bluuebunny/crossref_metadata_2025 huggingface dataset:
Fuzzy-proportional-integral-derivative hybrid controller design for ultra-high temperature milk processing
Authors: Ahmad Naseer , Arsalan Muhammad
Published: July 2023

In the ultra-high temperature (UHT) process, fluid temperature is raised above 135 °C for a short period of time (typically 4 seconds) and then quickly cooled ensuring no microbes remain in the final product. To have better quality processed milk, a stringent temperature control system is necessary. To solve this problem a detailed control-oriented mathematical model of the heating system for UHT application is developed and a detailed block diagram is established by identifying various systems and signals. To draw the merits of a feedforward controller (transfer function or fuzzy logic based) and proportional-integral-derivative (PID) feedback compensator, a fuzzy PID hybrid controller is designed and simulated in a MATLAB environment. Findings of the simulation results indicate that the fuzzy-PID hybrid compensator concatenates the benefits of both controllers. PID controller processes the error signal and tracks the setpoint whereas the feedforward controller (transfer function or fuzzy) effectively rejects the disturbance signal’s effect on the controlled variable. The fuzzy-PID hybrid controller performs better than the individual PID or fuzzy controller.
Distinct Inflammatory Milieu in Patients With Right Heart Failure
Authors: Yang Bin Q. , Park Arick C. , Liu Jason , Byrnes Kathleen , Javaheri Ali , Mann Douglas L. , Schilling Joel D.
Published: July 2023

BACKGROUND:

Right heart failure (RHF) is associated with worse clinical outcomes. In addition to hemodynamic perturbations, the syndrome of RHF involves liver congestion and dysfunction. The mechanisms that underlie heart-liver interactions are poorly understood and may involve secreted factors. As a first step to understand the cardiohepatic axis, we sought to elucidate the circulating inflammatory milieu in patients with RHF.

METHODS:

Blood samples were collected from the inferior vena cava and hepatic veins during right heart catheterization from 3 groups of patients: (1) controls with normal cardiac function, (2) patients with heart failure who did not meet all criteria of RHF, and (3) patients who met prespecified criteria for RHF defined by hemodynamic and echocardiographic parameters. We performed a multiplex protein assay to survey levels of several circulating markers and analyzed their association with mortality and the need for a left ventricular assist device or heart transplant. Finally, we leveraged publicly available single-cell RNA sequencing data and performed tissue imaging to evaluate the expression of these factors in the liver.

RESULTS:

In this study, RHF was associated with elevated levels of a subset of cytokines/chemokines/growth factors compared with controls. In particular, soluble CD163 (cluster of differentiation 163) and CXCL12 (chemokine [C-X-C motif] ligand 12) were higher in RHF and predicted left ventricular assist device/transplant-free survival in an independent validation cohort. Furthermore, single-cell RNA sequencing and immunohistochemistry of human liver biopsies suggest that these factors are expressed by Kupffer cells and may be liver derived.

CONCLUSIONS:

RHF is associated with a distinct circulating inflammatory profile. Soluble CD163 and CXCL12 are novel biomarkers that can prognosticate patient outcomes. Future studies to define how these molecules influence heart failure phenotypes and disease progression may lead to new approaches to the management of patients with RHF.
Two new species of Crinipellis (Marasmiaceae, Agaricales) from Kerala State, India
Authors: SHARAFUDHEEN SHAHINA A. , MANIMOHAN PATINJAREVEETTIL , LATHA K. P. DEEPNA
Published: July 2023

Two new species of Crinipellis, Crinipellis minima and C. fibrillosa, are described from Kerala State, India, based on both morphological characteristics and molecular phylogenetic analysis using the internal transcribed spacers of nuclear ribosomal DNA (nrITS). Detailed descriptions, photographs and comparisons with phenetically and phylogenetically related species are provided. The nrITS-based phylogenetic tree inferred from the Maximum Likelihood analysis confirmed both the novelty and the placement of these species within the genus Crinipellis.
Varicosporellopsis shangrilaensis sp. nov. (Nectriaceae, Hypocreales), a new terricolous species isolated from the rhizosphere soil of Astragalus polycladus in northwestern Yunnan, China
Authors: DOU ZHENG-RONG , ZHANG FA , ZHOU GUO-JUN , GONG GAO-FEN , DING JIA-JIE , FAN XU-HANG , JIANG BEI , WANG KAI-LING
Published: July 2023

Two fungal strains were isolated from the rhizosphere soil of a Chinese medicinal herb plant, Astragalus polycladus, in northwestern Yunnan, China. Both of them were identified as a new fungal species of Varicosporellopsis based on the evidence of morphology and phylogenetic analysis of ITS, LSU, TUB and ACT sequences data. Phylogenetic analysis of combined ITS and LSU sequence data revealed that strains MTF 7 and KLF 01 belong to the genus Varicosporellopsis with the highest sequence similarity (95.51%) to the type strain V. americana CBS 148257 and formed a sister lineage to V. americana CPC 40768 with high support values (100% ML, 1.00 BI). Morphologically, V. shangrilaensis is characterized by macronematous, branched conidiophores, phialidic conidiogenous cells, reniform macroconidia and spherical microconidia. This new species is the first reported of Varicosporellopsis in China. The morphological description, illustrations and phylogenetic analysis of V. shangrilaensis are provided in this study.
Asystasia venui (Justicieae: Acanthaceae): A new species from West Bengal, India
Authors: KUMAR ANANT , KRISHNA GOPAL , BHATTACHARJEE AVISHEK
Published: July 2023

Asystasia venui (Justicieae: Acanthaceae), a new species is described and illustrated from West Bengal, India. Morphologically, it resembles A. atroviridis and A. neesiana, but differs from these two species in having smaller corolla tube and calyx lobes, papillose ovary, glandular hairy capsules, and papillose ovary, lax racemes with glandular pubescent rachis respectively. A detailed morphological description of Asystasia venui, together with photographs, comparative illustrations and a key to the species of Asystasia occurring in India is provided for identification.
Taxonomic and phylogenetic appraisal of a new holomorphic Neophyllachora species from Chiang Mai, Thailand
Authors: LITERATUS IRISH C. E. , MAHARACHCHIKUMBURA SAJEEWA S. N. , WITHEE PATCHAREEYA , HAITUK SUKANYA , TAMAKAEW NISACHON , NGUANHOM JEERAPA , MONKHUNG SARARAT , THIYAGARAJA VINODHINI , CHEEWANGKOON RATCHADAWAN
Published: July 2023

Tar spot is a common fungal disease often caused by Phyllachoraceae species, mostly on leaves and also on stems and fruits of a variety of host plant families. We identified a Neophyllachora species from Ficus religiosa leaves in Chiang Mai, Thailand. Phylogenetic analyses using maximum-likelihood (ML) and Bayesian inference (BI) showed the taxonomic placement of our taxon within Neophyllachora. The newly obtained sequences recovered as a sister and distinct clade to Neophyllachora fici with high bootstrap support. Our collection mainly differs from N. fici in having septate paraphyses, hyaline to olivaceous ascospores with 1-2 guttules, and mucilaginous sheath. A holomorphic fungus, Neophyllachora religiosa sp. nov. is introduced here based on the evidence from morpho-molecular analyses. The genus and the species are also identified as the first geographical record to Thailand and the first host record to Ficus religiosa. The synopsis table for the existing species of Neophyllachora and the key to the genus is provided.
Hohenbuehelia filicina sp. nov. (Agaricales, Basidiomycota), from Southwestern Siberia, Russia
Authors: KALININA LYUDMILA B. , AGEEV DMITRY V. , BULYONKOVA TATIANA M.
Published: July 2023

Hohenbuehelia filicina, a new species from Southwestern Siberia, Russia is described. It is morphologically, ecologically and phylogenetically well differentiated from the other species of the genus. The unique combination of morphology (relatively long stipe, white fruitbodies) and substrate preference (growing exclusively on live ostrich ferns) make the species easily recognizable even in the field. Phylogenetic analysis was performed to confirm the identity of new species.
Morpho-anatomical study of Sargassum (Fucales, Phaeophyceae) diversity reveals noteworthy collections and range extensions from southwestern Vietnam
Authors: VAN TU NGUYEN
Published: July 2023

Sargassum is widely distributed marine brown seaweed taxon with high diversity and taxonomic debates. To improve our understading of the Sargassum flora of southwestern Vietnam, more than 108 specimens of Sargassum were collected in the Phu Quoc Island and nearby localities. Five species were newly recorded in southwestern Vietnam based on morpho-anatomical evidence; S. cinereum, S. confusum and S. siliquosum were limited to southwestern Vietnam, and ranges of S. feldmannii and S. microcystum were extended to the Phu Quoc Island. Their descriptions, illustrations, and voucher specimens are provided in the present study. The findings are useful for future monitoring surveys and have conservation and ecosystem applications.
Taxonomic revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti, 1902 (Hymenoptera: Braconidae: Doryctinae)
Authors: BELOKOBYLSKIJ SERGEY A. , CASTRO CLÓVIS SORMUS DE , SHIMBORI EDUARDO MITIO , ZALDÍVAR-RIVERÓN ALEJANDRO , PENTEADO-DIAS ANGÉLICA MARIA , BRAET YVES
Published: July 2023

A revision of the Neotropical species of the braconid wasp genus Pedinotus Szépligeti and molecular characterization of some species based on the COI mitochondrial DNA gene are provided. Twenty four new species are described: P. avispas sp. nov., P. bororo sp. nov., P. botocudo sp. nov., P. brunniventris sp. nov., P. cerdai sp. nov., P. daedalus sp. nov., P. dispar sp. nov., P. dominica sp. nov., P. elongatus sp. nov., P. glabroscutum sp. nov., P. guyanensis sp. nov., P. haliti sp. nov., P. intermedius sp. nov., P. maracas sp. nov., P. nigriceps sp. nov., P. nitidus sp. nov., P. nolli sp. nov., P. peruanus sp. nov., P. plaumanni sp. nov., P. propodealis sp. nov., P. rondoni sp. nov., P. subtristis sp. nov., P. szepligetii sp. nov., and P. trinidad sp. nov. Moreover, P .brasiliensis Szépligeti, 1902, P. columbianus Enderlein, 1912, P. ferrugineus (Enderlein, 1920), P. niger Marsh 2002, P. pardalotus Marsh 2002, P. rojasi Marsh 2002, P. tundisii Felix et Penteado-Dias, 2004 and P. variegatus Marsh 2002 are redescribed. The following new synonyms are proposed: Lamquetia Braet, Barbalho et Achterberg, 2003 under Pedinotus Szépligeti, 1902 (syn. nov.); L. marshi Braet et Barbalho, 2003 and P. fasciatus Castro, Nunes et Penteado-Dias, 2010 under P. pardalotus Marsh, 2003 (syn. nov.). The following new combination is suggested: P. rufus (Braet et van Achterberg, 2003), comb. nov. (from Lamquetia rufa). A key to the Neotropical species of Pedinotus is provided.
The Linguistic Structure of Haiku/Senryu and Its Evolution Over Time
Authors: Friedenberg Jay , Farrelly Colleen , Cameron Isabel , Mourani Richard
Published: July 2023

Although computational linguistic methods have been applied to spoken and written text, they have only recently been used to study poetry. Here, we examine the linguistic components of contest-winning haiku and compare them to a control sample of poems published in an industry-standard journal. We look also at differences between haiku and senryu and what stylistic trends may have affected these poems over time. The results show that winning haiku are shorter than those in a representative journal. Journal poems also have fewer pronouns and more adjectives and nouns. All of the poems show a decrease in words over a decade-long time span. This trend may reflect changes in stylistic writing conventions. The length of such poems probably also relates to innate working memory span limitations. Haiku that limit the number of images and ideas within this limit likely facilitate cognitive processing and increase aesthetic appeal.
Republicanism and Imperialism at the Frontier: A Post-Black Lives Matter Archeology of International Relations
Authors: Shilliam Robbie
Published: July 2023

In the summer of 2020, International Relations (IR) scholars rushed to respond to the national and global irruptions of support for Black Lives Matter. But the relationship of ‘domestic’ racism in the United States to foreign policy and IR is long standing in the field, and non-marginal at that: in 1960, Hans Morgenthau provided a clear analysis of such connections in light of Brown vs. Board of Education. The ‘post’ in postcolonial acts as an intellectual provocation: in the aftermath of an event, how might we rethink received traditions of inquiry that prove ill equipped to explain and evaluate the event itself? The explanatory value of the ‘post’ lies in both exposing the disciplinary conventions of absence and retrieving obfuscated presences that provide alternative modes of inquiry. Picking up on Morgenthau’s lost intervention, I provide a contribution to what might be called post-Black Lives Matter (BLM) IR. I weave an intellectual archeology of the long-standing intimacy of republicanism and imperialism via the racialized concept of the ‘frontier’. I bring together the arguments and narratives of four authors who are progenitors of and/or mainstream scholars in the field: William Francis Allen, Frederick Jackson Turner, Morgenthau, and Merze Tate. I claim that this archeology of the ‘frontier’ might help us to grapple responsibly and incisively with IR post-BLM.

Républicanisme et impérialisme à la frontière : une archéologie des relations internationales post-Black Lives Matter
The Worldmaking of Mobile Vernacular Capitalists: Tracing Entanglements Between Race, Caste and Capital
Authors: Dilawri Shikha
Published: July 2023

This article traces the colonially inscribed spread of global capitalism through the lives and legacies of mobile vernacular capitalists in the Indian Ocean during the early-to-mid 20th century, centring the merchant-turned-industrialist-and-philanthropist Nanji Kalidas Mehta. Turning to a figure that shaped and challenged the infrastructures and outcomes of empire, but advanced forms of hierarchical differentiation – between capital and labour, and across race and caste – this article makes two interventions. First, it complicates literature on worldmaking by highlighting a figure in a register distinctive from the ‘progressive’ internationalisms associated with Bandung. Second, it reveals entanglements between race, caste and capital, illuminating how local hierarchies have been incorporated into differentiating logics of colonial capitalism. Considering sites, subjects and categories beyond an Atlantic frame lends to more capacious understandings of racial capitalism while challenging readings of caste as a subcontinent-bounded, feudal residue. This ultimately presents a more complex picture of global hierarchies shaping the (post)colonial present.

La construction du monde des capitalistes autochtones nomades : tracer des liens entre race, caste et capital
Benchmarking Recycled Binder Blends Using Statistical Analysis: A Case Study of Virginia and North Carolina
Authors: Preciado Jaime , Gulzar Saqib , Fried Andrew , Castorena Cassie , Underwood Benjamin Shane , Habbouche Jhony , Boz Ilker
Published: July 2023

Recycling agents (RAs) are added to asphalt binder blends containing recycled materials to mitigate the negative effects of adding oxidized material to asphalt mixtures. Several methods exist to select a particular RA dosage to restore a specific Superpave performance parameter. However, the rheological similarities between the RA-modified systems and typical virgin binders across the complete range of temperatures remain to be ascertained. In this study, two RA dosage selection procedures, one aiming to restore high-temperature performance grade and the other aiming to restore low-temperature performance grade were statistically compared. Quality assurance datasets from Virginia and North Carolina were used to benchmark the typical virgin binder properties, and 17 recycled binder blends using constituent materials from the two states were studied with respect to Superpave binder properties. Both univariate and bivariate statistical analyses were applied to compare and contrast the rheological properties of these blends with the benchmarked virgin binder properties for the two states. Then, a statistical similarity analysis was done using the Mahalanobis distance to evaluate the rheological properties of these blends with those of the reference binders. The study found that both dosage selection procedures were successful in achieving rheological similarity at target-specific temperatures and for specific binder properties but might not necessarily yield similar properties at other temperatures. Finally, an example application is presented using statistical analysis to select an RA dosage that yields a rheological fingerprint more similar to that of virgin binder systems.
The American action film and the Arendt–Pitkin ‘tyranny of “the Social”’
Authors: Barker Chris
Published: July 2023

Hanna Pitkin explains that Arendt’s defense of collective political action tends to reify and mystify an opposing concept Arendt calls ‘the Social’. Was Arendt actually right about the rise of ‘the Social’? Does the deep-set global mass entertainment culture tend to sap action even when it purportedly celebrates it? And what can viewing publics and counter-publics tell us about the meaning and reception of ‘the Social’, especially in this massively online era? This article surveys different ways of thinking about the basic problem presented by American popular action cinema, and especially big-budget Hollywood action films, through an Arendtian lens. In presenting this overview, the article looks to reorient traditional philosophical concerns about screen violence and its censorship, and to offer a holistic reappraisal of ‘the Social’ and ‘action’ by placing democratic theory in closer dialogue with film studies.
Study on the optimization of high-speed turnout crossing structures based on actual elastic deformation of point and splice rails
Authors: Wang Pu , Zhao Zhenhua , Ma Junqi , Wang Shuguo
Published: July 2023

In this paper, to address the shortcomings of the crossing structure design based on the elastic bending center method and the lack of related research, an optimization method for high-speed turnout crossing structures was proposed based on the actual elastic deformations of point and splice rails. Based on the finite element theory, the actual loading characteristics and spatial variable section characteristics of point and splice rails were fully considered, and a refined simulation analysis model of the switching system of point and splice rails in crossing areas was established. Moreover, the elastic deformation lines of point and splice rails in the nonworking state were obtained for the first time, which were consistent with actual situations. On this basis, system optimization was performed for the connecting parts of the crossing with a movable point in a high-speed turnout. In the crossing structure simulation model, the length adjustment values of the first–sixth spacer blocks between the branch line–wing and point rails and between the mail line–wing splice rails were ≤1 mm. Moreover, the lengths of the seventh–ninth spacer blocks decreased by gradually increasing amounts, and the length of the ninth spacer block decreased the most (∼6 mm). The length of the second spacer block between the point and splice rails slightly increased, but the length of the third spacer block significantly decreased by 6 mm. The length adjustment value of the distance block between the point and splice rails was smallest (0.7 mm). The calculated optimal lengths of the connecting parts of the crossing were found to be close to the empirical values used in actual manufacturing processes, and the dimension optimization patterns were completely consistent with actual situation, which validates the proposed optimization method. Thus, the proposed method can effectively improve the coordination between rails and connecting parts in crossing areas, substantially reduce internal stresses in crossing systems, and improve their assembly performance and service life. Moreover, the proposed optimization parameters can provide valuable references for the research on next-generation high-speed turnouts (400 km/h) and for improving the designs of existing high-speed turnouts.
Systemic lupus erythematosus-related acute lung disease
Authors: Triboulet Félicien , Guérin Emmanuelle , Boussouar Samia , Hékimian Guillaume , Pha Micheline , Rouvier Philippe , Mathian Alexis , Quentric Paul , Moyon Quentin , Hié Miguel , Schmidt Matthieu , Combes Alain , Luyt Charles-Edouard , Amoura Zahir , Pineton de Chambrun Marc
Published: July 2023

Introduction

Systemic lupus erythematosus (SLE) is non-organ specific autoimmune disease with mainly skin, joint, and kidney involvement. SLE-related acute lung disease (ALD) is rare, poorly investigated and can lead to acute respiratory failure. We conducted a retrospective study aiming to describe clinical features, treatments and outcome of SLE-related APD.

Methods

We retrospectively included all patients with SLE and ALD admitted from November 1996 and September 2018 to La Pitié-Salpêtrière Hospital, after exclusion of viral or bacterial lung infection, cardiac failure or any other alternate diagnosis.

Results

During the time of the study, 14 patients with 16 episodes were admitted to our center: female 79%, mean age ± SD at admission 24 ± 11 years. ALD was inaugural of the SLE in 70% cases. SLE main organ involvement were: arthritis 93%, skin 79%, serositis 79%, hematological 79%, kidney 64%, neuropsychiatric 36% and cardiac 21%. 11 episodes required ICU admission for a median time of 8 days. Chest CT-scan revealed mostly basal consolidation and ground-glass opacities. When available, bronchoalveolar lavage mostly revealed a neutrophilic alveolitis with alveolar hemorrhage in 67% cases. Symptomatic respiratory treatments were: oxygen 81%, high-flow nasal canula oxygen 27%, non-invasive ventilation 36%, mechanical ventilation 64% and venovenous extracorporeal membrane oxygenation 18%. SLE-specific treatments were: corticosteroids 100%, cyclophosphamide 56% and plasma exchange 25%. All patients but one survived to ICU and hospital discharge. Two patients had a relapse of SLE-related ALD but none had interstitial lung disease during follow-up.

Conclusion

Systemic lupus erythematosus-related acute respiratory failure is a severe event, mostly occurring at SLE onset, typical harboring a basal consolidation pattern on chest CT-scan and alveolar hemorrhage on BAL pathological examination. Mortality in our cohort is lower than previously reported but these results needs to be confirmed in further larger studies.
Adherence to African-Centered Norms and Help Seeking for Emotional Distress Among Black Men
Authors: Lateef Husain
Published: July 2023

Research demonstrates that Black American men are significantly less likely to seek help for mental distress than other gendered or racial groups. Yet, Afrocentric theorists propose that African cultural norms of interdependence may serve as important facilitators in promoting mental health in Black populations. This study explored how Ubuntu—an African construct expressing adherence to principles of compassion, interdependence, and humanism —is associated with help-seeking perceptions among Black men. Results from surveying 300 participants recruited using social media, showed that Black men with higher acceptance toward African cultural norms reported higher inclination to seek mental health services for emotional distress. Implications for future research and practice to improve uptake of mental health services of Black men are provided.
Chemotherapy-Induced Neutropenia as a Prognostic Factor in Patients With Advanced Epithelial Ovarian Carcinoma
Authors: Xu Yaping , Wei Mingjing , Cheng Xiaodong , Li Xiao
Published: July 2023

Background

To evaluate the prognostic value of chemotherapy-induced neutropenia (CIN) in epithelial ovarian carcinoma (EOC) treated with primary surgery followed by platinum-based chemotherapy.

Methods

The records of primary EOC treated between Jan 1st 2002 and Dec 31st 2016 were reviewed according to the including and excluding criteria. CIN was defined as absolute neutrophil count (ANC) after chemotherapy <2.0 × 109/L. Patients with CIN were further divided into mild and severe CIN (ANC <1.0 × 109/L), early-onset and late-onset (>3 cycles) CIN. Clinical characteristic was compared by chi-square test. Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan–Meier analysis, univariate and multivariate Cox regression models.

Results

Among 735 EOC patients enrolled, no significant differences of the prognosis were found between patients with and without CIN, early and late CIN, mild and severe CIN. However, Kaplan–Meier curve (65 vs 42 months for CIN vs non-CIN, P = .007) and Cox regression analysis (HR 1.499, 95% CI 1.142-1.966; P = .004) both revealed that CIN was significantly related with better OS in advanced EOC patients, but not for PFS. So, subgroup analysis was further conducted and date suggested that CIN was an independent predictor of better survival in advanced EOC with suboptimal surgery (PFS: 18 vs 14 months, P = .013, HR 1.526, 95% CI 1.072-2.171, P = .019; OS: 37 vs 27 months, P = .013, HR 1.455, 95% CI 1.004-2.108; P = .048).

Conclusions

CIN might be used as an independent prognostic indicator of advanced EOC, especially for those patients with suboptimal surgery.
Production of partially hydrogenated soybean oil with low trans-fatty acids using surface dielectric barrier discharge cold plasma
Authors: Sirati Zoha Chahardehi , Gharachorloo Maryam , Ghomi Marzdashti Hamidreza , Azizinezhad Reza
Published: July 2023

This study examined the feasibility of applying surface dielectric barrier discharge cold plasma (SDBDCP) to partially hydrogenate crude soybean oil. The oil sample was treated for 13 h using SDBDCP at 15 kV with 100% hydrogen gas under room temperature and atmospheric pressure. Fatty acid composition, iodine value, refractive index, carotenoid content, melting point, peroxide value, and free fatty acids content (FFA) were investigated during SDBDCP treatment. Analysis of fatty acid composition demonstrated an increase in the content of saturated and monounsaturated fatty acids (from 41.32% to 55.3%) and a decrease in the content of polyunsaturated fatty acids (from 58.62% to 40.98%), which resulted in a reduction of the iodine value to 98.49 over the treatment time. Also, the fatty acid profile indicated that the total detected level of trans-fatty acids was very low (0.79%). After a 13-h treatment, the samples showed a refractive index of 1.4637, melting point of 10 °C, peroxide value of 4.1 meq/kg, and FFA content of 0.8%. In addition, the results revealed a 71% decline in the carotenoid content of the oil sample due to the saturation of their double bonds. Therefore, these findings suggest that SDBDCP can be effectively used for hydrogenation along with bleaching oil.
Intestinal tuberculosis can masquerade as Crohn’s disease: A teachable moment
Authors: KC Pooja , Bhattarai Madhur , Adhikari Subodh , Parajuli Prakriti , Bhandari Sujata , Bhattarai Himal Bikram , Sharma Niraj Kumar , Karki Shailendra , Acharya Suryakiran , Basnet Bibhusan
Published: July 2023

Intestinal tuberculosis and Crohn’s disease are chronic granulomatous diseases with similar clinical presentations and can mimic one another. Their treatment modalities are completely different; however, sometimes it is challenging to differentiate them. We report a case of a 51-year-old female presenting with abdominal pain and on-and-off diarrhea for 4 years with weight loss. Clinical symptoms along with multiple aphthous ulcers in the terminal ileum and negative tuberculin test favored the diagnosis of Crohn’s disease. The patient did not respond to steroids. A repeat colonoscopy with acid-fast bacilli stain showed Mycobacterium tuberculosis. This case highlights that acid-fast bacilli culture and tuberculosis polymerase chain reaction to confirm or rule out the diagnosis of intestinal tuberculosis in all patients suspected of Crohn’s disease.
Improving Primary Healthcare Access for Asylum Seekers and Refugees: A Qualitative Study From a Swiss Family Physician Perspective
Authors: Oehri Johanna , Chernet Afona , Merten Sonja , Sydow Veronique , Paris Daniel H.
Published: July 2023

Since 2015 the need for evidence-based guidance in primary health care management of refugees, asylum seekers, and immigrants has dramatically increased. The aims of this study were to identify the challenges met by primary care physicians in Switzerland, by performing semi-structured interviews and to identify possible approaches and interventions. Between January 2019 and January 2020, 20 GPs in 3 Swiss cantons were interviewed. The interviews were transcribed, coded with MAXQDA 18, and analyzed using the framework methodology. Following relevant findings were highlighted; (i) problems relating to health insurance companies among (health-insured) asylum seekers and refugees were negligible; (ii) there is a high acceptance for vaccination by refugees, asylum seekers, and immigrants; (iii) limitations in time for consultations and adequate reimbursement for practitioners pose a serious challenge; (iv) the majority of consultations are complaint-oriented, preventive consultations are rare; and (v) the language barrier is a major challenge for psychosocial consultations, whereas this appears less relevant for somatic complaints. The following issues were identified as high priority needs by the study participants; (i) increased networking between GPs, that is, establishing bridging services with asylum centers, (ii) improved training opportunities for GPs in Migration Medicine with regular updates of current guidelines, and (iii) a standardisation of health documentation facilitating exchange of medical data, that is, digital/paper-based “health booklet” or “health pass.”
A Combined Reinforcement Learning and Model Predictive Control for Car-Following Maneuver of Autonomous Vehicles
Authors: Wang Liwen , Yang Shuo , Yuan Kang , Huang Yanjun , Chen Hong
Published: July 2023

Model predictive control is widely used in the design of autonomous driving algorithms. However, its parameters are sensitive to dynamically varying driving conditions, making it difficult to be implemented into practice. As a result, this study presents a self-learning algorithm based on reinforcement learning to tune a model predictive controller. Specifically, the proposed algorithm is used to extract features of dynamic traffic scenes and adjust the weight coefficients of the model predictive controller. In this method, a risk threshold model is proposed to classify the risk level of the scenes based on the scene features, and aid in the design of the reinforcement learning reward function and ultimately improve the adaptability of the model predictive controller to real-world scenarios. The proposed algorithm is compared to a pure model predictive controller in car-following case. According to the results, the proposed method enables autonomous vehicles to adjust the priority of performance indices reasonably in different scenarios according to risk variations, showing a good scenario adaptability with safety guaranteed.
Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study
Authors: Chien Chia-Yin , Chang Chun-Wei , Liao Ming-Feng , Chu Chun-Che , Ro Long-Sun , Wu Yih-Ru , Chang Kuo-Hsuan , Chen Chiung-Mei , Kuo Hung-Chou
Published: July 2023

Background

Approximately 10% to 20% of myasthenia gravis (MG) patients have experienced a myasthenic crisis (MC), which contributes to morbidity and mortality. MC triggered by infection is associated with poor outcomes. However, there is a lack of prognostic factors that clinicians can utilize to target interventions for preventing recurrent infection-triggered MC. This study aimed to characterize clinical manifestations, comorbidities, and biochemical profiles associated with recurrent infection-triggered MC in MG patients.

Methods

This retrospective study included 272 MG patients hospitalized with an infection requiring at least 3 days of antibiotics from January 2001 to December 2019. Patients were further stratified into non-recurrent or recurrent infection groups. Clinical features such as gender, age, concomitant diseases, acetylcholine receptor antibodies and biochemical data (including electrolytes and coagulants), muscle strength of pelvic and shoulder girdle, bulbar and respiratory function, management with an endotracheal tube, Foley catheter, or plasmapheresis, duration of hospitalization, and culture pathogens were recorded.

Results

The recurrent infection group was significantly older than the non-recurrent group (median age, 58.5 versus 52.0 years). Pneumonia was the most common infection and Klebsiella pneumoniae was the most common pathogen. The presence of concomitant diabetes mellitus, activated partial thromboplastin time prolongation, the duration of hospitalization, and hypomagnesaemia were independently associated with recurrent infection. The presence of deep vein thrombosis, thymic cancer, and electrolyte imbalances i.e., hypokalemia, and hypoalbuminemia were significantly associated with a risk for infection. The influence of endotracheal intubation, anemia, and plasmapheresis during hospitalization were inconsistent.

Conclusions

The independent risk factors for recurrent infections in MG patients identified in this study include the presence of concomitant diabetes mellitus, hypomagnesaemia, activated partial thromboplastin time prolongation, and longer duration of hospitalization, highlighting the need for targeted interventions to prevent recurrent infections in this population. Further research and prospective studies are warranted to validate these findings and refine interventions for optimizing patient care.
Smoking cessation after diagnosis of COPD is associated with lower all-cause and cause-specific mortality: a nationwide population-based cohort study of South Korean men
Authors: Doo Jang Ho , Kim Sung Min , Park Young Jun , Kim Kyae Hyung , Oh Yun Hwan , Kim Ji Soo , Park Sang Min
Published: July 2023

Background

The most effective way to halt the advancement of COPD is smoking cessation. However, limited data are available on the question of whether quitting smoking within two years after COPD diagnosis reduces the risk of mortality. The goal of our research was to analyze the relationship between quitting smoking after COPD diagnosis and the risks of all-cause and cause-specific mortality, using the Korean National Health Insurance Service (NHIS) database.

Methods

This study included 1,740 male COPD patients aged 40 years or more who had been newly diagnosed within the 2003–2014 time period and had smoked prior to their COPD diagnosis. The patients were categorized into two groups according to their smoking status after COPD diagnosis: (i) persistent smokers (ii) quitters (smoking cessation within two years of COPD diagnosis). Multivariate Cox proportional hazard regression was performed to determine the adjusted hazard ratio (HR) and 95% confidence interval (CI) for both all-cause and cause-specific mortality.

Results

Among 1,740 patients (mean age, 64.6 years; mean follow-up duration, 7.6 years), 30.5% stopped smoking after COPD diagnosis. Quitters gained a 17% risk reduction in all-cause mortality (aHR, 0.83; 95% CI, 0.69–1.00) and a 44% risk reduction in cardiovascular mortality (aHR, 0.56; 95% CI, 0.33–0.95) compared with persistent smokers.

Conclusion

Our study found that patients who quit smoking within two years after COPD diagnosis had lower risks of all-cause and cardiovascular mortality relative to persistent smokers. These results can be used to encourage newly diagnosed COPD patients to stop smoking.
Physical function and activity, pain, and health status in adults with myelomeningocele after orthotic management from childhood: a descriptive study
Authors: Bartonek Åsa , Eriksson Marie
Published: July 2023

Background

Individuals with myelomeningocele (MMC) exhibit neurological deficits below the lesion level involving both motor and sensory functions. Ambulation and functional outcomes in patients offered orthotic management since childhood were investigated.

Methods

Physical function, physical activity, pain, and health status were assessed in a descriptive study.

Results

Of 59 adults with MMC, aged 18–33 years, 12 were in the community ambulation (Ca), 19 in the household ambulation (Ha), six in the non-functional (N-f), and 22 in the non-ambulation (N-a) groups. Orthoses were used by 78% (n = 46), i.e., by 10/12 in the Ca, 17/19 in the Ha, 6/6 in the N-f, and 13/22 in the N-a groups. In the ten-metre walking test, the non-orthosis group (NO) walked faster than those wearing ankle-foot orthoses (AFOs) or free-articulated knee-ankle-foot orthoses (KAFO-Fs), the Ca group faster than the Ha and N-f groups, and the Ha group faster than the N-f group. In the six-minute walking test, the Ca group walked farther than the Ha group. In the five times sit-to-stand test, the AFO and KAFO-F groups required longer than the NO group, and the KAFO-F group longer than the foot orthosis (FO) group. Lower extremity function with orthoses was higher in the FO than the AFO and KAFO-F groups, higher in the KAFO-F than the AFO group, and higher in the AFO group than in those using trunk-hip-knee-ankle-foot orthoses. Functional independence increased with ambulatory function. Time spent in physical recreation was higher in the Ha than the Ca and N-a groups. There were no differences between the ambulation groups in rated pain or reported health status.

Conclusion

The physical function results in persons with MMC improve our understanding of this population’s heterogeneity and shed light on the importance of individualized orthotic management. The similarities between the various ambulatory levels in physical activity, pain, and health status may mirror opportunities to achieve equal results regardless of disability level. A clinical implication of the study is that orthotic management is likely to be beneficial for the patient with MMC of which the majority used their orthoses for most time of the day.
Evaluation of a workplace assessment method designed to improve self-assessment in operative dentistry: a quasi-experiment
Authors: Alfakhry Ghaith , Mustafa Khattab , Ybrode Kamal , Jazayerli Bashar , Milly Hussam , Abohajar Salam , Hassan Hussam , Alhomsi Khaled , Jamous Issam
Published: July 2023

Background

Dental education has placed continued emphasis on self-regulated learning (SRL) and its subprocess, self-assessment. This study set out to evaluate the effectiveness of a novel workplace assessment method in developing trainees’ self-assessment of operative procedures.

Methods

A Direct Observation of Procedural Skills (DOPS) form was modified for the use and measurement of self-assessment. Participants were trained on how to conduct self-assessment using the designed assessment form and its grading rubric. Feedback and feedforward sessions were given to address self-assessment and performance issues. A P-value less than 0.10 was considered significant and the confidence level was set at 90%.

Results

Thirty-two Year 5 dental students with an age mean of 22.45 (SD = 0.8) completed five self DOPS encounters during the clinical operative dentistry module in 2022. The aggregated total deviation (absolute difference) between self-assessment and teacher assessment decreased consistently in the five assessment encounters with a significant mean difference and a medium effect size (P = 0.064, partial Eta squared = 0.069). Participants’ self-assessment accuracy differed from one skill to another and their ability to identify areas of improvement as perceived by teachers improved significantly (P = 0.011, partial Eta squared = 0.099). Participants’ attitudes towards the assessment method were positive.

Conclusions

The findings suggest that the self DOPS method was effective in developing participants’ ability to self-assess. Future research should explore the effectiveness of this assessment method in a wider range of clinical procedures.
Middle Eastern nurses’ views/experiences of work and well-being with the support measures during past disease outbreaks and COVID-19: a qualitative systematic review
Authors: Marair Sara Ahmed , Slater Nigel
Published: July 2023

Background

The potential psychological health impact of pandemics on nurses has been increasingly widely recognised, as have recommendations to establish support measures for nurses’ well-being. Despite the availability of support measures significant number of nurses still experienced burnout and mental distress during Covid-19. Few efforts have been made in the wider literature to understand how nurses experience well-being support or how they perceive it affects their well-being during pandemics. In the Middle East, understanding and exploring well-being support measures during pandemics from nurses’ perspectives has not received significant attention.

Objective

To investigate nurses’ perspectives and experiences of well-being support measures during prior pandemics and the Covid-19 pandemic in the Middle East.

Methods

A systematic qualitative review was undertaken utilising the JBI model as a framework. Searches were carried out in databases comprised CINAHL, MEDLINE, NUsearch Library of Nottingham University and Google Scholar. Moreover, a manual search through reference lists for relevant studies were carried out.

Data extraction and synthesis

Eleven studies were included in the review. The findings from the included qualitative studies were extracted using the JBI-QARI data extraction tool for qualitative research. The results were synthesised using a meta-synthesis in line with the JBI approach.

Results

The included studies yielded an aggregate of 111 findings and were categorised into 14 categories, followed by four synthesised findings. These were: [1] nurses experienced challenges during MERS, yet different strategies were implemented by leaders and nurses to manage these challenges; [2] some well-being support measures were unfulfilled during Covid-19; [3] additional aspects compounded negatively on nurses’ well- being; and [4] nurses showed maturity during Covid-19.

Conclusion

In comparison to prior health emergencies, well-being support measures during Covid-19 were not sufficiently adopted. Nurse policymakers and managers should consider these support measures to correspond with nurses’ needs and explore the contextual factors that affect their implementation.

Trial registration

PROSPERO (CRD42022344005).
The effect of widowhood on depression of caregivers
Authors: Pang Jiahui , Liang Dachuan , Wu Yuanyang
Published: July 2023

Background

It is known that caregivers are more likely to be depressed compared to those without caregiving burden. The disappearance of caregiving burden after widowhood may alleviate depression, but at the same time the diminishment of marital resources caused by widowhood may exacerbate depression. So, what effect does widowhood have on depression among caregivers?, which was valuable for promoting the mental health of caregivers in the context of China’s aging.

Methods

China Health and Retirement Longitudinal Study (CHARLS), a longitudinal data, was selected and the effect of widowhood on depression among middle-aged and elderly caregivers was explored by using Ordinary Least Squares and Propensity Score Matching methods based on 2018 CHARLS data. The channels and subgroup difference were also analyzed.

Results

Widowhood significantly increased CES-D scores of caregivers, and there were higher CES-D scores among women, the middle-aged, rural residents, and those with higher levels of education. Widowhood increased depression of caregivers through reducing personal economic resources, and increasing possibilities to live with children and participate in social activities.

Conclusions

Caregivers who experienced widowhood tend to be depressed and concerted efforts are needed. On the one hand, more social security measures and economic subsidy policy should focus on the middle-aged adults and elderly who experienced widowhood. On the other one hand, it is helpful to relieve depression by providing more social support from society and families to the middle-aged adults and elderly who experienced widowhood.
A de novo heterozygous variant in ACOX1 gene cause Mitchell syndrome: the first case in China and literature review
Authors: Shen Mengxiao , Chen Qian , Gao Yanyan , Yan Hongyu , Feng Shuo , Ji Xinna , Zhang Xue
Published: July 2023

Background

Mitchell syndrome (MITCH) is a rare autosomal dominant hereditary disorder, characterized by episodic demyelination, sensorimotor polyneuropathy and hearing loss. MITCH is caused by heterozygous mutation in the ACOX1 gene, which encodes straight-chain acyl-CoA oxidase, on chromosome 17q25.1.  Only 5 unrelated patients have been reported so far, and no reports from China. Here, we describe the first MITCH case in a Chinese individual.

Case presentation

A 7-year-old girl initially presented with diffuse desquamatory rash at age 3. Her clinical symptoms in order of presentation were diffuse desquamatory rash, gait instability, ptosis with photophobia, hearing loss, abdominal pain, diarrhea, nausea, and dysuria. Genetic analysis demonstrated that the patient carried a heterozygous variant c.710A>G(p.Asp237Ser) in the ACOX1 gene, which can cause MITCH symptoms. This is the first MITCH case with gastrointestinal and urinary tract symptoms. After administrating N acetylcysteine amide (NACA), some symptoms were relieved and the patient’s condition improved.

Conclusion

This is the first MITCH case in the Chinese population, and we expanded the genotype spectrum of it. The p.Asp237Ser may be a mutational hotspot in ACOX1 regardless of race. In terms of diagnosis, patients with recurrent rash, gait instability, and hearing loss with some autonomic symptoms should raise the suspicion of MITCH and proper and prompt treatment should be given.