bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring drivers and barriers to the utilization of community client-led ART delivery model in South-Western Uganda: patients’ and health workers’ experiences
Authors: Kintu Timothy Mwanje , Ssewanyana Anna Maria , Kyagambiddwa Tonny , Nampijja Pretty Mariam , Apio Patience Kevin , Kitaka Jessica , Kabakyenga Jerome Kahuma
Published: October 2021

Background

In an effort to accommodate the growing number of HIV clients, improve retention in care and reduce health care burden, the differentiated service delivery (DSD) models were introduced in 2014. One such model, Community Client-Led ART Delivery (CCLAD) was rolled out in Uganda in 2017. The extent of utilization of this model has not been fully studied. The aim of the study was to explore the patients’ and health workers’ experiences on the utilization of CCLAD model at Bwizibwera Health Centre IV, south western Uganda.

Methods

This was a descriptive study employing qualitative methods. The study had 68 purposively selected participants who participated in 10 focus group discussions with HIV clients enrolled in CCLAD; 10 in-depth interviews with HIV clients not enrolled in CCLAD and 6 in-depth interviews with the health workers. Key informant interviews were held with the 2 focal persons for DSD. The discussions and interviews were audio recorded, transcribed verbatim and then translated. Both deductive and inductive approaches were employed to analyse the data using in NVivo software.

Results

Patients’ and health workers’ experiences in this study were categorized as drivers and barriers to the utilization of the CCLAD model. The main drivers for utilization of this model at different levels were: individual (reduced costs, living positively with HIV, improved patient self-management), community (peer support and contextual factors) and health system (reduced patient congestion at the health centre, caring health workers as well as CCLAD sensitization by health workers). However, significant barriers to the utilization of this community-based model were: individual (personal values and preferences, lack of commitment of CCLAD group members), community (stigma, gender bias) and health system (frequent drug stockouts, certain implementation challenges, fluctuating implementing partner priorities, shortage of trained health workers and insufficient health education by health workers).

Conclusion

Based on our findings the CCLAD model is meeting the objectives set out by Differentiated Service Delivery for HIV care and treatment. Notwithstanding the benefits, challenges remain which call on the Ministry of Health and other implementing partners to address these hindrances to facilitate the scalability, sustainability and the realisation of the full-range of benefits that the model presents.
Long-term predictors of severe exacerbations and mortality in a cohort of well-characterised adults with asthma
Authors: Tupper Oliver Djurhuus , Ulrik Charlotte Suppli
Published: October 2021

Background

We aimed to explore long-term predictors of severe exacerbations and mortality in adults with well-characterised asthma.

Study design and methods

Adults (aged ≥ 15) with an objectively verified diagnosis of asthma were recruited from a Danish respiratory outpatient clinic between 1974 and 1990. All individuals were followed in Danish registries for vital status, hospital admissions for asthma and cause of death until end of 2017. Predictors of exacerbations were obtained from a repeated measures model. Standardised mortality rates (SMR) for all-causes were compared with the Danish background population. Hazard ratios for mortality were obtained from a cox proportional hazards model in a two-step process.

Results

At baseline, the cohort comprised 1071 patients (mean age 38, SD 16, 61% women), of whom 357 (33%) died during follow-up, with 93 (26%) dying from asthma (primary diagnosis). We found an SMR of 1.24 (95% CI 1.11–1.37, p < 0.001) for all-cause mortality. Baseline predictors for asthma-related death and repeated severe exacerbations were increasing age, ever smoker, FEV1 < 80% pred., high blood eosinophils, longer duration of symptoms and use of SABA > twice daily. Being non-atopic, having a positive histamine challenge test and symptoms more than twice a week were also predictors of repeated exacerbations.

Conclusions

Markers of poor asthma control, including high use of SABA, are predictors of long-term exacerbation rate and mortality over 30 years in patients with well-characterised asthma. Improving asthma control, including lung function and reducing use of reliever medication, is vital for improving the long-term outcome of asthma.
DEL in China: the D antigen among serologic RhD-negative individuals
Authors: Yin Qinan , Flegel Willy Albert
Published: October 2021

Background

Providing RhD-negative red cell transfusions is a challenge in East Asia, represented by China, Korea, and Japan, where the frequency of RhD-negative is the lowest in the world.

Findings

Among 56 ethnic groups in China, the RhD-negative frequency in Han, the prevalent ethnicity, is 0.5% or less, similar to most other ethnic groups. The Uyghur ethnic group has the highest reported RhD-negative frequency of up to 4.7%, as compared to 13.9% in the US. However, an estimated 7.15 million RhD-negative people live in China. The RhD-negative phenotype typically results from a loss of the entireRHDgene, causing the lack of the RhD protein and D antigen. The DEL phenotype carries a low amount of the D antigen and types as RhD-negative in routine serology. The DEL prevalence in RhD-negative individuals averages 23.3% in the Han, 17% in the Hui and 2.4% in the Uyghur ethnicities. The Asian typeDEL, also known asRHD*DEL1andRHD:c.1227G > Aallele, is by far the most prevalent among the 13DELalleles observed in China.

Conclusion

The purpose of this review is to summarize the data on DEL and to provide a basis for practical strategy decisions in managing patients and donors withDELalleles in East Asia using molecular assays.
Propitious temporal changes in clinical outcomes after transcatheter compared to surgical aortic valve replacement; a meta-analysis of over 65,000 patients
Authors: Panchal Ankur , Kyvernitakis Andreas , Rayarao Geetha , Doyle Mark , Biederman Robert W. W.
Published: October 2021

Background

The treatment of symptomatic severe aortic stenosis (AS) has rapidly evolved over the past decade, in both transcatheter (TAVR) and surgical aortic valve replacement (SAVR), resulting in reported improved clinical outcomes. Operator experience and technical improvements have improved outcomes especially for patients undergoing TAVR. We sought to determine and compare 1-year outcomes using a contemporary meta-analysis.

Method

We searched the Medline (MESH), Cochrane and Google scholar databases using keywords “AS”, “atrial fibrillation” (AFib) and “stroke”. We performed a meta-analysis to compare TAVR with SAVR populations for post-procedural stroke, all-cause and cardiovascular mortality at 1-year.

Results

A total of 23 studies met criteria for analysis with total population of 66,857 patients, of which 61,913 had TAVR and 4944 had SAVR. Temporal trends demonstrated overall improvement in outcome for both, TAVR and SAVR groups through the decade. Outcomes, in terms of stroke (3.1% vs. 5%), all-cause (12.4% vs. 10.3%) and cardiovascular mortality (7.2% vs. 6.2%) were similar at 1-year, in TAVR versus SAVR, respectively.

Conclusion

Despite overall gradual improvement in both TAVR and SAVR outcomes over the decade, there is a statistical overlap in confidence intervals for all-cause, cardiovascular mortality and postprocedural stroke at 1-year. While 23 individual studies demonstrate considerable advantages of each technique in certain cohorts, integrating over 65,000 pts with our stratified surgical analysis suggests that TAVR is comparable to SAVR for low and intermediate risk population while superior to SAVR only in the highest-risk population for short and intermediate term outcomes. This has substantial socio-economic implications as we contemplate expanding our TAVR indications to low/intermediate risk populations.
Unusual course of disease and genetic profile in Li-Fraumeni syndrome-associated osteosarcoma – a case report
Authors: Puzik Alexander , Uhl Markus , Ruf Juri , Schumacher Tilmann , Kontny Udo
Published: October 2021

Background

Osteosarcoma is a highly malignant tumour associated with numerous and complex genetic alterations like copy number alterations. Recent whole genome studies revealed distinct mutations in several candidate oncogenes.

While clinical parameters stratify osteosarcoma patients in risk groups, genetic profiles have not yet been used to tailor tumour treatment. However, specific copy number alterations seem to have a prognostic impact in osteosarcoma treatment.

Somatic TP53 gene mutation frequently occurs in sporadic osteosarcoma. When arising germline, TP53 mutation leads to Li-Fraumeni syndrome and may result in early life osteosarcoma. The effect of Li-Fraumeni syndrome on the genetic profile of osteosarcoma and the consideration of the syndrome during cancer treatment are topics of current research.

Case presentation

We report a 25-year-old female with pelvic osteosarcoma refusing continuation of therapy. She interrupted neo-adjuvant chemotherapy according to EURAMOS-1/COSS recommendations and declined local or further adjuvant therapy. Surprisingly, she remained in sustained remission for the osteosarcoma but eventually died from newly diagnosed breast cancer. After establishment of breast cancer, we detected TP53 germline mutation and investigated the osteosarcoma material with array-CGH.

Conclusion

Genetic examination of the tumour evidenced several copy number alterations with striking differences to previously reported data. We discuss possible influences of the genetic profile on the unusual clinical course and the significance of Li-Fraumeni syndrome for the genetic profile. Specific loss of (proto-) oncogenes might have contributed to the unusual case. Further large-scale genetics of Li-Fraumeni patients combined with detailed clinical data will help to identify specific genetic risk profiles and improve treatment.
Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic – what a difference a year makes
Authors: Sommer D. D. , Cote D. , McHugh T. , Corsten M. , Tewfik M. A. , Khalili S. , Fung K. , Gupta M. , Sne N. , Engels P. T. , Weitzel E. , Brown T. F. E. , Paul J. , Kost K. M. , Anderson J. A. , Sowerby L. , Mertz D. , Witterick I. J.
Published: October 2021

Background

During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations.

Main body

Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented.

Conclusion

These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations.

Graphical abstract
Presence of adipose tissue along the posteromedial tibial border
Authors: Takumi Okunuki , Hirofumi Tanaka , Hiroshi Akuzawa , Hiroki Yabiku , Toshihiro Maemichi , Masatomo Matsumoto , Takuma Hoshiba , Tsukasa Kumai
Published: October 2021

Purpose

The flexor digitorum longus and posterior tibial tendon as well as the perforating veins are located along the distal posteromedial tibial border. Adipose tissue may surround these structures and possibly play a role in reducing mechanical stress. This study aimed to examine the adipose tissue along the posteromedial tibial border via magnetic resonance imaging (MRI), ultrasound, and gross anatomical examination.

Methods

The lower legs of 11 healthy individuals were examined every 3 cm from the medial malleolus using MRI and ultrasound. The fat fraction was calculated using fat fraction images. In addition, the gross anatomy of the flexor digitorum longus origin and adipose tissue along the posteromedial tibial border was examined in seven fresh cadavers. The fat fraction was compared at different heights along the posteromedial tibial border and in Kager’s fat pads; we also compared the height of the flexor digitorum longus origin and adipose tissue.

Results

In vivo, the adipose tissue was identified along the entire posteromedial tibial border using MRI and ultrasound. There was no significant difference in fat fraction between Kager’s fat pads and the adipose tissue along the posteromedial tibial border, except at the 6 cm mark. All seven cadavers presented adipose tissue along the posteromedial tibial border, significantly more distal than the flexor digitorum longus origin.

Conclusion

The adipose tissue was identified along the posteromedial tibial border via MRI, ultrasound, and gross anatomical examination; thus, this tissue may play a role in reducing friction and compressive stress in tendons.
Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers
Authors: Esmael Ahmed , Elsherief Mohammed , Razek Ahmed Abdel Khalek Abdel , El-Sayed Nehal Tharwat Mohammed , Elsalam Mohammed Abd , Flifel Mohamed E. , Shawki Saad
Published: October 2021

Background

Reliable and acceptable biomarkers are needed to anticipate the outcome and cognitive impairment following ischemic stroke. The goal of this research is to examine the association of ASPECTS with cognitive decline, biomarkers of stroke, and acute ischemic stroke outcomes. This study included 120 patients with ischemic stroke in the middle cerebral artery region. The initial NIHSS, non-contrast CT brain assessed by ASPECTS, and the biomarkers of cognitive decline such as ESR, CRP, S100B, MMP9, and glutamate were investigated. The Montreal Cognitive Assessment and modified Rankin scale (mRS) were evaluated after 3 months. Correlations between ASPECTS, MoCA, biomarkers of cognitive impairment, and mRS were done by Spearman correlation.

Results

The incidence of cognitive impairment in our patients was 25.8%. Stroke biomarkers (ESR, CRP, S100B, MMP9, and glutamate) were significantly increased in cognitively disabled individuals with significantly lower mean MoCA scores than in cognitively intact patients. There was a strong direct correlation linking the initial ASPECTS and total MoCA test score after 3 months follow-up. Cases with unfavorable outcomes were older, more incidence of hypertension, and had higher average initial NIHSS (P < 0.05). While the average ASPECTS scores for the favorable outcome group of patients were significantly higher and there was a significant negative correlation between the initial ASPECTS and modified Rankin Scale score.

Conclusions

ASPECTS is a reliable scale to identify the extent of acute ischemic injury and could participate in assessing the outcome. ASPECTS and particular neurocognitive stroke biomarkers will enable the early detection of post-stroke cognitive impairment.

Trial registration Registration of Clinical Trial Research: ClinicalTrials.gov ID: NCT04235920
Bringing fruity meat dishes of Ottoman cuisine into businesses
Authors: Güldemir Osman , Tugay Onur , Şallı Gökhan , Yıldız Emrah , Çelik Yeşil Seher
Published: October 2021

Aim of this research is to promote the inclusion of traditional Ottoman fruity meat dishes into business. Chefs working in various food establishments in Eskisehir were given training on fruity meat dishes for a total of 40 h in 10 training segments. Interviews were conducted, analyzed and evaluated in terms of the themes. The inclusion of fruity meat dishes of Ottoman cuisine in businesses would pose no difficulty at any stage of preliminary preparation, cooking, or budgeting. The inclusion of these dishes in the fast-breaking menu during the Ramadan and making small adjustments in accordance with customer feedback would help include these meals. During this study, the kitchen staff gained insight regarding Ottoman cuisine, they became more adept at implementing fruity meat techniques, and the business managers and owners showed much care and support toward upholding of Ottoman ethnic foods. Recognizing the growing demand for ethnic food, fruity meat dishes of Ottoman cuisine is been brought into businesses.
Crinecerfont Lowers Elevated Hormone Markers in Adults With 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia
Authors: Auchus Richard J , Sarafoglou Kyriakie , Fechner Patricia Y , Vogiatzi Maria G , Imel Erik A , Davis Shanlee M , Giri Nagdeep , Sturgeon Julia , Roberts Eiry , Chan Jean L , Farber Robert H
Published: October 2021

Context

Classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21OHD) is characterized by impaired cortisol synthesis and excess androgen production. Corticotropin-releasing factor type 1 receptor (CRF1R) antagonism may decrease adrenal androgen production.

Objective

This work aimed to evaluate the safety, tolerability, and efficacy of crinecerfont (NBI-74788), a selective CRF1R antagonist, in 21OHD.

Methods

This open-label, phase 2 study, with sequential cohort design (NCT03525886), took place in 6 centers in the United States. Participants included men and women, aged 18 to 50 years, with 21OHD. Interventions included 4 crinecerfont regimens, each administered orally for 14 consecutive days: 50 or 100 mg once daily at bedtime (cohorts 1 and 2, respectively); 100 mg once daily in the evening (cohort 3); and 100 mg twice daily (cohort 4). Participants could enroll in more than 1 cohort. Main outcomes included changes from baseline to day 14 in adrenocorticotropin (ACTH), 17-hydroxyprogesterone (17OHP), androstenedione, and testosterone.

Results

Eighteen participants (11 women, 7 men) were enrolled: cohort 1 (n = 8), cohort 2 (n = 7), cohort 3 (n = 8), cohort 4 (n = 8). Mean age was 31 years; 94% were White. Median percent reductions were more than 60% for ACTH (–66%), 17OHP (–64%), and androstenedione (–64%) with crinecerfont 100 mg twice a day. In female participants, 73% (8/11) had a 50% or greater reduction in testosterone levels; male participants had median 26% to 65% decreases in androstenedione/testosterone ratios.

Conclusion

Crinecerfont treatment for 14 days lowered ACTH and afforded clinically meaningful reductions of elevated 17OHP, androstenedione, testosterone (women), or androstenedione/testosterone ratio (men) in adults with 21OHD. Longer-term studies are required to evaluate the effects of crinecerfont on clinical end points of disordered steroidogenesis and glucocorticoid exposure in patients with 21OHD.
RememberingŎmŏni: Using Chinese Memoirs to Understand Sino-North Korean Interactions during the Korean War
Authors: Brazinsky Gregg A.
Published: October 2021

This article assesses the memoirs of Chinese volunteers as a source for better understanding social interactions between the Chinese and North Koreans during the Korean War. The hundreds of thousands of Chinese soldiers serving in Korea were an almost ubiquitous presence in wartime North Korea. Yet the relationship between the volunteers and North Korean civilians has not been the subject of many studies. Memoirs written by the volunteers are one of the few sources that document these interactions. Among the subjects the volunteers wrote about, their encounters with older North Koreans whom they called “mothers” or ŏmŏni were among the most prominent. While acknowledging the propagandistic intent behind some of these memoirs, the article argues that they do shed light on some of the emotional norms that shaped relations between North Korean women and the volunteers even if they cannot always be treated as completely reliable descriptions of events.
KisaengPerformers and the New Media in Colonial Korea
Authors: Choi Hye Eun
Published: October 2021

Kisaeng, who had been hereditary female performers in pre-twentieth-century Korea, became modern professional performers during Korea’s colonial period (1910–45). Among them, some talented kisaeng attained high status in modern media as vocal performers, even while the general reputation of kisaeng steadily declined in the colonial period. These kisaeng performers who sought artistic success in the new media occupied two categories. One was yŏryu myŏngch’ang (female master vocalists), who excelled at Korean traditional music, and the other was kisaeng kasu (kisaeng singers), who specialized in modern popular music. Despite their shared social and cultural roots, these kisaeng performers have rarely been examined together in recent scholarship, which has tended to adhere to the disciplinary distinction between traditional and popular music. By examining the activities of yŏryu myŏngch’ang and kisaeng kasu in the same frame, this article demonstrates the ways in which both groups of kisaeng performers, rather than simply being transmitters of Chosŏn music culture, contributed to the modern diversification of music in colonial Korea. It further shows that these kisaeng, who were accomplished artistically, sought wealth and recognition as modern professionals in the colonial Korean music market.
Islam Out of History
Authors: Idris Murad
Published: October 2021

The definition of Islam as submission, the claim that Islam needs a Luther, and the desire to identify jihād with private and spiritual struggle, all reflect a series of compulsions and elisions. The three idioms are fundamental to how Islam has been constituted in language as a subject and as a problem. They each also have forgotten genealogies. This article outlines these genealogies and their intersection through the politics of translating Islam as submission, peace, or salvation; of narrating its place and temporality in modernity; and of reinterpreting historical texts and exemplars through the prism of liberalism and toleration. These three moves take Islam out of history. The dislocation of Islam winds through three disciplinary moments that track political theory’s investments in philology, teleology, and philosophy. The article concludes by pointing toward critical possibilities and resources that emerge out of alternative discursive formations—formations that dwell alongside or behind the three idioms and that remain suppressed in them.
Subversive Archaism
Authors: Herzfeld Michael
Published: October 2021

In Subversive Archaism, Michael Herzfeld explores how individuals and communities living at the margins of the modern nation-state use nationalist discourses of tradition to challenge state authority under both democratic and authoritarian governments. Through close attention to the claims and experiences of mountain shepherds in Greece and urban slum dwellers in Thailand, Herzfeld shows how these subversive archaists draw on national histories and past polities to claim legitimacy for their defiance of bureaucratic authority. Although vilified by government authorities as remote, primitive, or dangerous—often as preemptive justification for violent repression—these groups are not revolutionaries and do not reject national identity, but they do question the equation of state and nation. Herzfeld explores the political strengths and vulnerabilities of their deployment of heritage and the weaknesses they expose in the bureaucratic and ethnonational state in an era of accelerated globalization.
Exercise Snacks: A Novel Strategy to Improve Cardiometabolic Health
Authors: Islam Hashim , Gibala Martin J. , Little Jonathan P.
Published: October 2021

We define exercise snacks as isolated ≤1-min bouts of vigorous exercise performed periodically throughout the day. We hypothesize that exercise snacks are a feasible, well-tolerated, and time-efficient approach to improve cardiorespiratory fitness and reduce the negative impact of sedentary behavior on cardiometabolic health. Efficacy has been demonstrated in small proof-of-concept studies. Additional research should investigate this novel physical activity strategy.
Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing
Authors: Schultz Martin G. , La Gerche Andre , Sharman James E.
Published: October 2021

We propose that for correct clinical interpretation of exaggerated exercise blood pressure (EEBP), both cardiorespiratory fitness and exercise workload must be considered. A key recommendation toward achieving the correct clinical interpretation of EEBP is that exercise BP should be measured during submaximal exercise with a fixed external workload.
Επισκληρίδιος αναλγησία ελεγχόμενη από την ασθενή (Patient controlled epidural analgesia - PCEA) με διάλυμα ροπιβακαΐνης 0,15% και φεντανύλης 2μg/ml κατά τη διάρκεια φυσιολογικού τοκετού
Authors: Δραχτίδη Καλλιόπη
Published: October 2021

Η παρούσα μελέτη αποσκοπεί στη συγκριτική αξιολόγηση δύο διαφορετικών τρόπων ρύθμισης της ελεγχόμενης από την ασθενή επισκληριδίου αναλγησίας (Patient Controlled Epidural Analgesia, PCEA) χρησιμοποιώντας το ίδιο διάλυμα κατά τη διάρκεια φυσιολογικού τοκετού. Πρόκειται για μια προοπτική τυχαιοποιημένη μελέτη, στην οποία συμπεριλήφθηκαν 52 επίτοκες που έλαβαν επισκληρίδιο αναλγησία με χορήγηση διαλύματος ροπιβακαΐνης 0,15% με φεντανύλη 2 μg/ml κατά τον φυσιολογικό τοκετό. Οι επίτοκες χωρίστηκαν σε δύο ομάδες ανάλογα με τη ρύθμιση της PCEA. Στην ομάδα Β/D (n=26) εφαρμόστηκε συνεχής έγχυση (5 ml/h) και κατ’ επίκληση χορήγηση (5 ml ανά 10 min), ενώ στην ομάδα D (n=26) εφαρμόστηκε μόνο κατ’ επίκληση χορήγηση (5 ml ανά 10 min). Πρωταρχικός στόχος ήταν η συνολική κατανάλωση τοπικού αναισθητικού. Δευτερεύοντες στόχοι ήταν η επάρκεια της αναλγησίας [VAS scores, η επάνοδος οξέος πόνου (Breakthrough pain)] και οι παράμετροι έκβασης από τη μητέρα και από το νεογνό. Δεν παρατηρήθηκε στατιστική διαφορά μεταξύ των δύο ομάδων όσον αφορά τα δημογραφικά χαρακτηριστικά, τη διάρκεια του 1ου και 2ου σταδίου του τοκετού, την έκβαση του τοκετού, τις δόσεις διάσωσης, τον κινητικό αποκλεισμό (Bromage scale), τη συνολική χορήγηση ωκυτοκίνης και εφεδρίνης, τις ανεπιθύμητες ενέργειες και την ικανοποίηση των επιτόκων, καθώς και τα Apgar scores και το pH των νεογνών. Η συνολική κατανάλωση τοπικού αναισθητικού ήταν μεγαλύτερη στην ομάδα B/D σε σχέση με την ομάδα D (p=0.015). Στατιστική διαφορά με υψηλότερα VAS scores στην ομάδα D βρέθηκε μόνο στο τέλος του δεύτερου σταδίου του τοκετού (p=0.036) και 60 λεπτά μετά τη χορήγηση της δοκιμαστικής επισκληριδίου δόσης (p=0.022). Τα επεισόδια Breakthrough pain (VAS>4) ήταν συχνότερα στην ομάδα D (p=0.035). Συμπερασματικά, στον ανώδυνο τοκετό με PCEA, ο συνδυασμός συνεχούς επισκληριδίου έγχυσης και κατ’ επίκληση χορήγησης αυξάνει τη συνολική κατανάλωση τοπικού αναισθητικού και μειώνει τα επεισόδια Breakthrough pain, χωρίς όμως να επιδρά στη συνολική ικανοποίηση των επιτόκων και στην έκβαση των νεογνών.
Natural language processing and information extraction
Authors: Στυλιανού Νικόλαος
Published: October 2021

Το αντικείμενο της παρούσας διατριβής είναι η Επεξεργασία Φυσικής Γλώσσας και η Εξαγωγή Πληροφοριών από κείμενα. Η διατριβή ασχολείται με τα ακόλουθα ερευνητικά προβλήματα που αφορούν συγκεκριμένες εργασίες της Επεξεργασίας Φυσικής Γλώσσας και Εξαγωγής Πληροφοριών: α) βελτίωση της διαδικασίας λήψης κλινικών αποφάσεων μέσω της Αναγνώρισης Βιοϊατρικών Οντοτήτων, β) βελτιστοποίηση της Εξόρυξης Βιοϊατρικών Επιχειρημάτων, γ) αποδοτικότερη τεχνική Μοντελοποίησης Γλώσσας με χρήση απομακρυσμένων πληροφοριών, δ) ανάπτυξη εφαρμογών Επεξεργασίας Φυσικής Γλώσσας για επίλυση πραγματικών προβλημάτων. Αρχικά, παρουσιάζονται μια σειρά από καινοτόμες αρχιτεκτονικές για καλύτερη Αναγνώριση Βιοϊατρικών Οντοτήτων, στοχευμένες σε οντότητες Ιατρικής Βασισμένης στη Τεκμηρίωση. Αυτές οι σημασιολογικές οντότητες είναι πιο περιγραφικές από βιοϊατρικές οντότητες γενικών κατηγοριών, προσφέρουν χρήσιμες πληροφορίες κατά την δημιουργία σχεδίων θεραπείας καθώς και είναι πιο δύσκολο να αναγνωριστούν από μοντέλα Μηχανικής Μάθησης. Η αρχιτεκτονικές βαθιών νευρωνικών δικτύων που προτάθηκαν σκοπεύουν στη βελτίωση της απόδοσης της αναγνώρισης όλων των βιοϊατρικών οντοτήτων και παρέχουν πιο αποδοτική λύση στις εργασίες αυτές. Επιπλέον μελετάται η χρήση οντοτήτων Ιατρικής Βασισμένης στη Τεκμηρίωση για την εξαγωγή συμπερασμάτων από ιατρικές δημοσιεύσεις. Για την περαιτέρω βελτίωση της κλινικής πρακτικής, επεκτείνουμε τη προσέγγισή μας για εξαγωγή συμπερασμάτων για τη δημιουργία δομών συμπερασμάτων από ιατρικές δημοσιεύσεις. Παρουσιάζεται μία καινοτόμα προσέγγιση Εξόρυξης Βιοϊατρικών Επιχειρημάτων, η οποία χρησιμοποιεί οντότητες Ιατρικής Βασισμένης στη Τεκμηρίωση. Το τελικό σύστημα έχει αυξημένη απόδοση σε όλες της εργασίες της Εξόρυξης Επιχειρημάτων και δημιουργεί πιο περιγραφικές δομές συμπερασμάτων. Αξιοποιώντας τη σημασία των σημασιολογικών οντοτήτων, παρουσιάζουμε δύο μεθοδολογίες για την χρήση αναφορικών πληροφοριών στην Αναπαράσταση Γλώσσας. Συνδυάζοντας την Επίλυση Αναφορών με την Αναπαράσταση Γλώσσας, παρουσιάζουμε νέες αρχιτεκτονικές για την αποδοτική χρήση αναφορικών εκφράσεων και τη δημιουργία κρυμμένων αναπαραστάσεων των οντοτήτων που περιγράφονται. Τα τελικά μοντέλα αναπαράστασης γλώσσας έχουν καλύτερη απόδοση σε εργασίες Επεξεργασίας Φυσικής Γλώσσας, με μικρή αύξηση στην υπολογιστική πολυπλοκότητα. Τέλος, παρουσιάζονται μια σειρά από εφαρμογές εργασιών Επεξεργασίας Φυσικής Γλώσσας σε πραγματικά προβλήματα και μελετάται η πρόσθετη αξία των εφαρμογών αυτών. Οι εφαρμογές αυτές είναι, ένα σύστημα ανάλυσης συναισθημάτων σε πραγματικό χρόνο με τη χρήση τεχνολογιών εξαγωγής τοποθεσίας, μία δομή για την μετατροπή μεγάλων αποθετηρίων εγγράφων σε Γράφους Γνώσης και μία πλατφόρμα εφαρμογής αλγορίθμων Μηχανιης Μάθησης, ανοιχτού κώδικα, για την διασύνδεση της ερευνητικής κοινότητας και της ελεύθερης αγοράς.
Hybrid Multi-User Precoding with Manifold Discriminative Learning for Millimeter-Wave Massive MIMO Systems
Authors:   Shanghai Normal University, Shanghai 200234, China, Zhou Xiaoping , Wang Bin , Zhang Jing , Zhang Qian , Wang Yang
Published: October 2021

In large-array millimeter-wave (mmWave) systems, hybrid multi-user precoding is one of the most attractive research topics. This paper first presents a low-dimensional manifolds architecture for the analog precoder. An objective function is formulated to maximize the Energy Efficiency (EE) in consideration of the insertion loss for hybrid multi-user precoder. The optimal scheme is intractable to achieve, so that we present a user clustering hybrid precoding scheme. By modeling each user set as a manifold, we formulate the problem as clustering-oriented multi-manifolds learning. We discuss the effect of non-ideal factors on the EE performance. Through proper user clustering, the hybrid multi-user precoding is investigated for the sum-rate maximization problem by manifold quasi conjugate gradient methods. The high signal to interference plus noise ratio (SINR) is achieved and the computational complexity is reduced by avoiding the conventional schemes to deal with high-dimensional channel parameters. Performance evaluations show that the proposed scheme can obtain near-optimal sum-rate and considerably higher spectral efficiency than some existing solutions.
The Effect of Vegetation on the Propagation Loss of V2I Network in High Altitude and Mountainous Area
Authors:   College of Physics and Electronic Information, Yunnan Normal University, China, Xie Dongjie , Guo Rong , Li Huafu , Jing Yanmei , He Wenxue
Published: October 2021

With the gradual formation of the commercialization of the fifth-generation communication technology, the Internet of Vehicles technology has developed rapidly, and the vehicle to infrastructure (V2I) network technology is an important part of the Internet of Vehicles. In high-altitude and mountainous areas, the communication quality of the V2I network is not only affected by terrain, but forest vegetation will also cause greater propagation loss. Aiming at the influence of vegetation in high-altitude and mountainous complex environment on the propagation loss of V2I network, this paper establishes an equivalent model of vegetation in high-altitude and mountainous areas, and analyzes the relationship between propagation loss, propagation distance and frequency of transmitting antenna. At the same time, through digital elevation model (DEM) data and triangulated irregular network (TIN), MATLAB was used to simulate the communication coverage of V2I network in the complex area covered by vegetation, and the influence of vegetation on the propagation loss of V2I network in high altitude and mountainous areas was obtained. In the future, constructing the Internet of Vehicles in a complex environment, the results of research in this article will provide a scientific basis for network quality with high reliability and low latency.
Spectrum Sensing on High Density Cognitive Radio Vehicular Ad Hoc Network
Authors:   Pan African University, Institute for Basic Sciences, Technology, and Innovation, Kenya, Rop K. V. , Langat P. K. , Ouma H. A.
Published: October 2021

Intelligent Transport System (ITS) has emerged as the most probable technology for improved transport experience more so in environments with high vehicular density. Effective vehicular communication is however hindered by spectrum scarcity due to the already crowded licensed spectrum. This has led to the emergence of Cognitive Radio (CR) systems as a solution to the spectrum scarcity problem. A crucial component in CR is spectrum sensing. Various spectrum sensing techniques including Cyclostationary, Matched Filter, and Energy detection have been proposed and applied with varied outcomes. In this paper, the above mentioned detection techniques are discussed and an improved energy detection based cooperative spectrum sensing scheme is proposed for improved communication in vehicular ad hoc networks (VANET). The proposed scheme showed an improvement in the performance of a network which in turn could lead to more efficient utilization of spectrum.
SDN Enabled DDoS Attack Detection and Mitigation for 5G Networks
Authors:   Macquarie University, Sydney, Australia, Aryal Bhulok , Abbas Robert , Collings Iain B.
Published: October 2021

This paper proposes a hybrid technique for distributed denial-of-service (DDoS) attack detection that combines statistical analysis and machine learning, with software defined networking (SDN) security. Data sets are analyzed in an iterative approach and compared to a dynamic threshold. Sixteen features are extracted, and machine learning is used to examine correlation measures between the features. A dynamically configured SDN is employed with software defined security (SDS), to provide a robust policy framework to protect the availability and integrity, and to maintain privacy of all the networks with quick response remediation. Machine learning is further employed to increase the precision of detection. This increases the accuracy from 87/88% to 99.86%, with reduced false positive ratio (FPR). The results obtained based on experimental data-sets outperformed existing techniques.
Improvement of K-nearest Neighbors (KNN) Algorithm for Network Intrusion Detection Using Shannon-Entropy
Authors:   School of Information and Communication Technology, Hanoi University of Science and Technology, Hanoi, Vietnam, Bach Nguyen Gia , Hoang Le Huy , Hai Tran Hoang
Published: October 2021

Non-parametric Nearest Neighbor is an algorithm seeking for the closest data points based on the Euclidean Norm (the standard distance between two data points in a multidimensional space). The classical K-nearest Neighbor (KNN) algorithm applies this theory to find K data points in a vicinity of the considering data, then uses majority voting to label its category. This paper proposes a modification to the original KNN to improve its accuracy by changing that Euclidean Norm based on Shannon-Entropy theory in the context of Network Intrusion Detecton System. Shannon-Entropy calculates the importance of features based on the labels of those data points, then the distance between data points would be re-calculated through the new weights found for these features. Therefore, it is possible to find the more suitable K data points nearby. NSL - KDD dataset is used in this paper to evaluate the performance of the proposed model. A comparison is drawn between the results of the classic KNN, related work on its improvement and the proposed algorithm as well as novel deep learning approaches to evaluate its effectivenes in different scenarios. Results reveal that the proposed algorithm shows good performance on NSL - KDD data set. Specifically, an accuracy up to 99.73% detecting DoS attacks is obtained, 5.46% higher than the original KNN, and 1.15% higher than the related work of M-KNN. Recalculating the Euclidean-Norm distance retains the contribution of the features with low importance to the data classification, while assuring that features with higher importance will have a higher impact. Thus, the proposal does not raise any concern for losing information, and even achieves high efficiency in the classification of features and data classification.
Performance Analysis of 3GPP NB-IoT Downlink System towards 5G Machine Type Communication (5G-MTC)
Authors:   5G IoT Lab, Sikkim Manipal Institute of Technology, Sikkim Manipal University, Gangtok, 737101, India, Chettri Lalit , Bera Rabindranath , Barauh Jayanta Kumar
Published: October 2021

5G Technology is the most recent scientific development in wireless communication and it is evolving day by day to meet the demand of near future. As per 3GPP, NB-IoT is chosen as a most promising technology that has been specified for 5G machine type communication (5G-MTC). Since 5G relies on low power wide area networks (LPWAN) and NB-IoT is suitable low power technology in deploying MTC in 5G networks. NB-IoT operates in a licensed spectrum bands and has the potential to guarantee quality of service (QoS). NB-IoT is a specified LPWAN that is based upon system bandwidth of 180 kHz and sub carrier spacing can be considered as 3.75 kHz and 15 kHz as per 3GPP, NB-IoT in downlink system only supports 15 kHz sub carrier spacing. NB-IoT is a top competitor for other low power networks that operates in both licensed and unlicensed spectrum ad 3GPP has specialized NB-IoT as a top priority in 5G networks to support massive machine type communication. In this article, we have studied the technologies for NB-IoT and its implementation in 5G MTC. We also designed a NB-IoT downlink system based on 3GPP guidelines considering sub carrier spacing as 15 kHz and its performance analysis is carried out for MTC scenario. The analysis is performed with two different antenna configurations and compared its performance analysis in terms of BER, FER and QPSK constellation of NPDCCH and NPDSCH after channel estimation. The BER and FER of both NPDCCH and NPDSCH decrease with SNR, resulting the better performance towards machine type communications in 5G.
Evolutionary Programming: A Population-Based Optimization Algorithm for Coded Multiuser Systems
Authors:   Weihai Beiyang Electric Group Co. Ltd., Weihai, Shandong, China, Qin Yu , Qin Zhiliang , Zhang Zhongkai , Li Yingying , Lu Qidong
Published: October 2021

We consider iterative channel detection and estimation for coded multiuser systems. The conventional A Posteriori Probability (APP) channel detector has a computational complexity growing exponentially with the number of users. In this paper, we study the channel detection problem from a combinatorial optimization viewpoint and derive a low-complexity soft-output channel detector based on the Evolutionary Programming (EP) optimization algorithm. An iterative channel estimator based on tentative soft estimates fed back from channel decoders is used to provide refined channel parameters to the channel detector. It is shown that the proposed iterative receiver can significantly reduce the computational complexity with slight performance degradation compared to the conventional receiver based on APP detection.
A Cost-Effective Two-Way Household Wireless Door Intercom System
Authors:   Department of Electrical, Electronics and Computer Engineering, Afe Babalola University, Ado-Ekiti, Nigeria, Ejidokun Temitayo O. , Oke Oluwole J. , Omitola Ibukun M. , Oduneye Toyese
Published: October 2021

This study utilized a wireless transceiver module (NRF24L01) and ATmega328 to implement a cost-effective household door intercom. The intercom consist of two units; the outdoor and indoor. The outdoor unit was used by the guest to communicate with the household owner to notify them of their presence at the door while the indoor unit was used to respond to the call. The transceiver module transmits and receives audio signals between the two units, while ATmega328 handles the conversion of the signal from analog to digital during transmission and vice-versa at reception. The outcome of the test and analysis carried out on the developed prototype shows that it is user-friendly, consumes less power, and also proves that it is a cost-effective solution that can be affordable and made to be readily available to the consumer.
Un fragmento de retablo-tabernáculo del siglo XIII procedente de El Sotillo (Guadalajara).
Authors: Salgado Pantoja José Arturo
Published: October 2021

Un fortuito hallazgo en la iglesia parroquial de El Sotillo (Guadalajara) ha permitido identificar un extraordinario fragmento procedente de un retablo-tabernáculo del tercer cuarto del siglo XIII. La pieza en cuestión es un ala abatible del mismo, hecha en madera de pino, en la que se observan las imágenes en relieve de San José y el arcángel San Gabriel bajo estilizados arcos apuntados y otros detalles ornamentales.
Aportaciones documentales sobre el escultor Pedro Roldán.
Authors: Romero Torres José Luis
Published: October 2021

El escultor Pedro Roldán nació en Sevilla en 1624, pero se ha investigado poco sobre su extensa familia de Antequera. En esa ciudad nacieron otros hermanos mayores que el artista y uno menor que se desconocían hasta ahora. Con esta documentación se afianza la hipótesis de que la infancia y los inicios de su formación artística transcurrieron en Antequera. En este artículo se aportan nuevos documentos sobre sus abuelos, padres, hermanos, tíos, sobrinos y primos de Antequera y Archidona; y se aclaran algunas homonimias. También se da a conocer nueva información familiar sobre el escultor Julián Roldán Guerrero, quien aprendió y trabajó con Pedro Roldán. Entre esos documentos: el matrimonio de los padres, su nacimiento en Archidona en 1637, el de sus hermanos y la muerte de su padre.
Entre órganos y violines: Guillermo d’Enoyer y el VI conde de Luque (1739-1796).
Authors: Luengo Pedro
Published: October 2021

El contexto musical de la corte del VI conde de Luque ha sido subrayado por estudios previos, pero no así el origen de sus instrumentos. Este trabajo pretende reconstruir algunos procesos de adquisición y construcción, así como sus autores. Para ello, se ha partido de la documentación histórica conservada. Como resultado se han identificado varias obras del organero francés Guillermo d’Enoyer, la construcción de instrumentos de cuerda frotada para una orquesta completa, así como la adquisición de violines italianos o una caja de música. Gracias a estos datos se entiende con más detalle el grado de internacionalización y actualidad musical ofrecida por la corte del conde de Luque.
Sheep condyle model evaluation of bone marrow cell concentrate combined with a scaffold for repair of large osteochondral defects
Authors: Tamaddon Maryam , Blunn Gordon , Xu Wei , Alemán Domínguez Maria Elena , Monzón Mario , Donaldson James , Skinner John , Arnett Timothy R. , Wang Ling , Liu Chaozong
Published: October 2021

Aims

Minimally manipulated cells, such as autologous bone marrow concentrates (BMC), have been investigated in orthopaedics as both a primary therapeutic and augmentation to existing restoration procedures. However, the efficacy of BMC in combination with tissue engineering is still unclear. In this study, we aimed to determine whether the addition of BMC to an osteochondral scaffold is safe and can improve the repair of large osteochondral defects when compared to the scaffold alone.

Methods

The ovine femoral condyle model was used. Bone marrow was aspirated, concentrated, and used intraoperatively with a collagen/hydroxyapatite scaffold to fill the osteochondral defects (n = 6). Tissue regeneration was then assessed versus the scaffold-only group (n = 6). Histological staining of cartilage with alcian blue and safranin-O, changes in chondrogenic gene expression, microCT, peripheral quantitative CT (pQCT), and force-plate gait analyses were performed. Lymph nodes and blood were analyzed for safety.

Results

The results six months postoperatively showed that there were no significant differences in bone regrowth and mineral density between BMC-treated animals and controls. A significant upregulation of messenger RNA (mRNA) for types I and II collagens in the BMC group was observed, but there were no differences in the formation of hyaline-like cartilage between the groups. A trend towards reduced sulphated glycosaminoglycans (sGAG) breakdown was detected in the BMC group but this was not statistically significant. Functional weightbearing was not affected by the inclusion of BMC.

Conclusion

Our results indicated that the addition of BMC to scaffold is safe and has some potentially beneficial effects on osteochondral-tissue regeneration, but not on the functional endpoint of orthopaedic interest. Cite this article: Bone Joint Res 2021;10(10):677–689.
Ultrasound-targeted simvastatin-loaded microbubble destruction promotes OA cartilage repair by modulating the cholesterol efflux pathway mediated by PPARγ in rabbits
Authors: Wang Xinwei , Wang Danbi , Xia Peng , Cheng Kai , Wang Qi , Wang Xiaoju , Lin Qiang , Song Jiulong , Chen Anliang , Li Xueping
Published: October 2021

Aims

To evaluate the effect of ultrasound-targeted simvastatin-loaded microbubble destruction (UTMDSV) for alleviation of the progression of osteoarthritis (OA) in rabbits through modulation of the peroxisome proliferator-activated receptor (PPARγ).

Methods

In vitro, OA chondrocytes were treated with ultrasound (US), US-targeted microbubble destruction (UTMD), simvastatin (SV), and UTMDSVon alternate days for four weeks. Chondrocytes were also treated with PPARγ inhibitor, PPARγ inhibitor+ UTMDSV, and UTMDSV. The cholesterol efflux rate and triglyceride levels were measured using an assay kit and oil red O staining, respectively. In vivo, the OA rabbits were treated with a single intra-articular injection of UTMD, SV, and UTMDSVevery seven days for four weeks. Cartilage histopathology was assessed by safranin-O staining and the Mankin score. Total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) in rabbit knee synovial fluid were detected by enzyme-marker assay. Aggrecan, collagen II, and PPARγ expression levels were analyzed by Western blotting (WB).

Results

In vitro, UTMDSVsignificantly increased the cholesterol efflux rate and aggrecan, collagen II, and PPARγ levels in OA chondrocytes; these effects were blocked by the PPARγ inhibitor. In vivo, UTMDSVsignificantly increased aggrecan, collagen II, PPARγ, and HDL-C levels, while TC levels and Mankin scores were decreased compared with the UTMD, SV, OA, and control groups.

Conclusion

UTMDSVpromotes cartilage extracellular matrix synthesis by modulating the PPARγ-mediated cholesterol efflux pathway in OA rabbits. Cite this article: Bone Joint Res 2021;10(10):693–703.