bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical undergraduates’ self-evaluation: before and after curriculum reform
Authors: Wu Jeng-Cheng , Tang Kung-Pei , Hsu Yi-Hsin Elsa , Yang Ya-Ting , Chu Jan-Show , Lin Yen-Kuang , Hou Wen-Hsuan
Published: April 2022

Background

In 2013, Taiwan launched a curriculum reform—the 7-year undergraduate medical education program was shortened to 6 years. This study explored the evaluation results from students regarding the curriculum reform and investigated graduates’ perceptions regarding the curriculum organization of the two academic training programs affected by this curricular reform.

Methods

A cross-sectional survey was conducted from May 14 to June 12, 2019. The 315 graduates from both the 7-year and 6-year curriculum programs in the same medical school in Taipei were invited to participate in this study. In total, 197 completed questionnaires were received, representing a response rate of 62.5%. The results of the principal component analysis confirmed the validity of the constructs employed in this self-administered questionnaire.

Results

The t-test results yielded two main findings. First, the graduates from the 6-year program had significantly lower scores for preparedness for the upcoming postgraduate-year residency training than did their 7-year program counterparts. Additionally, the male graduates had significantly higher scores in terms of perceptions regarding curriculum organization and preparedness for postgraduate-year residency training than the female graduates. The results of stepwise regression also indicated that the sex difference was significantly correlated with graduates’ readiness for their postgraduate-year residency training.

Conclusion

To avoid sex disparities in career development, a further investigation of female medical students’ learning environment and conditions is necessary. In addition to the cross-sectional study of students’ perceptions, further repeated measurements of the objective academic or clinical performance of graduates in clinical settings are desirable.
Development of clinical-guideline-based mobile application and its effect on head CT scan utilization in neurology and neurosurgery departments
Authors: Meidani Zahra , Atoof Fatemeh , Mobarak Zohre , Nabovati Ehsan , Daneshvar Kakhki Reza , Kouchaki Ebrahim , Fakharian Esmaeil , Nickfarjam Ali Mohammad , Holl Felix
Published: April 2022

Background

There is little evidence regarding the adoption and intention of using mobile apps by health care professionals (HCP) and the effectiveness of using mobile apps among physicians is still unclear. To address this challenge, the current study seeks two objectives: developing and implementing a head CT scan appropriateness criteria mobile app (HAC app), and investigating the effect of HAC app on CT scan order.

Methods

A one arm intervention quasi experimental study with before/after analysis was conducted in neurology & neurosurgery (N&N) departments at the academic hospital. We recruited all residents' encounters to N&N departments with head CT scan to examine the effect of HAC app on residents' CT scan utilization. The main outcome measure was CT scan order per patient for seven months at three points, before the intervention, during the intervention, after cessation of the intervention -post-intervention follow-up. Data for CT scan utilization were collected by reviewing medical records and then analyzed using descriptive statistics, Kruskal-Wallis, and Mann-Whitney tests. A focus group discussion with residents was performed to review and digest residents' experiences during interaction with the HAC app.

Results

Sixteen residents participated in this study; a total of 415 N&N encounters with CT scan order, pre-intervention 127 (30.6%), intervention phase 187 (45.1%), and 101 (24.3%) in the post-intervention follow-up phase were included in this study. Although total CT scan utilization was statistically significant during three-time points of the study (P = 0.027), no significant differences were found for CT utilization after cessation of the intervention (P = 1).

Conclusion

The effect of mobile devices on residents' CT scan ordering behavior remains open to debate since the changes were not long-lasting. Further studies based on real interactive experiences with mobile devices is advisable before it can be recommended for widespread use by HCP.
The economic costs of limited health literacy in China: evidence from China’s National Health Literacy Surveillance data
Authors: Liu Lefan , Huang Jing , Li Guoxing , Chen Zhuo , He Tianfeng
Published: April 2022

Background

Limited health literacy is a public health challenge contributing to the rising health care costs. We assess the economic costs of limited health literacy in China using data from the National Health Literacy Surveillance survey.

Methods

Our data includes a sample of 6316 residents aged 15–69 years old living in Ningbo, China, in 2019. We use box plots to examine the distribution of out-of-pocket health expenditure by the level of health literacy. We then use the estimates from a two-part model to assess the contribution of limited health literacy to individual medical spending and the aggregate health expenditure at different levels of health literacy for the adult population in Ningbo.

Results

Medical costs of limited health literacy are about 10% (177 CNY or about 25 USD) of the annual medical expense of a resident aged 15–69 living in Ningbo. The medical cost of limited health literacy is greater among the rural, female, and older groups than others. If the proportion of people with adequate health literacy increases from 22 to 30% (the target level by 2030), the aggregate out-of-pocket health expenditure in Ningbo will decrease by 100 million CNY (14 million USD), or 0.88% of the 2019 Ningbo government expenditure on health care.

Conclusions

This paper highlights the direct and indirect economic costs associated with limited health literacy. The results should help policymakers evaluate the cost-effectiveness of relevant programs that aim to improve residents’ health literacy.
The potential impact of Anopheles stephensi establishment on the transmission of Plasmodium falciparum in Ethiopia and prospective control measures
Authors: Hamlet Arran , Dengela Dereje , Tongren J. Eric , Tadesse Fitsum G. , Bousema Teun , Sinka Marianne , Seyoum Aklilu , Irish Seth R. , Armistead Jennifer S. , Churcher Thomas
Published: April 2022

Background

Sub-Saharan Africa has seen substantial reductions in cases and deaths due to malaria over the past two decades. While this reduction is primarily due to an increasing expansion of interventions, urbanisation has played its part as urban areas typically experience substantially less malaria transmission than rural areas. However, this may be partially lost with the invasion and establishment of Anopheles stephensi. A. stephensi, the primary urban malaria vector in Asia, was first detected in Africa in 2012 in Djibouti and was subsequently identified in Ethiopia in 2016, and later in Sudan and Somalia. In Djibouti, malaria cases have increased 30-fold from 2012 to 2019 though the impact in the wider region remains unclear.

Methods

Here, we have adapted an existing model of mechanistic malaria transmission to estimate the increase in vector density required to explain the trends in malaria cases seen in Djibouti. To account for the observed plasticity in An. stephensi behaviour, and the unknowns of how it will establish in a novel environment, we sample behavioural parameters in order to account for a wide range of uncertainty. This quantification is then applied to Ethiopia, considering temperature-dependent extrinsic incubation periods, pre-existing vector-control interventions and Plasmodium falciparum prevalence in order to assess the potential impact of An. stephensi establishment on P. falciparum transmission. Following this, we estimate the potential impact of scaling up ITN (insecticide-treated nets)/IRS (indoor residual spraying) and implementing piperonyl butoxide (PBO) ITNs and larval source management, as well as their economic costs.

Results

We estimate that annual P. falciparum malaria cases could increase by 50% (95% CI 14–90) if no additional interventions are implemented. The implementation of sufficient control measures to reduce malaria transmission to pre-stephensi levels will cost hundreds of millions of USD.

Conclusions

Substantial heterogeneity across the country is predicted and large increases in vector control interventions could be needed to prevent a major public health emergency.
‘I thought I had fibroids, and now I don’t’: a mixed method study on health-related quality of life in uterine sarcoma patients
Authors: den Hollander Dide , Lidington Emma , Singer Susanne , Sodergren Samantha C. , Salah Samer , Fiore Marco , Benson Charlotte , Desar Ingrid M. E. , Burgers Vivian W. G. , Husson Olga , van der Graaf Winette T. A.
Published: April 2022

Background

Uterine sarcomas are rare subtypes of primary urogenital tumours and need tailored treatment. This study aimed to examine the impact of diagnosis and treatment on health-related quality of life (HRQoL) in patients with uterine sarcoma and measures available to assess HRQoL in this group.

Methods

Thirteen patients with uterine sarcoma and 23 health care professionals were purposively sampled from sarcoma reference centers and participated in a semi-structured interview exploring HRQoL. Patients were also asked to review the EORTC QLQ-C30 and EORTC QLQ-EN24 for relevance. Data were analysed using thematic analysis and descriptive statistics.

Results

The most commonly reported physical health issues were related to sexual dysfunction and urological symptoms. Hormone-related issues and gastrointestinal symptoms were also identified. Cancer-generic issues such as functional problems, fatigue, pain, and treatment-related adverse effects were also reported. Regarding mental health, fears (about having sex, of recurrence, or of death), altered body-image, and dealing with lacking knowledge regarding sarcoma had an impact on HRQoL. Social health issues were related to the impact on relationships with others, limitations in undertaking activities, loss of independence, changes in work or study capacity, and financial difficulties. Most of the items of the EORTC QLQ-C30 and EORTC QLQ-EN24 questionnaires were rated as relevant. Questions about lack of knowledge about sarcoma, shock of diagnosis, and menopausal symptoms were lacking from existing measures.

Conclusions

Uterine sarcoma patients experience a variety of concerns covering the physical, mental, and social domains of HRQoL that are in the main EORTC instruments, but not all of them. Combining cancer-generic, location- and sarcoma-specific items is recommended to assess HRQoL in this patient group.

Trial registration NCT04071704.
The regulatory role of NAAG-mGluR3 signaling on cortical synaptic plasticity after hypoxic ischemia
Authors: Li Kexin , Lu Meng , Cui Mengxu , Wang Xiaoming , Zheng Yang
Published: April 2022

Background

Synapses can adapt to changes in the intracerebral microenvironment by regulation of presynaptic neurotransmitter release and postsynaptic neurotransmitter receptor expression following hypoxic ischemia (HI) injury. The peptide neurotransmitter N-acetylaspartylglutamate (NAAG) exerts a protective effect on neurons after HI and may be involved in maintaining the function of synaptic networks. In this study, we investigated the changes in the expression of NAAG, glutamic acid (Glu) and metabotropic glutamate receptors (mGluRs), as well as the dynamic regulation of neurotransmitters in the brain after HI, and assessed their effects on synaptic plasticity of the cerebral cortex.

Methods

Thirty-six Yorkshire newborn pigs (3-day-old, males, 1.0–1.5 kg) were selected and randomly divided into normal saline (NS) group (n = 18) and glutamate carboxypeptidase II inhibition group (n = 18), both groups were divided into control group, 0–6 h, 6–12 h, 12–24 h, 24–48 h and 48–72 h groups (all n = 3) according to different post-HI time. The content of Glu and NAAG after HI injury were detected by 1H-MRS scanning, immunofluorescence staining of mGluRs, synaptophysin (syph) along with postsynaptic density protein-95 (PSD95) and transmission electron microscopy were performed. ANOVA, Tukey and LSD test were used to compare the differences in metabolite and protein expression levels among subgroups. Correlation analysis was performed using Pearson analysis with a significance level of α = 0.05.

Results

We observed that the NAAG and mGluR3 expression levels in the brain increased and then decreased after HI and was significantly higher in the 12–24 h (P < 0.05, Tukey test). There was a significant positive correlation between Glu content and the expression of mGluR1/mGluR5 after HI with r = 0.521 (P = 0.027) and r = 0.477 (P = 0.045), respectively. NAAG content was significantly and positively correlated with the level of mGluR3 expression (r = 0.472, P = 0.048). When hydrolysis of NAAG was inhibited, the expression of synaptic protein PSD95 and syph decreased significantly.

Conclusions

After 12–24 h of HI injury, there was a one-time elevation in NAAG levels, which was consistent with the corresponding mGluR3 receptor expression trend; the NAAG maintains cortical synaptic plasticity and neurotransmitter homeostasis by inhibiting presynaptic glutamate vesicle release, regulating postsynaptic density proteins and postsynaptic receptor expression after pathway activation.
Evaluation of morphological characteristics for incomplete discoid medial meniscus with an oversized posterior segment
Authors: Araki Shotaro , Tsubosaka Masanori , Muratsu Hirotsugu , Inokuchi Takao , Maruo Hiroaki , Miya Hidetoshi , Kuroda Ryosuke , Matsushita Takehiko
Published: April 2022

Background

A discoid medial meniscus is rare in comparison with a discoid lateral meniscus. We encountered a new type of incomplete discoid with an oversized posterior segment. Therefore, this study aimed to report cases of medial meniscus with an oversized posterior segment and analyze the morphological characteristics by comparing them to cases with a discoid medial meniscus and normal medial meniscus.

Methods

Four patients with an oversized posterior segment medial meniscus (oversize group, mean age: 25.3 ± 12.0 years) and seven patients with a discoid medial meniscus (discoid group, mean age: 34.4 ± 19.6) were identified using magnetic resonance imaging (MRI) and diagnosed by arthroscopic findings in our hospital. Fifty patients without medial meniscal injury were retrospectively selected as the normal group (normal group, mean age: 24.0 ± 11.3 years). The clinical symptoms were examined. The anteroposterior (AP) length of both the anterior and posterior segments, AP length ratio of the posterior segment to the AP length of the medial tibial plateau, and mediolateral (ML) width of the mid-body of the medial meniscus were also evaluated using MRI and compared among the three groups.

Results

All patients in the oversize group complained of medial knee pain during deep knee flexion. In sagittal MRI, posteriorly deviated indentations were also observed at the medial tibial plateau in all cases in the oversize group. There was a significant difference in the AP length of the posterior segment between the normal and oversize groups (14.3 ± 2.8 vs. 23.6 ± 2.8 mm,P < 0.001), whereas there was no significant difference in the AP length of the anterior segment (9.1 ± 2.1 vs. 9.5 ± 1.9 mm,P = 0.869). The ML width of the mid-body in the normal, oversize, and discoid groups was 9.3 ± 1.8, 19.9 ± 2.6, and 25.8 ± 1.9 mm, respectively (normal vs. oversize group:P < 0.001, oversize vs discoid group:P = 0.01, normal vs. discoid group:P < 0.001).

Conclusions

Oversized posterior and normal anterior segments characterize this new type of incomplete discoid medial meniscus as a morphological abnormality.
Sex-related differences in visuomotor skill recovery following concussion in working-aged adults
Authors: Smeha Nicole , Kalkat Ravneet , Sergio Lauren E. , Hynes Loriann M.
Published: April 2022

Background

The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate somatosensory information into an appropriate motor response. Performance on such rule-based, “cognitive-motor integration” tasks is affected in concussion. Here, we investigate the relationship between visuomotor skill performance, concussion history, and sex during the course of a post-concussion management program.

Methods

Fifteen acutely concussed working-aged adults, 11 adults with a history of concussion, and 17 healthy controls all completed a recovery program over the course of 4 weeks. Prior to, mid-way, and following the program, all participants were tested on their visuomotor skills.

Results

We observed an overall change in visuomotor behaviour in all groups, as participants completed the tasks faster and more accurately. Specifically, we observed significant visuomotor skill improvement between the first and final sessions in participants with a concussion history compared to no-concussion-history controls. Notably, we observed a stronger recovery of these skills in females.

Conclusions

Our findings indicate that (1) concussion impairs visuomotor skill performance, (2) the performance of complex, rule-based tasks showed improvement over the course of a recovery program, and (3) stronger recovery in females suggests sex-related differences in the brain networks controlling skilled performance, and the effect of injury on these networks.
Severe thyrotoxicosis as initial presentation of gastric choriocarcinoma: a case report
Authors: Iñiguez-Ariza Nicole M. , Cuenca Dalia , Franco-Granillo Juvenal , Villalobos-Prieto Alberto , Pineda-Díaz Janet , Baquera-Heredia Javier
Published: April 2022

Background

Extragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin.

Case presentation

A 62-year-old Hispanic female presented with a 3-week history of shortness of breath, palpitations, extreme weakness, new-onset hot flashes, and right flank pain. Her physical examination was remarkable for tachycardia, hepatomegaly, hyperreflexia, and tremor; goiter was absent. Laboratory studies revealed increased lactate dehydrogenase, alkaline phosphatase, suppressed thyroid stimulating hormone, very elevated T4, and absent thyroid stimulating immunoglobulin. 18F-fluorodeoxyglucose positron emission tomography-computed tomography exhibited hepatomegaly with multiple large fluorodeoxyglucose-avid liver masses and a focus of fluorodeoxyglucose avidity in the stomach with no structural correlate. A thyroid scan (99mTcO
4
−
) showed diffusely increased tracer uptake. She was started on propranolol and methimazole. Upon stabilization of severe thyrotoxicosis, upper endoscopy was performed, showing a ~ 5 cm bleeding lesion in the greater stomach curvature body; biopsy was consistent with choriocarcinoma; beta-human chorionic gonadotropin hormone was 2,408,171 mIU/mL. The patient received methotrexate followed by etoposide and cisplatin. Methimazole was titrated down, and upon liver failure the medication was stopped. The thyrotoxicosis was effectively controlled with antithyroid drug and concurrent chemotherapy. At ~ 1.5 months after initial diagnosis, the patient died due to bleeding/acute liver failure with coagulation defects followed by multiple organ failure.

Conclusions

Severe thyrotoxicosis can represent an unusual initial presentation of metastatic choriocarcinoma in the setting of extreme elevation of beta-human chorionic gonadotropin. Primary gastric choriocarcinoma is an aggressive malignancy with very poor outcomes. The co-occurrence of severe thyrotoxicosis with advanced primary gastric choriocarcinoma and imminent liver failure complicates management options.
Impaired phosphate transport in SLC34A2 variants in patients with pulmonary alveolar microlithiasis
Authors: Jönsson Åsa Lina M. , Hernando Nati , Knöpfel Thomas , Mogensen Susie , Bendstrup Elisabeth , Hilberg Ole , Christensen Jane Hvarregaard , Simonsen Ulf , Wagner Carsten A.
Published: April 2022

Background

Variants in SLC34A2 encoding the sodium-dependent phosphate transport protein 2b (NaPi-IIb) cause the rare lung disease pulmonary alveolar microlithiasis (PAM). PAM is characterised by the deposition of calcium-phosphate concretions in the alveoli usually progressing over time. No effective treatment is available. So far, 30 allelic variants in patients have been reported but only a few have been functionally characterised. This study aimed to determine the impact of selected SLC34A2 variants on transporter expression and phosphate uptake in cellular studies.

Methods

Two nonsense variants (c.910A > T and c.1456C > T), one frameshift (c.1328delT), and one in-frame deletion (c.1402_1404delACC) previously reported in patients with PAM were selected for investigation. Wild-type and mutant c-Myc-tagged human NaPi-IIb constructs were expressed in Xenopus laevis oocytes. The transport function was investigated with a 32Pi uptake assay. NaPi-IIb protein expression and localisation were determined with immunoblotting and immunohistochemistry, respectively.

Results

Oocytes injected with the wild-type human NaPi-IIb construct had significant 32Pi transport compared to water-injected oocytes. In addition, the protein had a molecular weight as expected for the glycosylated form, and it was readily detectable in the oocyte membrane. Although the protein from the Thr468del construct was synthesised and expressed in the oocyte membrane, phosphate transport was similar to non-injected control oocytes. All other mutants were non-functional and not expressed in the membrane, consistent with the expected impact of the truncations caused by premature stop codons.

Conclusions

Of four analysed SLC34A2 variants, only the Thr468del showed similar protein expression as the wild-type cotransporter in the oocyte membrane. All mutant transporters were non-functional, supporting that dysfunction of NaPi-IIb underlies the pathology of PAM.
Arthropod fauna of Thymelaea hirsuta in the Egyptian western desert, with a special reference to Olpium kochi
Authors: Hegazy Esmat , Khafagi Wedad , Agamy Essam
Published: April 2022

Background

Natural and semi-natural ecosystems in the Egyptian Western Desert are in serious danger of being degraded or lost through overgrazing, and overcutting of dominant vegetation, shrubs and trees and tourism activities. The study shows the effect of Man's use during 1990 and recently in 2018 led to desertification.

Results

Thymelaea hirsuta (L.) (Thymelaeceae) was an important component (shrubs) in the natural ecosystems of the Egyptian Western Desert that harbors rich arthropod fauna all the year around. The spiders, pesudocorions (Arachnida: Araneae), and insects associated with this shrub were monthly sampled in 1990 at two different protected sites. One is on a very nice coastal ridge, semi-arid site, and the other is in the inland depression, arid site. The sites had distinctive characteristic of populations of non-insect predatory arthropods responding to habitat characteristics. The insects, spiders and pseudoscorpions occurred throughout the year in both sites. However, on the less arid site, the pronounced insect population occurred in winter months while the non-insect was relatively higher in summer months. On the more arid site, the highest insect population was in winter and the non-insect population was higher in autumn. The false-scorpion Olpium kochi Simon (Arachnida, Pseudoscorpionida, Olpiidae), a native rare predator to the Saharan fauna, was very common and its activity reflects its effective predatory role in both sites. In 2017–2018, several visits to the above sites showed that they were completely degraded and most of figs, olive, palm trees and dominant vegetations were removed. The survived shrub populations were very far from each other, sparse very low number and are very poor in arthropod fauna. Thus, several visits were essential to be paid just to collect enough numbers of O. kochi. The life-cycle of O. kochi is through egg-stage and three nymphal instars. There was no active feeding period by the end of each of these stages. Adults can live for 2–4 months. The developmental period takes 10 to 14 months/generation. Cannibalism tendency was among nymphs, but was very rare among fed or starved adults.

Conclusions

The study sites were seriously degraded with irreversible changes. The nice cost ridge was completely degraded and lost by removing the leading dominant vegetations and fruit trees and replacing building houses. Houses replaced most of the site in the inland depression for more desertification.
The phytopathogen Xanthomonas campestris scavenges hydroxycinnamic acids in planta via the hca cluster to increase virulence on its host plant
Authors: Chen Bo , Li Rui-Fang , Zhou Lian , Song Kai , Poplawsky Alan R. , He Ya-Wen
Published: April 2022

Xanthomonas campestris pv. campestris (Xcc) is the causal agent of black rot of cruciferous plants, which harbor high levels of hydroxycinnamic acids (HCAs) in their above-ground parts. Thus, upon infection of the host plant, the pathogen experiences a complex cocktail of HCAs. The present study shows that Xcc can efficiently degrade the HCAs, 4-hydroxycinnamic acid (4-HCA), ferulic acid (FA) and sinapic acid (SiA), via an hca cluster which encodes putative genes for a 4-hydroxycinnamoyl-CoA synthetase/4-HCA ligase HcaL, a benzaldehyde dehydrogenase HcaD, a 4-hydroxycinnamoyl-CoA hydratase/lyase HcaH and a member of the MarR-family of transcriptional factors, HcaR. Xcc also degrades the HCA caffeic acid, but with an alternative mechanism. RT-PCR and subsequent GUS assays show that the hca cluster is transcribed within a single operon, and its transcription is specifically induced by 4-HCA, FA and SiA. Furthermore, we show that HcaR negatively regulates hca transcription when its ligand, the proposed degradation pathway intermediate HCA-CoA, is not present. HcaR specifically binds to a 25-bp site, which encompasses the -10 elements of the hca promoter. Finally, GUS histochemical staining and subsequent quantitative analysis shows that the hca cluster is transcribed in planta during pathogenesis of Chinese radish, and hca deletion mutant strains exhibit compromised virulence in cabbage. Together, these results suggest that the ability to degrade HCAs contributes to Xcc virulence by facilitating its growth and spread, and by protecting the pathogen from HCA toxicity. A working model to explain Xcc HCA sensing and subsequent induction of the HCA degradation process is proposed.
Phase II Study of Nivolumab and Salvage Nivolumab/Ipilimumab in Treatment-Naive Patients With Advanced Clear Cell Renal Cell Carcinoma (HCRN GU16-260-Cohort A)
Authors: Atkins Michael B. , Jegede Opeyemi A. , Haas Naomi B. , McDermott David F. , Bilen Mehmet A. , Stein Mark , Sosman Jeffrey A. , Alter Robert , Plimack Elizabeth R. , Ornstein Moshe , Hurwitz Michael , Peace David J. , Signoretti Sabina , Denize Thomas , Cimadamore Alessia , Wu Catherine J. , Braun David , Einstein David , Catalano Paul J. , Hammers Hans
Published: April 2022

PURPOSE

To determine the value of tumor cell programmed death-ligand 1 (PD-L1) expression as a predictive biomarker of nivolumab monotherapy efficacy in treatment-naive patients with clear cell renal cell carcinoma (ccRCC) and the efficacy of salvage nivolumab/ipilimumab in patients with tumors unresponsive to nivolumab monotherapy.

METHODS

Eligible patients with treatment-naive ccRCC received nivolumab until progressive disease (PD), toxicity, or completing 96 treatment weeks (part A). Patients with PD before or stable disease at 48 weeks could receive salvage nivolumab/ipilimumab (part B). The primary end point was improvement in 1-year progression-free survival in patients with tumor PD-L1 expression > 20% versus 0%.

RESULTS

One hundred twenty-three patients were enrolled. The objective response rate (ORR) was 34.1% (95% CI, 25.8 to 43.2). ORR by International Metastatic RCC Database Consortium category was favorable-risk 57.1%, intermediate-risk/poor-risk 25.0%, and by sarcomatoid features 36.4%. The ORR was 26.9%, 50.0%, and 75.0% for patients with the tumor PD-L1 expression of 0, 1-20, or > 20%, respectively (trend test P value = .002). The median duration of response was 27.6 (19.3 to not reached) months, with 26 of 42 responders including 17 of 20 with favorable-risk disease remaining progression-free. The 1-year progression-free survival was 34.6% and 75.0% in the PD-L1 = 0% and > 20% categories, respectively ( P = .050). Ninety-seven patients with PD or prolonged stable disease were potentially eligible for part B, and 35 were enrolled. The ORR for part B was 11.4%. Grade ≥ 3 treatment-related adverse events occurred in 35% of patients on nivolumab and 43% of those on salvage nivolumab/ipilimumab.

CONCLUSION

Nivolumab monotherapy is active in treatment-naive ccRCC. Although efficacy appears to be less than that of nivolumab/ipilimumab in patients with intermediate-risk/poor-risk disease, favorable-risk patients had notable benefit. Efficacy correlated with tumor PD-L1 status. Salvage nivolumab/ipilimumab was frequently not feasible and of limited benefit.
Presurgical Thalamus Volume in Postoperative Delirium: A Longitudinal Observational Cohort Study in Older Patients
Authors: Fislage Marinus , Feinkohl Insa , Pischon Tobias , Spies Claudia D. , Borchers Friedrich , Winterer Georg , Zacharias Norman ,   on behalf of the BioCog Consortium
Published: April 2022

BACKGROUND:

Previous studies suggest a role of the thalamus in cognitive function, while others implicate it as a central effect site of anesthetics. Yet, its role in postoperative neurocognition in the aging brain remains uncertain. We used presurgical thalamic volume as a functional indicator and determined its association with postoperative delirium (POD).

METHODS:

For this study, 301 older adults (aged ≥65) without dementia and scheduled for surgery were enrolled. Before surgery, participants underwent magnetic resonance imaging (MRI). Thalamus volume was segmented using Freesurfer (Version 5.3.). Participants were screened for POD twice a day until discharge or for a maximum of 7 days. POD was defined as a positive screening on ≥1 of 4 validated instruments: Richmond Agitation Sedation Scale (RASS), Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method (CAM), and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score. A logistic regression associated thalamus volume with POD with adjustment for age, global brain atrophy, and physical status according to the American Society of Anesthesiologists (ASA) classification.

RESULTS:

In this cohort, 44 participants (14.6%) were diagnosed with POD. Independently of age, global brain atrophy, and physical status score, a higher preoperative thalamus volume was associated with a reduced odds of POD (odds ratio per 1-cm3 increment; 0.73 [95% confidence interval (CI), 0.58–0.92]; P = .008).

CONCLUSIONS:

A larger thalamus volume was associated with reduced odds of POD. Thus, the thalamus marks a region of interest in POD in the aging brain. These findings may help to understand the neuronal basis of POD.
“Buy-in”
Authors: Kilian Jon
Published: April 2022

Apply It!

• Each client a health professional comes across fits into the Health Belief Model and Biopsychosocial model in their own specific way at that period in time; it is vital to identify and address potential barriers as soon as possible to optimize outcomes.

• Educating your client on the “why” can address each of the six constructs of the Health Belief Model and, therefore, may be the best strategy to begin to elicit behavioral change.

• The goal from the beginning of each client interaction should be to build rapport; this will be the basis on which any strategy used for behavioral change depends. To do so, connect, engage, and follow-through.

• Building culture is a long-term goal of the overall workplace; be exemplary, intentional, and consistent in your behaviors.
Internet searches for Invisalign® orthodontic aligner: an infodemiological study using google trends tool
Authors: Dos Santos Everton Guilherme Jesus , Pereira Natanael Eric Batista , Ribeiro Ramon De Souza Trindade , Lima Ricardo Barbosa , Taga Márcio Luiz Lima
Published: April 2022

Aim: to evaluate the internet searches for Invisalign® in Brazil and worldwide between 2018 and 2021, using the Google Trends tool. Methods: An infodemiological study was carried out. The relative search volume (RSV) for the term “invisalign” in Google platform was retrieved for each year of study, both in Brazil and worldwide, using a standard procedure. Results and Conclusion: Both in Brazil and worldwide, there was a statistically significant increase in RSV between 2018 and 2021 (all p <0.05), indicating progressively more interest in Invisalign® clear aligner on the internet.
Mechanisms and policies for resource allocation in clouds and next generation networks
Authors: Νταρζάνος Γεώργιος
Published: April 2022

Το οικοσύστημα του Διαδικτύου σήμερα αποτελείται από ένα μεγάλο εύρος φορέων όπως οι Πάροχοι Δικτύων Κινητής Τηλεφωνίας (Mobile Network Operators - MNOs), οι Πάροχοι Υπηρεσιών Υπολογιστικής Νέφους (Cloud Service Providers - CSPs), τα Δίκτυα Διανομής Περιεχομένου (Content Delivery Networks - CDNs), οι Πάροχοι Περιεχομένου (Content Providers - CPs), οι Πάροχοι Υπηρεσιών Over-the-Top (OTT) κ.λ.π.. Οι φορείς αυτοί προσφέρουν αμοιβαίως συμπληρωματικές λειτουργίες και αλληλεπιδρούν μεταξύ τους για την από κοινού παροχή υπηρεσιών προστιθέμενης αξίας σε επιχειρήσεις και τελικούς χρήστες. Ωστόσο, αυτοί οι φορείς είναι ορθολογικές (rational) οντότητες που αναζητούν κέρδη. Συνεπώς, αν και συνεργάζονται λειτουργικά, ανταγωνίζονται μεταξύ τους για τη διανομή των εσοδών από τους πελάτες των προσφερόμενων υπηρεσιών. Στην παρούσα διδακτορική διατριβή, προτείνουμε και αξιολογούμε υποδείγματα και μηχανισμούς που διευκολύνουν την αλληλεπίδραση αυτών των φορέων, καθώς και μηχανισμούς και πολιτικές που επιτυγχάνουν αποτελεσματική κατανομή πόρων και εσόδων σε συνεργατικά και σε ανταγωνιστικά οικοσυστήματα, καθώς και σε ενδιάμεσες περιπτώσεις συνεργασίας. Ειδικότερα, μελετάμε: (i) τη δημιουργία ομοσπονδιών από πολλαπλούς CSPs, εστιάζοντας στην παροχή υπηρεσιών υπολογιστικής νέφους που αξιοποιούν τους συλλογικά διαθέσιμους υπολογιστικούς πόρους, (ii) τις αλληλεπιδράσεις πολλαπλών MNOs κατά τη δημιουργία τεμαχίων δικτύου (network slices) τα οποία πρέπει να διασχίζουν πολλούς MNOs προκειμένου να καταστεί δυνατή η εξυπηρέτηση των αντίστοιχων από-άκρο-σε-άκρο εφαρμογών, και (iii) την από κοινού εξέταση της ανάθεσης χρηστών και της τοποθέτησης περιεχομένου σε Σταθμούς Βάσης Μικρού Κελιού (Small-cell Base Station - SBS), όπου ένας MNO και ένας CP συνεργάζονται για την αποτελεσματική διαχείριση των διαθέσιμων πόρων του ασύρματου δικτύου και της χωρητικότητας αποθήκευσης περιεχομένου (caches).
On the stability of random matrices
Authors: Πούλιος Νικόλαος
Published: April 2022

Η διδακτορική διατριβή αποσκοπεί σε μια πολυδιάστατη οικογένεια προβλημάτων στα μαθηματικά. Επιπλέον ένα από τα τρία θέματα που παρουσιάζονται στη διατριβή αυτή είναι η διαδικασία της διάχυσης σε δυναμικά χρηματοοικονομικά δίκτυα. Τα γραφήματα αυτά είναι συνεκτικά, κατευθυνόμενα και σταθμισμένα δίκτυα τραπεζών (κόμβοι), όπου τα αρχικά κεφάλαια και η ποσότητα δανείων που μεταφέρονται από την μία τράπεζα (κόμβο) στην άλλη θεωρούνται γνωστά. Με άλλα λόγια προσπαθούμε να θεραπέυσουμε προβλήματα στο χρηματοοικονομικό τομέα όπου αρχικά έχουμε τραπεζικά δυναμικά δίκτυα που χαρακτηρίζονται από διαφορετικά επίπεδα αρχικών μοχλεύσεων και καταλήγουμε να έχουμε ένα σταθερό τραπεζικό δίκτυο χάρη στη διαδικασία της διάχυσης. Επίσης, παρουσιάζουμε αρκετά παραδείγματα όπου επιβεβαιώνετε η θεωρία μας και μέσω πρακτικών παραδειγμάτων. Τέλος, έχουμε την πεποίθηση ότι η δουλειά αυτή μπορεί να επεκταθεί κάνοντας χρήση της μαθηματικής θεωρίας ελέγχου με σκοπό να κάνουμε αυτά τα δίκτυα πιο εύκολα ελέγξιμα.Επιπλέον, ένα άλλο πρόβλημα που παρουσιάζετε στη διατριβή αυτή είναι η έννοια των almost zeros πολυωνυμικών διανυσμάτων ή πινάκων. Στο θέμα αυτό το κίνητρό μας ήταν η κατανόηση αλλά και να παρουσιάσουμε πως η έννοια των almost zeros εξαρτάται από την τυχαιότητα. Πιο συγκεκριμένα μελετάμε και παρουσιάζουμε τα στατιστικά χαρακτηριστικά των almost zero και την τιμή τους για δοθέντες τυχαίους πολυωνυμικούς πίνακες. Τέλος, διάφορα παραδείγματα παρουσιάζονται για να είναι πιο κατονοητή η μελέτη αυτού του θέματος.Τέλος, το τελευταίο θέμα στο οποίο πραγματευόμαστε είναι η μελέτη σε γραμμικά, χρονικά-αμετάβλητα πολυμεταβλητά συστήματα που περιγράφονται από συστήματα εξισώσεων. Πιο συγκεκριμένα εστιάζουμε σε τυχαία συστήματα όπου οι παράμετροι έχουν αντικατασταθεί από τυχαίους πίνακες. Επιπροσθέτως, ορίζουμε την έννοια της ε-ελεγξιμότητας για τυχαία συστήματα για δοθέν θετικό αριθμό ε. Επίσης, θεωρούμε τη στοιχειώδη κατηγορία τυχαίων πινάκων Gaussian ortogonal ensemble (GOE) και υπολογίζουμε ότι το ε-μη-ελεγξιμότητα ενός τέτοιου τυχαίου συστήματος εξαρτάται από την κατανομή των στοιχείων του. Στην περίπτωση αυτή η ε-μη-ελεγξιμότητα υπολογίζεται.
Ο ρόλος των μεταλλάξεων των γονιδίων TACI και CTLA4 στην κοινή ποικίλη ανοσοανεπάρκεια
Authors: Κάκκας Ιωάννης
Published: April 2022

Συγκεκριμένες μεταλλάξεις του γονιδίου TACI (ομόζυγες, ετερόζυγες και διπλά ετερόζυγες) αποτελούν τις συχνότερες (5-15%) γνωστές γενετικές «βλάβες» οι οποίες σχετίζονται αιτιοπαθογενετικά µε την Κοινή Ποικίλη Ανοσοανεπάρκεια (ΚΠΑ), η οποία είναι η πιο συχνή κλινικά σημαντική Πρωτοπαθής Αντισωματική Ανεπάρκεια (ΠΑΑ) στον άνθρωπο. Η παρουσία τους έχει συσχετιστεί με αυξημένη πιθανότητα εμφάνισης καλοήθους λεμφικής υπερπλασίας και αυτοάνοσης κυτταροπενίας στους συγκεκριμένους ασθενείς. Ομοίως, η παρουσία μεταλλάξεων του γονιδίου CTLA4 σε ασθενείς με κλινικό φαινότυπο συμβατό με ΚΠΑ, έχει συσχετιστεί με αυξημένη πιθανότητα εμφάνισης λεμφικής υπερπλασίας και εκδηλώσεων αυτοανοσίας. Σκοπός της παρούσας μελέτης ήταν η αξιολόγηση της επίπτωσης των µεταλλάξεων των γονιδίων TACI και CTLA4 σε Έλληνες ασθενείς µε κλινικό φαινότυπο ΚΠΑ, καθώς και η προσπάθεια ανάδειξης τυχόν συσχετίσεων μεταξύ των προαναφερθεισών µεταλλάξεων και του κλινικού φαινοτύπου της νόσου. Το υλικό της μελέτης αποτέλεσαν 117 Έλληνες ασθενείς με ΚΠΑ (110) και IgA ανεπάρκεια με συνοδό ανεπάρκεια υποτάξεων της IgG (7). Για την ανίχνευση µεταλλάξεων στα γονίδια TACI και CTLA4, χρησιμοποιήθηκαν οι τεχνικές της αλυσιδωτής αντίδρασης πολυμεράσης (Polymerase Chain Reaction, PCR) και της αλληλούχισης βάσεων (Sequencing). Για την στατιστική ανάλυση χρησιμοποιήθηκε το πρόγραμμα SPSS 23.0. Σε 17 ασθενείς (14.5%) διαπιστώθηκε η παρουσία αιτιοπαθογενετικά σχετιζόμενων με την ΚΠΑ μεταλλάξεων του γονιδίου TACI. Σε 13 ασθενείς (76.5%) οι μεταλλάξεις ήταν απλές ετερόζυγες, ενώ σε τέσσερις (23.5%) ήταν συνδυασμένες ετερόζυγες. Η συχνότερα ανιχνευθείσα μετάλλαξη ήταν η C104R (58.8%), ακολουθούμενη από τις I87N (23.5%) και A181E (11.8%), ενώ οι μεταλλάξεις R20C, C62Y, P151L, K188M και E236X ανιχνεύτηκαν μόνο σε έναν ασθενή η καθεμία. Οι ασθενείς με τις προαναφερθείσες μεταλλάξεις του γονιδίου TACI ήταν συχνότερα άνδρες (p: 0.011), εμφάνιζαν συχνότερα καλοήθεις λεμφικές υπερπλασίες (σπληνομεγαλία ή/και λεμφαδενοπάθεια, p: 0.047 και p: 0.002 αντίστοιχα) και αυτοάνοσες κυτταροπενίες (p: 0.046), ενώ είχαν συχνότερα ιστορικό αμυγδαλεκτομής (p: 0.015) και αδενοειδεκτομής (p: 0,031). Μόνο σε τρεις ασθενείς (2,6%) ανιχνεύτηκαν μεταλλάξεις του γονιδίου CTLA4. Λόγω του πολύ μικρού αριθμού τους, δεν ήταν εφικτή η διεκπεραίωση στατιστικής ανάλυσης. Η συχνότητα εμφάνισης των αιτιοπαθογενετικά σχετιζόμενων με την ΚΠΑ μεταλλάξεων του γονιδίου TACI στους ασθενείς της μελέτης μας είναι συμβατή με την αναφερόμενη στην διεθνή βιβλιογραφία. Επίσης, από τα αποτελέσματα της μελέτης μας υποστηρίζεται περαιτέρω η διαπίστωση ότι παρουσία τους έχει συσχετιστεί με αυξημένη πιθανότητα εμφάνισης καλοήθους λεμφικής υπερπλασίας και αυτοάνοσης κυτταροπενίας στους ασθενείς με ΠΑΑ και κλινικό φαινότυπο ΚΠΑ.
Η φύση και η θέση της γυναίκας στην Αττική τραγωδία
Authors: Τσέλιου Στυλιανή
Published: April 2022

Στη συγκεκριμένη μου εργασία εξέτασα τη φύση και τη θέση της γυναίκας στην Αττική Τραγωδία=( πλάγια ο τίτλος).Μελέτησα τους τρεις μεγάλους τραγικούς ποιητές, τον Αισχύλο, το Σοφοκλή και τον Ευριπίδη. Μέσα στις τραγωδίες τους ερεύνησα τις κάτωθι(δηλ. τις παρακάτω) πρωταγωνίστριες- ηρωίδες: την Κλυταιμνήστρα, την Ηλέκτρα, την μάντισσα Κασσάνδρα, την Αντιγόνη, την Ισμήνη, την Ιοκάστη, τη Δηιάνειρα, την Μήδεια, τη Φαίδρα, την Αγαυη. Έκανα μια μικρή αναφορά και στην Άλκηστη του Ευριπίδου. Εκτός από τις σημαντικότερες αυτές γυναίκες και βασίλισσες, μελέτησα και τον σπουδαίο ρόλο που διαδραμάτισαν όχι μόνο οι θνητές αυτές γυναίκες αλλά και κάποιες Θεές ή Θεότητες, οι οποίες είναι οι εξής: η Θεά Αθηνά, η θεά Αφροδίτη, η θεά Άρτεμη και οι Ευμενίδες. Εξέτασα και το ρόλο που έχει η τροφός πλάι στην οικοδέσποινα ή στην βασίλισσα της μέσα στην αττική τραγωδία. Σκοπό έχω να φανούν οι αρετές, οι ηθικές αξίες, η δύναμη, καθώς και η αδυναμία, τα ελαττώματα και τα πάθη των γυναικών αυτών. Αναφέρθηκα εν μέρει και σε γυναίκες φιλοσόφους, όπως η Υπατία, ή και στη δυναμική και αρκετά μορφωμένη για την εποχή της γυναίκα, την Ασπασία, σύζυγο του Περικλέους. Το θέμα των γυναικείων "αμαρτημάτων" απέχει πολύ από την έννοια της αμαρτίας από θρησκευτική άποψη , έτσι όπως αποκαλύπτεται μέσα στη Βίβλο. Μελέτησα επίσης την ευγένεια ,την καλοσύνη αυτών των γυναικών. Εξέτασα ποιες είναι υποτακτικές σύζυγοι, ποιες είναι άπιστες σύζυγοι, ποιες συγκρούονται με τους άνδρες τους και ποιες είναι στοργικές ή σκληρές μητέρες. Όλες τους όμως διαδραματίζουν πρωτεύοντα ρόλο και μέσα στην οικογένεια και μέσα στην κοινωνία. Μέσα από αυτήν την έρευνα μου φάνηκαν ποιες γυναίκες είναι εύθραυστες και ποιες σκληροπυρηνικές ή και παράλογες. Έκανα λόγο και για τις παρθένες, τις ανύπαντρες κόρες, καθώς και για τα ήθη και έθιμα τους. Μίλησα και για τις εταίρες, τις φιλελεύθερες γυναίκες και για τα γυναικεία δικαιώματα γενικότερα. Αποφάσισα να μελετήσω τη ζωή, τη δράση ,τη φύση και τη θέση της γυναίκας στην Αττική Τραγωδία, επειδή θεωρώ ότι το αρχαίο δράμα είναι πράγματι το αριστούργημα του ελληνικού πνεύματος.
Computer Technologies Accompanying Learning and Knowledge Control of Students: Design and Results of Application
Authors: Gorovaya V. , Shevchenko G.
Published: April 2022

Objects of research in the sphere of didactics and private techniques can be both the learning process and its result. In the national pedagogical literature, issues such as the principles of organization, the functions and stages of exercising control, pedagogical requirements to it, methods of control, etc. However, despite the studies carried out, the problem of control in training and evaluation of its results is still far from its solution. On the basis of theoretical analysis of modern trends in the development of teaching practice in the national higher school shows one of the ways to improve the process of pedagogical control through the use of computer technology. On the basis of didactic design and test methods in the article the model representation of students' knowledge control in support of computer technology: information-subject and operating, and the results of a pedagogical experiment with master's students are presented.
Management by Development of Human Capital in a Commercial Company
Authors: Borisov A. , Trofimova T. , Kuznecov A.
Published: April 2022

The article summarizes the results conducted by an empirical sociological study on the management of human capital development in the commercial company North - Telecom. Methodical research tools are analyzed, the advantages of the selected methods, in particular, the deep interview. An analysis of the current situation in the company through the consideration of the organizational structure, personnel, gender composition of employees and their level of education is given. Special attention is paid to the analysis of the activities of the company's management of employees, adaptation, health and motivation, as well as working conditions. The main problems are identified in the process of managing the development of human capital. The article analyzes the practice of managing the development of human capital based on the results of the depth interview with the management of the company and the survey of full-time employees.

The essential novelty of this work of steel, developed by the authors managerial recommendations for improving the human capital management system, based on key indicators of human capital as education, health, employee motivation.
Management of Labor Potential and Quality of Life of the Population Using Social Time
Authors: Golovin A.
Published: April 2022

The article explores the modern processes of labor potential management. The author’s approach to measuring labor potential using the social time budget is proposed. The work presents the main trends in the labor market, the dynamics of changes in the labor potential from 2011 to 2020. It also shows the relationship of labor potential and social time with the quality of life of the population, as well as provides the analysis of the structural influence of the social time use on the characteristics of the quality of life development for the regional population. The mechanisms for assessing the quality of life development based on the study of the budget of social time are described.
Mission of the Human Resources Management Chair
Authors: Zaharov N. , Malyavin S. , Legostev A. , Shelonaev S.
Published: April 2022

The article discusses the mission of the departments of personnel management in universities of the country. The author pays attention to the significance of the mission of the structural unit in the organization, its “weight”. He notes that there are units whose activities are directly related to the reputation of the organization, therefore, such a structural unit has a special responsibility both to the organization itself and to the public. The mission of such a unit is the essence of the synthetic unity of the functional responsibilities of the unit itself and the mission of the organization itself. And this essence is revealed in strengthening the reputation of the whole organization. Such a structural unit are the departments of personnel management in universities. It is noted that the essence of the mission of such departments is the principles of humanization of labor. The role of leading departments and leading scientists and teachers in the development of science and the educational direction of personnel management is noted. The problems and ways to overcome them are considered. First of all, it is safe, i.e. an employee in the workplace should not be worried about his future; in fairness, i.e. the share of the employee in the income must correspond to the share of his contribution; self-actualization of the employee in professional activity; democracy, i.e. participation of employees in the distribution of the organization's income.
Doświadczenia międzynarodowe w kontekście wdrożenia opieki farmaceutycznej w Polsce
Authors: Oberska Joanna , Prusaczyk Artur , Żuk Paweł , Jurewicz Błażej , Guzek Marika , Bogdan Magdalena
Published: April 2022

Ustawa o zawodzie farmaceuty oraz świadczenia planowane w ramach opieki farmaceutycznej w Polsce wprowadzą szereg zmian w funkcjonowaniu aptek ogólnodostępnych, które wymagają skutecznego i efektywnego wdrożenia. Celem niniejszej pracy była analiza doświadczeń międzynarodowych w zakresie opieki farmaceutycznej oraz poszukiwanie rozwiązań, które byłyby możliwe do zaimplementowania w Polsce. Analizie poddano zakresy świadczeń udzielanych w ramach opieki farmaceutycznej w Stanach Zjednoczonych, Wielkiej Brytanii, Królestwie Niderlandów, Szwecji, Austrii i Australii. Kraje te przeanalizowano pod kątem zakresu świadczonych usług w ramach opieki farmaceutycznej, przebiegu wdrożenia opieki farmaceutycznej, premiowania farmaceutów za świadczenie dodatkowych usług oraz pod kątem oceny systemu IT.