Symptoms?
Authors: Williams Tiffany R , Erving Christy L. , Gao Fanchen , Mitchell Taeja , Muwele Chomba , Martin Reniece , Blasingame Miaya
Published: April 2023

Black women uniquely experience a myriad of intersecting oppressions along with racial discrimination that increases their vulnerability to trauma. Experiences of racial discrimination manifest as race-related stress, or worse an emotional wound, race-related trauma. Protective factors that facilitate coping for Black women are resilience and social support. Under investigation were Black women’s experiences of racial stress, specifically, perseverative cognition (PC) and anticipatory race-related stress (ARRS), and trauma symptoms. PC and ARRS derive from the Prolonged Activation and Anticipatory Race-Related Stress Scale. The moderating effects of resilience and social support were also examined. Data were collected from 216 Black female students at a Historically Black University. The findings indicate (1) PC was associated with higher trauma symptoms (ß = 4.46; p < .001); (2) ARSS was positively associated with trauma symptoms (ß = 4.82; p < .001); (3) Social support (ß = -2.04; p < .001) and resilience (ß = -2.80; p < .05) moderated the association between ARRS and trauma symptoms such that the association between racial stress and trauma symptoms was stronger under the condition of low social support and resilience. Treatment must include culturally relevant interventions and capitalize on protective factors to facilitate healing for Black women.
Hydraulic characteristics optimization of an airfoil pillar-shaped flume based on the Hicks–Henne function and NSGA-II algorithm
Authors: Song Zhanqi , Yang Lei , Li Zhigang , Sun Bin
Published: April 2023

In order to improve the fine optimization technology of flow measurement facilities in irrigation areas, the hydraulic characteristics optimization system of an airfoil pillar-shaped flume is constructed. The optimization system integrates three modules of airfoil shape reconstruction by Hicks–Henne function, CFD numerical simulation calculation, and NSGA-II algorithm. It can efficiently find the shape design variable value that makes the hydraulic characteristics optimal. An example of the airfoil pillar-shaped flume in a rectangular channel at 30 L/s of discharge rate is given, and the specific optimization design concept of backwater height and head loss is presented. The results show that the backwater height is reduced by 9.49% compared with the prototype, and the head loss is reduced by 8.10% compared with the prototype, proving the feasibility of the optimization system. It can provide a theoretical reference for the optimization of hydraulic characteristics of similar measuring flumes.
A karst runoff generation module based on the near-surface critical zone structure and threshold behaviors
Authors: Zhao Jianfei , Li Guofang , Duan Yanan , Hu Yiming , Li Binquan , Liang Zhongmin
Published: April 2023

Hydrological simulation in karst areas is of great importance and challenge. It is a practical way to enhance the performance of existing hydrological models in karst areas by coupling karst modules that represent hydrological processes in these areas. The near-surface critical zone structure affects runoff generation in karst areas significantly and its complex hydrological processes could be simplified with threshold behaviors. This study proposed a three-thresholds-based karst runoff generation module (3T-KRGM), which used three reservoirs to represent water storage in the soil zone, soil–epikarst interface, and epikarst zone. The 3T-KRGM is coupled with the Xinanjiang (XAJ) model to extend the applicability of the model to karst areas. Both the improved XAJ model and the original XAJ model were used in the Shibantang watershed, which is a typical karst watershed located in southwest China. The results indicate that the performance of daily discharge simulations was obviously improved by introducing the 3T-KRGM. In addition, both the parameter sensitivity analysis and baseflow simulation demonstrate that the 3T-KRGM is rational in structure. The 3T-KRGM could also be easily coupled into other hydrological models, thus benefiting the hydrological simulation in karst areas.
Decision support system for selective withdrawal in water supply reservoirs: an approach based on thermal stratification
Authors: Soyer Elif , Bayram Haluk , Canıgeniş Nalan , Eren Onur
Published: April 2023

We consider the problem of determining water withdrawal depth in water supply reservoirs with multilevel intakes in an effective and systematic manner. In the traditional way, operators decide which intake port to use based on their own experience and water samples taken from various depths. Our goal is to provide assistance to operators in the decision-making process and establish a systematic approach for determining the appropriate water withdrawal level in a stratified reservoir. To achieve this, we propose an algorithmic approach as a decision support system for estimating the water withdrawal level. We validate our approach using long-term data collected from a water supply reservoir and compare the results with those of the operator's decisions. The results reveal that when the depth tolerance is set to 10 m, the approach and operator's decisions match at an 80% rate. However, when the depth tolerance is increased to 15 m, the matching percentage improves to over 90%.
Globalización y ciudad en el Caribe (1750-1870)
Authors: Fernández Prieto Leida , Von Grafenstein Johanna , Belmonte Postigo José Luis , Luengo Gutiérrez Pedro Manuel , Luque Azcona Emilio José , Azorín García Eduardo , Vidal Ortega Antonino , Román Romero Raúl
Published: April 2023

Globalización y ciudad en el Caribe (1750-1870)
Invenção de Natal
Authors: Araujo de Maria Anne Caroline , De Oliveira Tadeu
Published: April 2023

Reconhecido internacionalmente por suas obras, a exemplo da sua pesquisa de doutoramento A invenção do Nordeste e outras artes (1999) e História: a arte de inventar o passado (2007),  Durval Muniz de Albuquerque Junior concede uma entrevista de história oral sobre a construção social das espacialidades da cidade do Natal, capital do Rio Grande do Norte. No livro  A invenção do Nordeste e outras artes,  que foi fonte para a criação da peça teatral do grupo Carmin, Durval Albuquerque trouxe os mecanismos estéticos, históricos e culturais das primeiras décadas do século XX ,que contribuíram para a formação do nordeste como um espaço idealizado e deslocado do processo histórico. Nesta entrevista o historiador traça similaridades de uma construção da espacialidade de Natal, compondo a narrativa com elementos da política, do urbanismo e da cultura local.
Efficacy and safety of direct oral anticoagulants in children in real clinical practice
Authors: Yafoshkina T. Yu. , Shifrin Yu. A. , Fedorova D. V. , Florinskiy D. B. , Evstratov D. A. , Zharkov P. A.
Published: April 2023

Introduction. As well as standard anticoagulants, direct oral anticoagulants (DOAC) have been approved for treatment of thromboembolism in children, recently. Several clinical trials provide promising data on efficacy and safety of DOAC in children and young adults. But further studies aimed at evaluating the efficacy and safety of these drugs in children and adolescents are still needed.

The aim of the study is to evaluate the safety and effectiveness of the use DOACs in children.

Materials and methods. We have retrospectively analyzed the medical records of patients (0–17 years) of from 2013 to 2022 at our tertiary care Centre and selected patients, who were treated with apixaban, rivaroxaban or dabigatran for more than 14 days. Patients with arterial thrombosis, children, who were treated with combined anticoagulant therapy and those who were unable for follow-up were excluded. We assessed the rates of bleeding and recurrent venous thromboembolism (VTE).

Results. There were 67 patients, who were treated with DOAC in our center. Patients were divided into 2 groups: those, who received prophylactic anticoagulation (group 1 – 6 patients), and patients, who received DOAC therapy after venous thromboembolism (group 2 – 61 patients). The median follow-up time was 46 (25–365) days in the group 1, and 4 months (2 weeks – 36 month) in the group 2. There were no VTE episodes and 1 minor bleeding in group 1, while 1 (2 %) major, 4 (6 %) minor bleeding episodes in group 2. There were 4 (6 %) patients with recurrent VTE in group 2.

Conclusion. The majority of patients in this study received rivaroxaban (79 %). We found a moderately increased recurrence rate of VTE, which could be the result of a long follow-up period, and a comparable rate of bleeding, all of which were associated with rivaroxaban therapy. In the future, of particular interest, in our opinion, are prospective studies of DOACs as primary antithrombotic prophylaxis, as well as secondary prophylaxis in the highest-risk groups, and the results of an analysis of their use in real clinical practice.
Approaches to the treatment of a multisystem form of juvenile xanthogranuloma with central nervous system lesion
Authors: Natrusova M. V. , Burtsev E. A. , Bronina N. V. , Osipova D. S. , Evseev D. A. , Seliverstova E. V. , Bronin G. O. , Maschan M. A. , Kumirova Е. V.
Published: April 2023

Relevance. Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytic disorder. Cutaneous forms of the disease spontaneously regress within a few years, while systemic forms of JXG require treatment and may pose a threat to the lives of patients. Due to the lack of unified approach to the treatment of multisystem forms of JXG, the question of effective therapy tactics remains unresolved. The most common approach is to use Langerhans cell histiocytosis (LCH) treatment regimens for JXG. With the understanding of the leading role of mutations in the MEK-ERK signaling pathway in the pathogenesis of JXG, targeted therapy, BRAF- and MEK-inhibitors, are increasingly being considered in the treatment of JXG.

Clinical cases. We present two cases of multisystem JXG with central nervous system (CNS) lesions. The first patient with CNS and skin lesions was treated with chemotherapy, developed for the treatment of multisystem LCH, which allowed us to obtain an effect “active disease better” (AD better). The second JXG patient with brain, lungs, bones, and adrenal gland lesions, combined targeted therapy with BRAF- and MEKinhibitors, vemurafenib and cobimetinib, resulted in a “non active disease” (NAD) effect.

Conclusion. Multisystem form of JXG with CNS involvement is a rare oncological disease, the therapy of which has not been developed. With the introduction of molecular genetic profiling technology, it became possible to obtain NAD effect using targeted therapy.
The Birth of Polynesia: An Archaeological Journey Through the Kingdom of Tonga
Authors: Burley David
Published: April 2023

The “Birth of Polynesia” provides an archaeological narrative of the first people to settle in Polynesia in the Kingdom of Tonga, and the ensuing expansion from the founder settlement on Tongatapu northward through a myriad of islands to Sāmoa and beyond. It presents a comprehensive synthesis of the author’s three-decade-long research program tracking this settlement through a distinctive type of decorated pottery referred to as Lapita. The impact of the first Polynesians on pristine tropical environments, their subsistence practices as inferred through archaeological data, their material culture and art, the chronology and motivations behind the expansion, and the reflections of this past in the Tongan present are addressed in different chapters. Insights into the individuals, events and decisions influencing such a lengthy research endeavour are integrated throughout.
Efficacy of Pender's Health Promotion-based Model on Intervention for Enhancing University of Mosul Hypertensive Employees' Eating Behaviors: A Randomized Controlled Trial
Authors: Salem Abbas Ahmed , Muwfaq Younis Nasir
Published: April 2023

Dietary habits are an essential lifestyle element contributing to hypertension development and can be changed if adequately controlled and educated. The DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes consuming fruits, vegetables, and low-fat dairy products, is recommended to lower blood pressure and reduce sodium intake. The article aims to identify the Efficacy of Pender's Health Promotion-based Model on Intervention for Enhancing University of Mosul Hypertensive Employees' Eating Behaviors. A proper experimental design employing the randomized controlled trial approach is used to establish the efficiency of Pander's health promotion based on intervention for enhancing eating behaviors among University of Mosul hypertension personnel. The study was conducted at the University of Mosul from first December 2021 to the end of April 2022. The sample was selected from a homogeneous group of 220 employees. Random selection and random assignment are used to create the experimental and control group for every 25 employees. This study's results show statistically significant differences across all Pander Model principles connected to hypertension-associated eating behavior. On the other hand, the perceived barrier was the only belief that remained constant over time.The study indicated that the Pender model's health promotion demonstrates the relevance of hypertension prevention and has a favorable impact on employees' perceptions of perceived advantages, Self-efficacy, and perceived risks, social support and activity-related effect of unhealthy Hypertension advised employees to use their eating behavior through a healthy diet, physical activity and other healthy behaviors to hypertension control to prevent different health hazards, social support for activating "readiness" to break free from unhealthy habits and self-efficacy for self-assurance in blood pressure control.

Keywords: Efficacy, Pender's Model, health promotion, Hypertensive Employees, Eating Behaviors
Investigation of the Omentin-1 V109D gene polymorphism as a risk factor for the incidence of Polycystic Ovary Syndrome
Authors: Mohsen Ahmed M. , A. AL-Azawi Rawaa S. , H. Naji Hawraa , H. Kzar Hamzah , Al-Gazally Moaed E.
Published: April 2023

This study was conducted to assess the omentin-1 (OME-1) V109D gene SNP in women with PCOS and healthy control and to investigate the possible relationship between this adipokine and metabolic profile. This study includes 50 women in the range of age (19-43 Y) who have been diagnosed with PCOC as a patient group and 40 healthy women in age (17-45 Y) as a control group. Five ml of peripheral blood were drawn from both groups to perform the biochemical and genetic study. Metabolic profiles were assessed by spectrophotometric methods, and PCR-RFLP investigated V109D of OME-1 SNP. The results suggest a statistical decrease in FBG, BMI, TG, TC, and LDL(p-value<0.05) in the control group compared to the PCOS group and a statistical increase in HDL levels in control compared to the PCOS group. Genotyping analysis shows statistically significant differences between DD and VV genotypes in PCOS and control groups (OR=4.66 (CI 95%,1.6-8.3), (OR=2.4 (CI95%,0.7-6.9) respectively. These results suggest statistically significant differences in three genotypes (DD, DV, and VV) of the PCOS group depending on age and BMI (p-value <0.05). DD and VV genotypes of OME-1 V109D SNP have more risk factors for PCOS incidence and changes in metabolic profile in Iraqi women.

Keywords: Polycystic ovary syndrome, Omentin-1, risk factor, polymorphism genetic
Immune response to the two doses of mRNA vaccine: A cross-sectional study from a single center located in Wasit province, Iraq
Authors: Kudhair Abdullabass Hasaneen , Hamza Al-Shammari Ahmed , A.S.AL-Zuhairy Saeed
Published: April 2023

The pandemic controlling COVID-19 can cause the deaths of more than 4 million worldwide. Recently the production of the more effective vaccine genetically modified is the suitable solution for managing acute respiratory syndrome, SARS-CoV-2 was a talented emergency use license by FDA by a company of Pfizer-BioNTech (BNT162b2) mRNA the CRP and D dimer important blood markers for diagnosis and severity of this disease. The specific antibody SARS-CoV-2 IgG was the measurement titer after (14-20). After the intake first dose of vaccine by VIDAS® (BioMérieux, Marcy-L'Etoile, France), all volunteers have done screening examination by rapid test for detection not exposure to the previous infection, who had negative to SARS-CoV-2 IgG, after the second dose of vaccine, the specific IgG examination by using ELFA technique. CRP and D-dimer were used to monitor the blood markers to assess any side effects (side effects of the vaccine on the lung inflammatory and clotting system), measured after 48h of taking the vaccine in both doses. Ninety-four were included in this study (54 female and 40 male) and divided into two age groups. All the subjects had SARS-CoV-2 IgG after (10 and 20) days following the first dose and (10 and 20) days following the booster dose. The results were shown a non-significant difference in age between males and females. The mean value of the IgG titer against CoV antigen after 2nd dose of immunization is significantly higher than the corresponding value after the 1st dose. There is a non-significant correlation between the ages of immunized subjects with the IgG titer after receiving the second dose of the mRNA vaccine. The titer of IgG increased after the 2nd dose of vaccination while the C-reactive protein significantly decreased. The Pfizer mRNA vaccine gives an excellent active immune response to produce IgG after the booster dose, and results have not recorded any effect of the vaccine on the activity of blood inflammatory markers.

Keywords: COVID-19; immune response; mRNA vaccine; C-reactive protein, D-dimer, anti-SARS-CoV-2 IgG.
Effectiveness of a Personalized, Chess-Based Training Serious Video Game in the Treatment of Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial
Authors: Rodrigo-Yanguas María , Martín-Moratinos Marina , González-Tardón Carlos , Sanchez-Sanchez Fernando , Royuela Ana , Bella-Fernández Marcos , Blasco-Fontecilla Hilario
Published: April 2023

Background

Compared with traditional approaches, gaming strategies are promising interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). We developed a serious game, The Secret Trail of Moon (TSTM), for ADHD treatment.

Objective

The main objective of this clinical trial was to demonstrate the effectiveness of an add-on, either TSTM or Therapeutic Chess (TC), in previously optimally drug-titrated, clinically stable patients with ADHD.

Methods

This study is a prospective, unicentric, randomized clinical trial in clinically stable patients with ADHD, aged 12 to 22 years. The TSTM (n=35) and TC groups (n=34) performed 12 weekly sessions of their respective treatments. The control group (CG) patients (n=35) were called by phone every week, but they received no cognitive intervention. The primary end point was the change from baseline to end point in the parent “Behavior Rating Inventory of Executive Function-2” (BRIEF-2; patients’ parents) in the per-protocol population (31 serious videogame: 24 TC and 34 CG).

Results

Our study failed to probe clear-cut improvements in the global score of the BRIEF-2. However, the TC group showed improvements in measures of emotional control, emotional regulation, and inattention. The TSTM group showed improvements in measures of emotional regulation, inattention, and school context.

Conclusions

TSTM and TC did not improve executive function symptoms, but they improved ADHD symptomatology related to emotional regulation. Further studies with bigger samples are required to confirm these preliminary findings.

Trial Registration

ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065
Focusing on Digital Research Priorities for Advancing the Access and Quality of Mental Health
Authors: Torous John , Benson Nicole M , Myrick Keris , Eysenbach Gunther
Published: April 2023

Digital mental health solutions are now well recognized as critical to solving the global mental health crisis. As research accelerates, it is now clear that solutions ranging from computer-based therapy programs to virtual reality headsets and smartphone apps to large language model chatbots are of interest, feasible, and hold exciting potential to improve mental health. This research should now consider the next generation of scientific and clinical questions regarding if these new approaches are equitable, valid, effective, implementable, efficacious, and even cost-effective. This paper outlines several of the new frontiers for the next generation of research and introduces JMIR Publications’ partnership with the Society of Digital Psychiatry to further advance these aims.
Gender Parity Analysis of the Editorial Boards of Influential Dermatology Journals: Cross-Sectional Study (Preprint)
Authors: Szeto Mindy D , Sivesind Torunn E , Kim Lori S , O’Connell Katie A , Sprague Kathryn A , Nong Yvonne , Strock Daniel M , Cao Annie L , Wu Jieying , Toledo Lauren M , Wolfe Sophia M , Boothby-Shoemaker Wyatt , Dellavalle Robert P
Published: April 2023

UNSTRUCTURED

This study underscores the persistent underrepresentation of women in academic dermatology leadership positions by examining the gender composition of editorial boards across top dermatology journals, emphasizing the urgent need for proactive strategies to promote diversity, equity, and inclusion.