bluuebunny/crossref_metadata_2025 huggingface dataset:
When theory meets reality- a mismatch in communication: a qualitative study of clinical transition from communication skills training to the surgical ward
Authors: Berglund Leif , von Knorring Johanna , McGrath Aleksandra
Published: October 2023

Background

Communication skills training in patient centered communication is an integral part of the medical undergraduate education and has been shown to improve various components of communication. While the effects of different educational interventions have been investigated, little is known about the transfer from theoretical settings to clinical practice in the context of communication skills courses not integrated in the clinical curriculum. Most studies focus on single factors affecting transfer without considering the comprehensive perspective of the students themselves. The aim of this study is to explore how the students experience the transition to clinical practice and what they perceive as challenges in using patient centered communication.

Methods

Fifteen 4th year medical students were interviewed 3 weeks after the transition from an advanced communication skills course to surgical internship using semi-structured interviews. Qualitative content analysis was used to analyze the interviews.

Results

The analysis resulted in a theme ‘When theory meets reality- a mismatch in communication’. It was comprised of four categories that encompassed the transfer process, from theoretical education, practical communication training and surgical internship to students’ wishes and perceived needs.

Conclusions

We concluded that preparing the students through theoretical and practical training should reflect the reality they will face when entering clinical practice. When educating medical students as a group, their proclivity for perfectionism, high performance environment and achievement-related stress should be taken into consideration. The role of tutors being role models, offering guidance, giving feedback and providing support plays a major part in facilitating transfer of communication skills. To enable transfer to a larger extent, the environment needs to promote patient centeredness and students need more opportunities to practice communication with their patients.
Use of simulation scenarios and vote cards in teaching critical appraisal concepts in evidence-based medicine
Authors: Lin Ashleigh Peng , Chou Yun-Yun , Tam Ka-Wai
Published: October 2023

Background

The most effective method of teaching critical appraisal concepts remains unclear. We used simulation scenarios in a Risk-of-Bias (RoB) 2.0 framework to teach the various biases that may affect randomized controlled trials and assessed whether including this interactive session in an evidence-based medicine (EBM) course for third-year preclinical medical students can optimize their understanding of critical appraisal concepts.

Methods

The session had 13 modules, each corresponding to a particular risk of bias in RoB 2.0. Each module included a simulated scenario, followed by data presentation and a generalized conclusion. The students were subsequently asked to use colored vote cards to indicate whether they agreed, had some concern, or disagreed with the conclusion and to justify their answers. On the basis of the students’ answers, the facilitator debriefed the scenario and addressed the specific bias. In each module, the students were required to demonstrate critical thinking in analyzing the claims and quality of the supporting evidence and in justifying their decisions, thus conceptualizing their understanding of research biases.

Results

We included 306 students across two pilot sessions in spring 2020 and 2021, and the response rate was 97.4%. The students were least able to discern the following problems: baseline imbalances when assessing allocation bias (correct answers: 9.06%), missing outcome data when assessing attrition bias (correct answers: 11.65%), and balanced nonprotocol interventions when assessing performance bias (correct answers: 14.88%). The postcourse survey revealed several aspects of the interactive session that the students appreciated or found challenging.

Conclusion

Preclinical medical students generally appreciated the inclusion of simulation scenarios and vote cards in an EBM course. The use of vote cards facilitated medical students’ understanding of critical appraisal concepts, uncovered areas that they found challenging to understand, and encouraged their active participation. Such interactive sessions should be increasingly included in medical education.
Moral conflicts from the justice and care perspectives of japanese nurses: a qualitative content analysis
Authors: Tsunematsu Kayoko , Asai Atsushi , Kadooka Yasuhiro
Published: October 2023

Background

Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.

Method

Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person’s thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally’s taxonomy.

Results

Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.

Conclusions

The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.
Exploring elderly patients’ experiences and concerns about early mobilization implemented in postoperative care following lumbar spinal surgery: a qualitative study
Authors: Huang Jie , Li Pan , Wang Huiting , Lv Chenxi , Han Jing , Lu Xuemei
Published: October 2023

Background

Given its apparent benefits, early mobilization is becoming increasingly important in spinal surgery. However, the time point at which patients first get out of bed for mobilization after spinal surgery varies widely. Beginning in January 2022, we conducted a study of early mobilization (mobilization within 4 h postoperatively) following multi-segment lumbar decompression and fusion surgery in elderly patients. The study goal was to better understand elderly patients’ perceptions of early mobilization and ultimately contribute to the improvement of elderly patients’ perioperative experiences and quality of life.

Methods

We employed a qualitative descriptive study design involving face-to-face semi-structured interviews. Forty-five consecutive patients were invited, among whom 24 were enrolled and completed the qualitative investigation from February to June 2022. Of these 24 patients, 10 underwent early mobilization (mobilization within 4 h postoperatively) and 14 underwent mobilization at ≥ 24 h postoperatively. Three researchers conducted a 15-question interview the day before each patient’s discharge. The interviews were audio-recorded, and content analysis was used to assess the data.

Results

Six themes regarding the patients’ experiences and concerns about early mobilization were identified: worries, benefits, daily routines, pain, education, and support. The study results revealed the obstacles in early mobilization practice and highlighted the importance of perioperative education on early mobilization.

Conclusions

Clear and explicit guidance on early mobilization and a multidisciplinary mobilization protocol that incorporates a comprehensive pain management plan are essential for effective patient education. These measures may have positive effects on reducing patients’ stress and anxiety regarding postoperative early mobilization.
Pan-cancer analysis of NFE2L2 mutations identifies a subset of lung cancers with distinct genomic and improved immunotherapy outcomes
Authors: Wang Kewei , Li Zixi , Xuan Ying , Zhao Yong , Deng Chao , Wang Meidan , Xie Chenjun , Yuan Fenglai , Pang Qingfeng , Mao Wenjun , Cai Dongyan , Zhong Zhangfeng , Mei Jie
Published: October 2023

Background

Mutations in the KEAP1-NFE2L2 signaling pathway were linked to increased tumorigenesis and aggressiveness. Interestingly, not all hotspot mutations on NFE2L2 were damaging; some even were activating. However, there was conflicting evidence about the association between NFE2L2 mutation and Nrf2-activating mutation and responsiveness to immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC) and other multiple cancers.

Methods

The study with the largest sample size (n = 49,533) explored the landscape of NFE2L2 mutations and their impact response/resistance to ICIs using public cohorts. In addition, the in-house WXPH cohort was used to validate the efficacy of immunotherapy in the NFE2L2 mutated patients with NSCLC.

Results

In two pan-cancer cohorts, Nrf2-activating mutation was associated with higher TMB value compared to wild-type. We identified a significant association between Nrf2-activating mutation and shorter overall survival in pan-cancer patients and NSCLC patients but not in those undergoing ICIs treatment. Similar findings were obtained in cancer patients carrying the NFE2L2 mutation. Furthermore, in NSCLC and other cancer cohorts, patients with NFE2L2 mutation demonstrated more objective responses to ICIs than patients with wild type. Our in-house WXPH cohort further confirmed the efficacy of immunotherapy in the NFE2L2 mutated patients with NSCLC. Lastly, decreased inflammatory signaling pathways and immune-depleted immunological microenvironments were enriched in Nrf2-activating mutation patients with NSCLC.

Conclusions

Our study found that patients with Nrf2-activating mutation had improved immunotherapy outcomes than patients with wild type in NSCLC and other tumor cohorts, implying that Nrf2-activating mutation defined a distinct subset of pan-cancers and might have implications as a biomarker for guiding ICI treatment, especially NSCLC.
Exploring the translational potential of PLGA nanoparticles for intra-articular rapamycin delivery in osteoarthritis therapy
Authors: Ma Jian-Chao , Luo Tingting , Feng Binyang , Huang Zicheng , Zhang Yiqing , Huang Hanqing , Yang Xiao , Wen Jing , Bai Xiaochun , Cui Zhong-Kai
Published: October 2023

Osteoarthritis (OA) is a prevalent joint disease that affects all the tissues within the joint and currently lacks disease-modifying treatments in clinical practice. Despite the potential of rapamycin for OA disease alleviation, its clinical application is hindered by the challenge of achieving therapeutic concentrations, which necessitates multiple injections per week. To address this issue, rapamycin was loaded into poly(lactic-co-glycolic acid) nanoparticles (RNPs), which are nontoxic, have a high encapsulation efficiency and exhibit sustained release properties for OA treatment. The RNPs were found to promote chondrogenic differentiation of ATDC5 cells and prevent senescence caused by oxidative stress in primary mouse articular chondrocytes. Moreover, RNPs were capable to alleviate metabolism homeostatic imbalance of primary mouse articular chondrocytes in both monolayer and 3D cultures under inflammatory or oxidative stress. In the mouse destabilization of the medial meniscus (DMM) model, intra-articular injection of RNPs effectively mitigated joint cartilage destruction, osteophyte formation, chondrocytes hypertrophy, synovial inflammation, and pain. Our study demonstrates the feasibility of using RNPs as a potential clinically translational therapy to prevent the progression of post-traumatic OA.

Graphical abstract
State of the art on the separation and purification of proteins by magnetic nanoparticles
Authors: Le Thanh-Do , Suttikhana Itthanan , Ashaolu Tolulope Joshua
Published: October 2023

The need for excellent, affordable, rapid, reusable and biocompatible protein purification techniques is justified based on the roles of proteins as key biomacromolecules. Magnetic nanomaterials nowadays have become the subject of discussion in proteomics, drug delivery, and gene sensing due to their various abilities including rapid separation, superparamagnetism, and biocompatibility. These nanomaterials also referred to as magnetic nanoparticles (MNPs) serve as excellent options for traditional protein separation and analytical methods because they have a larger surface area per volume. From ionic metals to carbon-based materials, MNPs are easily functionalized by modifying their surface to precisely recognize and bind proteins. This review excavates state-of-the-art MNPs and their functionalizing agents, as efficient protein separation and purification techniques, including ionic metals, polymers, biomolecules, antibodies, and graphene. The MNPs could be reused and efficaciously manipulated with these nanomaterials leading to highly improved efficiency, adsorption, desorption, and purity rate. We also discuss the binding and selectivity parameters of the MNPs, as well as their future outlook. It is concluded that parameters like charge, size, core–shell, lipophilicity, lipophobicity, and surface energy of the MNPs are crucial when considering protein selectivity, chelation, separation, and purity.

Graphical abstract
Influence and optimization strategy of the magnetic field in 1.5 T MR-linac liver stereotactic radiotherapy
Authors: Liu Xin , Yin Peijun , Li Tengxiang , Yin Yong , Li Zhenjiang
Published: October 2023

Objective

To compare intensity reduction plans for liver cancer with or without a magnetic field and optimize field and subfield numbers in the intensity-modulated radiotherapy (IMRT) plans designed for liver masses in different regions.

Methods

This retrospective study included 62 patients who received radiotherapy for liver cancer at Shandong Cancer Hospital. Based on each patient's original individualized intensity-modulated plan (plan1.5 T), a magnetic field-free plan (plan0 T) and static intensity-modulated plan with four different optimization schemes were redesigned for each patient. The differences in dosimetric parameters among plans were compared.

Results

In the absence of a magnetic field in the first quadrant, PTV Dmin increased (97.75 ± 17.55 vs. 100.96 ± 22.78)%, Dmax decreased (121.48 ± 29.68 vs. 119.06 ± 28.52)%, D98 increased (101.35 ± 7.42 vs. 109.35 ± 26.52)% and HI decreased (1.14 ± 0.14 vs. 1.05 ± 0.01). In the absence of a magnetic field in the second quadrant, PTV Dmin increased (84.33 ± 19.74 vs. 89.96 ± 21.23)%, Dmax decreased (105 ± 25.08 vs. 104.05 ± 24.86)%, and HI decreased (1.04 ± 0.25 vs. 0.99 ± 0.24). In the absence of a magnetic field in the third quadrant, PTV Dmax decreased (110.21 ± 2.22 vs. 102.31 ± 26)%, L-P V30 decreased (10.66 ± 9.19 vs. 5.81 ± 3.22)%, HI decreased (1.09 ± 0.02 vs. 0.98 ± 0.25), and PTV Dmin decreased (92.12 ± 4.92 vs. 89.1 ± 22.35)%. In the absence of a magnetic field in the fourth quadrant, PTV Dmin increased (89.78 ± 6.72 vs. 93.04 ± 4.86)%, HI decreased (1.09 ± 0.01 vs. 1.05 ± 0.01) and D98 increased (99.82 ± 0.82 vs. 100.54 ± 0.84)%. These were all significant differences. In designing plans for tumors in each liver region, a total number of subfields in the first area of 60, total subfields in the second zone of 80, and total subfields in the third and fourth zones of 60 or 80 can achieve the dose effect without a magnetic field.

Conclusion

In patients with liver cancer, the effect of a magnetic field on the target dose is more significant than that on doses to organs at risk. By controlling the max total number of subfields in different quadrants, the effect of the magnetic field can be greatly reduced or even eliminated.
Enhanced grading methods for lumbar paraspinal fat infiltration and its prognostic value in predicting lumbar disc herniation
Authors: Wen Gang , Hou Wanmei , Xu Guangwei
Published: October 2023

Background

The simplified 3-grade system for measuring fat infiltration in the paraspinal muscles is widely utilized. In comparing our proposed 4-grade system to the existing 3-grade system, we evaluated its impact on results and particularly its ability to predict disc herniation, ultimately highlighting deficiencies in the latter. The objective of this investigation was to validate the efficacy of our newly proposed semi-quantitative simplified 4-grade system for assessing fat infiltration, as compared to the existing literature-based simplified 3-grade system, in terms of their predictive value for lumbar disc herniation.

Methods

Infiltration of the right and left lumbar multifidus and erector spinae muscles were assessed using a semi-quantitative 3- and 4-grade fat infiltration system on axial magnetic resonance imaging sections at the L3-S1 level in all subjects, with comparison of results between groups. The correlation between these grading systems and lumbar disc herniation was investigated.

Results

The simplified 3-degree system for measuring fat infiltration was not effective in predicting lumbar disc herniation (p > 0.05), while the 4-degree system proved to be useful in predicting it (p < 0.05). In both grading systems, females were found to have a higher risk of lumbar disc herniation than males (p < 0.05), and the risk increased with age and body mass index (BMI) (p < 0.001).

Conclusions

It was observed that using the 4-grade fat infiltration system to determine the level of fat infiltration in the paraspinal muscles is more effective in predicting lumbar disc herniation compared to the 3-grade system. The 4-grade fat infiltration grading system proves to be an efficient semi-quantitative method that can replace the simplified 3-grade system.
Clinical utilization of methylprednisolone in conjunction with tranexamic acid for accelerated rehabilitation in total hip arthroplasty
Authors: Huang Zuqi , Dong Huazhang , Ye Changping , Zou Zhuan , Wan Weiliang
Published: October 2023

Purpose

This study aimed to evaluate the efficacy and safety of combined methylprednisolone (MP) and tranexamic acid (TXA) in promoting accelerated rehabilitation following total hip arthroplasty (THA). We further investigated effective strategies for rapid rehabilitation post-THA.

Methods

Conducted as a randomized controlled trial involving 80 patients, the study allocated subjects into two groups. The control group received saline and TXA, whereas the experimental group was administered with an additional dose of MP. Several clinical parameters, including markers of inflammation, pain, nausea, and coagulation factors, were meticulously assessed in both groups.

Results

It was observed that the group receiving the MP + TXA treatment showcased significant reductions in postoperative levels of CRP and IL-6, as well as an alleviation in pain scores. Furthermore, this group demonstrated lower incidences of postoperative nausea and fatigue, facilitating enhanced hip joint mobility. Interestingly, this group did exhibit blood glucose fluctuations within the first 24 h postoperatively. However, there was no notable difference between the groups concerning transfusion rate, postoperative hospital stay duration, and coagulation profile, and no severe complications were reported.

Conclusion

The findings suggest that the combined administration of MP and TXA can appreciably enhance postoperative recovery, by reducing inflammatory markers, alleviating pain, reducing nausea and fatigue, and improving hip mobility, without leading to an increased risk of severe perioperative complications. This highlights the potential role of this combined therapy in facilitating improved postoperative patient experiences.
Family dyads, emotional labor, and holding environments in the simulated encounter: co-constructive patient simulation as a reflective tool in child and adolescent psychiatry training
Authors: Thomas Isaiah , Benoit Laelia , Duvivier Robbert , de Carvalho Filho Marco Antonio , Martin Andrés
Published: October 2023

Background

Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care, nor does it provide learners with an opportunity to engage with and reflect on these dynamics.

Methods

We organized as an educational opportunity a series of seven observed patient simulation sessions with a cohort of a dozen child and adolescent psychiatrists (eight fellows approaching graduation and four senior educators). In these sessions, we utilized the co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in most sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We approached the data collected during the simulations and their respective debriefings by using thematic analysis informed by a symbolic interactionist approach.

Results

Based on data from the debriefing sessions and longitudinal narratives, we identified four overarching themes: (1) Reflecting on dyadic challenges: role reversal and individuation; (2) Centering the child, allying with the parent, and treating the family system; (3) Ambivalence in and about the parent-child dyad; and (4) Longitudinal narratives and ambivalence over time.

Conclusion

The emotional experience of the simulations, for interviewers and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. These simulated cases called for emotional labor, particularly in the form of creating holding environments; in this way, the simulated encounters and the debriefing sessions became dialogic experiences, in which the patient and provider, parent and child, and learner and instructor could co-construct meaning and foster professional development as reflective practitioners.
The loss of B7-H4 expression in breast cancer cells escaping from T cell cytotoxicity contributes to epithelial-to-mesenchymal transition
Authors: Zhou Linlin , Wu Jichun , Ruan Mei , Xiao Yonglei , Lan Hailin , Wu Qiongwen , Yu Chen-Wei , Zhang Qiuyu
Published: October 2023

Background

B7 homology 4 (B7-H4), a potential target for cancer therapy, has been demonstrated to inhibit T cell cytotoxicity in the early stages of breast cancer. However, B7-H4 manipulating breast tumor immune microenvironment (TIME) in the tumor progression remains unknown.

Methods

We engineered T cells with B7-H4-specific chimeric antigen receptors (CARs) and performed a T cell co-culture assay to characterize B7-H4 expression level in breast cancer cells escaping from T cell cytotoxicity. We generated B7-H4 knockout (KO) and overexpression (OE) breast cancer cells to determine the epithelial-to-mesenchymal transition (EMT) and stemness characteristics in vitro and in vivo, including tumor proliferation, migration, metastasis and chemoresistance. The Cancer Genome Atlas breast cancer database was accessed to investigate the correlation between B7-H4 expression levels and EMT characteristics in patients with breast cancer.

Results

Our result found that B7-H4 expression level was significantly reduced in a subset of breast cancer cells that escaped from the cytotoxicity of B7-H4 CAR-T cells. Compared with wild type cells, B7-H4 KO cells prompt EMT and stemness characteristics, including migration, invasion and metastasis, and OE cells vice versa. The increase in H3K27me3 in KO cells confirmed the epigenetic reprogramming of cancer stem cells. The IC50 of doxorubicin or oxaliplatin significantly increased in KO cells, which was in agreement with a decrease in OE cells. Moreover, a trend of downregulated B7-H4 from stage I to stage II breast cancer patients indicates that the low-expressing B7-H4 breast cancer cells escaping from TIME have spread to nearby breast lymph nodes in the cancer progression.

Conclusions

Our study illuminates the novel role of renouncing B7-H4 in breast cancer cells through immune escape, which contributes to EMT processes and provides new insights for breast cancer treatments.
Exosomes derived from mesenchymal stem cells primed with disease-condition-serum improved therapeutic efficacy in a mouse rheumatoid arthritis model via enhanced TGF-β1 production
Authors: Choi Eun Wha , Lim I.-Rang , Park Ji Hong , Song Jiwoo , Choi Bongkum , Kim Sungjoo
Published: October 2023

Backgrounds

Rheumatoid arthritis (RA) is a chronic and systemic autoimmune disease characterized by synovial inflammation-mediated progressive destruction of the cartilage and bone, resulting in reduced quality of life. We primed human telomerase reverse transcriptase-overexpressing immortalized human adipose tissue-derived mesenchymal stem cells (iMSCs) with serum derived from a non-human primate RA model and studied the immunomodulatory ability of exosomes obtained from primed iMSCs.

Methods

After immunophenotyping, nanoparticle tracking analysis, and in vitro functional tests, Dulbecco’s phosphate-buffered saline (dPBS, Group C), exosomes derived from the supernatant of iMSCs (Exo-FBS, Group E), exosomes derived from the supernatant of iMSCs primed with RA serum (Exo-RA, Group F), and methotrexate (Group M) were administered in collagen-induced arthritis (CIA) model mice. dPBS was administered to the normal (N) group for comparison (n = 10/group).

Results

Exo-RA had a significantly higher number of exosomes compared to Exo-FBS when measured with nanoparticle tracking analysis or exosome marker CD81, and Transforming growth factor-β1 amounts were significantly higher in Exo-RA than in Exo-FBS. When Exo-FBS or Exo-RA was administered to the collagen-induced arthritis model, serum interleukin (IL)-4 and the proportion of Th2 (CD4+CD25+GATA3+) and M2 (CD11c − CD206+ of CD45+CD64+) cells were significantly increased compared to the control group. Furthermore, Exo-RA could alleviate cartilage damage by significantly lowering the concentrations of proinflammatory cytokines such as tumor necrosis factor-α, keratinocyte chemoattractant, and IL-12p70.

Conclusion

Exosomes derived from disease-condition-serum-primed iMSCs ameliorated cartilage damage in a RA model by enhancing TGF-β1 production, inducing Th2 and M2 polarization and lowering proinflammatory cytokines, TNF-α, KC, and IL-12p70 in the host. Patient-derived serum can be used as an iMSC priming strategy in iMSC-derived exosome treatment of RA.
Direction-of-arrival and power spectral density estimation using a single directional microphone and group-sparse optimization
Authors: Tengan Elisa , Dietzen Thomas , Elvander Filip , van Waterschoot Toon
Published: October 2023

In this paper, two approaches are proposed for estimating the direction of arrival (DOA) and power spectral density (PSD) of stationary point sources by using a single, rotating, directional microphone. These approaches are based on a method previously presented by the authors, in which point source DOAs were estimated by using a broadband signal model and solving a group-sparse optimization problem, where the number of observations made by the rotating directional microphone can be lower than the number of candidate DOAs in an angular grid. The DOA estimation is followed by the estimation of the sources’ PSDs through the solution of an overdetermined least squares problem. The first approach proposed in this paper includes the use of an additional nonnegativity constraint on the residual noise term when solving the group-sparse optimization problem and is referred to as the Group Lasso Least Squares (GL-LS) approach. The second proposed approach, in addition to the new nonnegativity constraint, employs a narrowband signal model when building the linear system of equations used for formulating the group-sparse optimization problem, where the DOAs and PSDs can be jointly estimated by iterative, group-wise reweighting. This is referred to as the Group-Lasso with$$l_1$$l1-reweighting (GL-L1) approach. Both proposed approaches are implemented using the alternating direction method of multipliers (ADMM), and their performance is evaluated through simulations in which different setup conditions are considered, ranging from different types of model mismatch to variations in the acoustic scene and microphone directivity pattern. The results obtained show that in a scenario involving a microphone response mismatch between observed data and the signal model used, having the additional nonnegativity constraint on the residual noise can improve the DOA estimation for the case of GL-LS and the PSD estimation for the case of GL-L1. Moreover, the GL-L1 approach can present an advantage over GL-LS in terms of DOA estimation performance in scenarios with low SNR or where multiple sources are closely located to each other. Finally, it is shown that having the least squares PSD re-estimation step is beneficial in most scenarios, such that GL-LS outperformed GL-L1 in terms of PSD estimation errors.
Orbital inflammatory pseudotumor: new advances in diagnosis, pathogenesis, and treatment
Authors: Fang Yenan , Shen Bingyan , Dai Qin , Xie Qiqi , Wu Wencan , Wang Min
Published: October 2023

Orbital inflammatory pseudotumor (OIP) is a benign, non-specific inflammatory disorder that commonly occurs in middle-aged adults and is usually unilateral but can occur bilaterally. Its clinical manifestations have tremendous clinical heterogeneity and vary according to the site of infiltration and the degree of lesions, including orbital pain, swelling, diplopia, proptosis, restricted eye movement, and decreased visual acuity. Clinical features, Image characteristics and pathological examinations often need to be evaluated to confirm the diagnosis. Currently, there is no systematic research on the pathogenesis of OIP, which may be related to immunity or infection. The first-line treatment is glucocorticoids. Radiotherapy, immunosuppressants, and biologics can be considered for treatment-resistant, hormone-dependent, or intolerant patients. In this review, we aim to summarize and focus on new insights into OIP, including new diagnostic criteria, pathogenesis, and discoveries in new drugs and treatment strategies. In particular, we highlight the literature and find that T cell-mediated immune responses are closely related to the pathogenesis of OIP. Further exploration of the mechanism and signaling pathway of T cells in the immune process will help to identify their therapeutic targets and carry out targeted therapy to treat refractory OIP and reduce the side effects of traditional treatments.
China Trends in Physical Inactivity from 2013 to 2019: An Analysis of 4.23 Million Participants
Authors: TU WEN-JUN , SUN HUAXIA , YAN FENG , FAN YANGYI , YI ZHIQIANG , LI JI-LAI , ZENG XIANWEI
Published: October 2023

Introduction

This study aimed to evaluate recent trends in physical inactivity prevalence by sociodemographic characteristics and the province of China’s residence between 2013 and 2019.

Methods

The study included 4,229,616 participants 40 yr or older from 414 geographically defined localities in China during the 7-yr period. Self-reported total physical inactivity was collected to determine the standardized prevalence of physical inactivity. Logistic regression analysis was used to examine the association between physical inactivity and stroke risk, obtaining odds ratios (OR) and 95% confidence intervals (CI).

Results

Results showed that the standardized prevalence of physical inactivity increased from 22.12% (95% CI = 21.99%–22.45%) in 2013 to 28.79% (95% CI = 28.48%–29.19%) in 2019, with an absolute difference of 6.67% (95% CI = 6.15% to 7.16%) and a yearly increase rate of 5.03% (95% CI = 4.85% to 5.21%). In 2019, physical inactivity was higher in female and rural participants (female = 29.55%, rural = 29.46%) than in male and urban participants (male = 28.03%, urban = 28.26%). The prevalence of physical inactivity also varied by race/ethnic groups, with the highest prevalence observed among Uyghur (47.21%) and the lowest among Yizu (14.84%). Additionally, the prevalence of physical inactivity differed by province, ranging from 14.44% in Beijing to 50.09% in Tianjin in 2019. Multivariate analyses showed that physical inactivity was associated with a higher risk of stroke (OR = 1.17, 95% CI = 1.12–1.21, P < 0.001).

Conclusions

In conclusion, our study found an overall increase in physical inactivity prevalence among Chinese adults ≥40 yr old from 2013 to 2019, with significant variation across regions, sex, ages, and race/ethnic groups.
Vergleich der langfristigen haltbarkeit von bioprothesen und der klinischen ergebnisse zwischen TAVI und AKE bei patienten mit schwerer symptomatischer aortenklappenstenose und niedrigem oder intermediärem operationsrisiko
Authors: Αλατάκη Σοφία
Published: October 2023

Αυτή η έρευνα έχει ως στόχο να μελετήσει την εμφάνιση εκφυλιστικών αλλοιώσεων και τα μακροπρόθεσμα κλινικά αποτελέσματα ασθενών με σοβαρή συμπωματική στένωση αορτικής βαλβίδας, οι οποίοι έχουν υποβληθεί σε διακαθετηριακή εμφύτευση αορτικής βαλβίδας (TAVI) ή χειρουργική αντικατάσταση αορτικής βαλβίδας (ΑΚΕ). Πρόκειται για μια ανάλυση propensity score matched ασθενών που υποβλήθηκαν σε TAVI (n=216) και AKE (n=216) μεταξύ 2008 και 2012. Μακροπρόθεσμα υπερηχοκαρδιογραφικά ευρήματα και κλινικά αποτελέσματα αξιολογήθηκαν τουλάχιστον έξι χρόνια μετά από TAVI/ΑΚΕ. Η εμφάνιση σοβαρών εκφυλιστικών αλλοιώσεων των βιολογικών προθέσεων παρατηρήθηκε σε 10.5% και 4.5% στους TAVI- και ΑΚΕ-ασθενείς αντίστοιχα, ένα αποτέλεσμα ωστόσο χωρίς στατιστική σημαντικότητα (hazard ratio [HR] 2.5; 95% confidence interval [CI] 0.7 to 8.3; p = 0.159). Αυτό το αποτέλεσμα ήταν επακόλουθο κυρίως της υψηλότερης εμφάνισης μέσης κλίσης πίεσης ≥40 mm Hg (7.0 vs 3.4%; p = 0.327) και ανεπάρκειας αορτικής βαλβίδας (4.7% vs 0%; p = 0.058) στους ΤΑVΙ-ασθενείς. Οι ασθενείς μετά από TAVI είχαν χαμηλότερο ποσοστό επιβίωσης στα έξι χρόνια σε σύγκριση με τους ασθενείς μετά από ΑΚΕ (40.7% vs 59.6%, respectively, p <0.001, HR 2.15; 95% CI 1.45 to 3.20). Το ποσοστό εμφάνισης καρδιαγγειακών επεισοδίων (14.4% TAVI vs 18.2% SAVR, HR 0.8; 95% CI 0.4 to 1.3; p = 0.347) και εμφύτευσης μόνιμου βηματοδότη (PPI; 16.0% TAVI vs 9.2% SAVR, p = 0.234) ήταν παρόμοιο μεταξύ των δύο ομάδων. Συμπερασματικά, η εμφάνιση μετρίων και σοβαρών εκφυλιστικών αλλοιώσεων των αορτικών βιολογικών προθέσεων δεν είχε στατιστικά σημαντική διαφορά μεταξύ των δύο ομάδων. Η εμφάνιση μέτριας ή σοβαρής ανεπάρκειας αορτικής βαλβίδας ήταν στατιστικά σημαντικά υψηλότερη στους TAVΙ- ασθενείς με την χρήση των βαλβίδων πρώτης γενιάς. Η αναγκαιότητα για εκ νέου χειρουργείο ή διακαθετηριακή αντικατάσταση ήταν χαμηλή και στις δύο ομάδες. Το ποσοστό επιβίωσης ήταν χαμηλότερο μετά από ΤΑVΙ, ενδεχομένως λόγω αδυναμίας και πολυνοσηρότητας των ΤΑVΙ- ασθενών. Το ποσοστό εμφάνισης καρδιαγγειακών επεισοδίων και εμφύτευσης μόνιμου βηματοδότη ήταν παρόμοιο μεταξύ των δύο ομάδων.
Exploring the anti-aging potential of natural products and plant extracts in budding yeast Saccharomyces cerevisiae: A review
Authors: Alugoju Phaniendra , Palanisamy Chella Perumal , Anthikapalli Naga Venkata Anusha , Jayaraman Selvaraj , Prasanskulab Anchalee , Chuchawankul Siriporn , Dyavaiah Madhu , Tencomnao Tewin
Published: October 2023

Aging is an inevitable multifactorial process associated with a decline in physiological functioning accompanied by a predisposition to a plethora of chronic ailments. Emerging anti-aging research studies using different model organisms have enabled scientists to uncover underlying molecular mechanisms of aging. Notably, the budding yeast Saccharomyces cerevisiae has been, and continues to be an indispensable model organism in the field of biomedical research for discovering the molecular causes of aging as well as the anti-aging potential of natural/synthetic compounds and plant extracts. Besides its ease of handling, genetic manipulation, and relatively inexpensive to grow, the budding yeast has preserved nutritional signaling pathways (such as the target of rapamycin (TOR)-Sch9 and the Ras-AC-PKA (cAMP-dependent protein kinase pathways) and two distinct aging paradigms such as chronological life span (CLS) and replicative life span (RLS). In the present review, we have explored the anti-aging properties of several natural products and phytoextracts and their underlying molecular mechanism of action on the CLS and RLS of yeast S. cerevisiae.
Application of the Concept of Category Management to Improve the System for the Sale of Goods and Services in the Field of Medical Services
Authors: Kucherenko Anna , Shafigullin D.
Published: October 2023

The article describes the practical applicability of the concept of category management to improve the management of goods and services. Through consideration of some category management tools (in particular, the distribution of categories by roles), the practical benefits of applying the concept of "category management" in the assortment policy of companies have revealed. The practical experience of applying the approach to the field of medical services has studied. A new approach to product categories has proposed – the transition from the traditional classification of services by medical specialty to a client-oriented approach. The new approach involves the transition from a professionally oriented classification using medical terms to the definition of categories according to the types of work performed for users of medical services. This approach is useful when planning marketing activities to attract customers, as it implies a transition to product categories that are understandable to the consumer.
ESG technologies and risks in Russia and the world. Modern methods of management
Authors: Garnov Andrey
Published: October 2023

The article is devoted to the analysis of the transformation of the view on the development of society in the direction of creating a balanced model of interaction between business and all stakeholders in order to save the planet for future generations. One of the main goals of a business is to make a profit. However, modern companies understand that in the long run, basing a business on profit maximization alone is unwise. After all, a significant decrease in resources and a negative impact on the environment will certainly lead to problems. In light of these changes, many companies are rethinking their strategy and implementing socially responsible approaches in their activities. They begin to take into account the interests of a wide range of stakeholders: customers, investors, employees, the state and society as a whole. This means that businesses need to be more transparent and accountable to their customers by offering them quality products and services. In addition, companies attract the attention of the public by demonstrating their social activity and concern for society - by organizing charity events, sponsoring social projects and taking part in solving public problems. Such changes help companies strengthen their image and improve their reputation, which contributes to increased trust from customers and the public at large. Moreover, this approach helps attract new investors and partners who demand social responsibility and high standards from companies. A key factor for the successful implementation of socially responsible approaches is changing the culture within the company. Leaders must ensure that all employees share the values of the company and take part in its social and environmental initiatives. Implementing socially responsible practices also requires investing in clean technology and equipment to help companies reduce their environmental footprint and use resources efficiently. Social responsibility is becoming one of the key factors for successful business development. It helps companies create a sustainable development model, meet the needs of stakeholders and preserve the resources of our planet for future generations. The introduction of socially responsible approaches is not only ethically correct, but also beneficial for the business as a whole.
On the Need to Use Digital Marketing in Enterprises in the Field of Security Systems
Authors: Malardyrova Victoria
Published: October 2023

The article reveals digital marketing; analyses the sphere of security systems of the Republic of Sakha (Yakutia) and identifies the main problems in it. It is proposed to turn to digital marketing to enhance the promotion of enterprises in the B2B market. The author describes the preliminary results of the work through monitoring. Future prospects are concluded, confirming the effectiveness of digital marketing.
The position statement of the Working Group on the treatment of post-traumatic stress disorders in adults
Authors: Koweszko Tytus , de Barbaro Bogdan , Izydorczyk Bernadetta , Mastalerz-Migas Agnieszka , Samochowiec Jerzy , Szulc Agata , Kowalska Adrianna , Wachowska Katarzyna , Gałecki Piotr
Published: October 2023

Zespół stresu pourazowego (ang. post-traumatic stress disorder, PTSD) to zaburzenie psychiczne występujące po udziale w traumatycznym wydarzeniu, takim jak doświadczenie klęski żywiołowej, udział w wypadku, zamach terrorystyczny lub konflikt zbrojny, bycie ofiarą gwałtu, tortur lub przemocy fizycznej, doznanie urazu lub znalezienie się w innej sytuacji niosącej wysokie ryzyko utraty życia. Ofiara traumy nie zawsze musi być w pozycji osoby bezpośrednio zagrożonej fizyczną krzywdą. Zaburzenie może rozwinąć się także na skutek ostrej reakcji na stres spowodowanej udziałem w sytuacji, w której to inny człowiek doznaje cierpienia na tyle niewyobrażalnego, że dalsze normalne życie świadka staje się niemożliwe. Chorzy często są przekonani, że bezpowrotnie utracili zdolność wcześniejszej egzystencji. W skali globalnej zespół stresu pourazowego stanowi coraz częściej rozpoznawane zaburzenie. Można przewidywać, że w Europie w związku z trwającą wojną na Ukrainie oraz kryzysem migracyjnym częstość występowania ciężkich zaburzeń związanych ze stresem traumatycznym będzie systematycznie rosła. Na przestrzeni ostatnich lat nastąpił znaczny postęp wiedzy i rozwoju metod służących przeciwdziałaniu PTSD. Potwierdzone empirycznie formy leczenia obejmują oddziaływania psychoterapeutyczne i farmakoterapeutyczne. Zaproponowane rekomendacje zostały opracowane przez zespół ekspertów z obszaru psychiatrii, psychologii klinicznej, psychoterapii i medycyny rodzinnej w celu przedstawienia wytycznych dotyczących postępowania terapeutycznego w praktyce lekarskiej i psychologicznej. Stanowisko grupy roboczej zostało opracowane zgodnie z wiedzą opartą na dowodach (evidence-based practice) w ramach trzyetapowego postępowania obejmującego: przegląd literatury, dyskusję dotyczącą zagadnienia oraz wypracowanie wspólnego stanowiska eksperckiego.
INDO–FRENCH DEFENCE PARTNERSHIP AND REGIONAL SECURITY BALANCE IN SOUTH ASIA
Authors: Bharti Mukesh Shankar
Published: October 2023

The article aims to describe the regional security challenges and major threats for India in South Asia. Since 1947, India has been suffering from external security threats such as a form of proxy warfare and terrorism from neighbouring countries. To this purpose, the article also examines recurring issues where India has major border issues with China in the Himalayan terrain to the Eastern region. India has been facing bigger security threats from China and Pakistan in the South Asia region. This article looks at defence cooperation between India and France through the prism of India’s serious security threats in the South Asian region. India’s soft power policy is reflected in a neo-realist approach and expanded by its long-standing defence cooperation with France. Therefore, India has been receiving support from the French government whenever the country needs defence equipment and other assistance. The article uses case studies and discourse analysis methods to answer the questions and draw the main findings and conclusions of the study. Finally, as a result of the study, India’s serious security threats in the South Asian region are pushing the country to purchase defence equipment from France. The relationship between India and France is strengthening bilateral cooperation at a broader level and shaping a strong strategic partnership by uniting in South Asia and the Indo-Pacific as well.
Éticas da identidade e éticas do convívio: a compatibilidade entre visões éticas e o estado democrático de direito/Ethics of identity and ethics of conviviality: the compatibility between ethical views and the democratic rule of law
Authors: Rodrigo Rodriguez José
Published: October 2023

O objetivo deste texto é oferecer uma classificação de algumas visões éticas em circulação no debate contemporâneo capaz de identificar quais delas são compatíveis ou não com o conceito e com as instituições do estado democrático de direito. O texto parte da análise de alguns modelos de pensamento presentes em visões éticas animalistas, feministas e decoloniais para identificar problemas de compatibilidade e problemas de caricatura, ou seja, quais destas visões desenvolvem tensões e incompatibilidades com ou oferecem visões caricaturais do estado democrático de direito. A partir destas reflexões, o texto propõe a distinção entre éticas da identidade e éticas do convívio e esboça as linhas gerais de um modelo institucional multinormativo que permita que ambas convivam democraticamente na mesma comunidade política.
Caring for a person living with dementia: identifying and assessing a carer's needs
Authors: Dening Karen Harrison
Published: October 2023

As the population ages and so do the numbers of people with dementia, there will also be an increase in the number of unpaid family carers. Estimates suggest that one in three of us will become a carer for someone with dementia during our lifetime, some caring for more than one person diagnosed with dementia in their family. There are currently over 700 000 people in the UK acting as primary unpaid carers for people with dementia, all of whom make a substantial contribution, both financially and physically, to their care and support. Carers of people with dementia can experience high levels of carer burden and distress as well poor health and wellbeing due to their caring roles. However, they can sometimes be less than visible to health and social care services as they may not identify themselves as carers or their needs may not be easily recognised which leaves them at risk. Identifying people in caring roles and assessing their needs are the first two steps in supporting them. Community nurses are well placed to do this within their roles.
Healing hearts, strengthening lives
Authors: Moses Keji
Published: October 2023

Keji Moses, founder and CEO of Mayah's Legacy, discusses the charity's work in supporting women and families after pregnancy loss