bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical importance of laboratory biomarkers in liver fibrosis
Authors: Banys Valdas , Aleknavičiūtė-Valienė Goda
Published: September 2022

Hepatic cirrhosis is a major health problem across the world, causing high morbidity and mortality. This disease has many etiologies, yet the result of chronic hepatic injury is hepatic fibrosis causing cirrhosis and hepatocellular carcinoma, as the liver’s architecture is progressively destroyed. While liver biopsy is currently the gold standard for fibrosis staging, it has significant disadvantages, leading to a growing interest in non-invasive markers. Direct biomarkers – hyaluronic acid, laminin, collagen type III N-peptide, type IV collagen and cholylglycine – are new and rarely applied in routine clinical practice. This is the case primarily because there is no general consensus regarding the clinical application and effectiveness of the individual biomarkers. The usage of these markers in routine clinical practice could be advantageous for patients with liver fibrosis, requiring a simple blood test instead of a biopsy. The former option would be especially attractive for patients who are contraindicated for the latter. This review summarizes recent findings on direct biomarkers of liver fibrosis and highlights their possible applications and potential benefit for liver fibrosis diagnostics and/or staging.
Urinary brain-derived neurotrophic factor and nerve growth factor as noninvasive biomarkers of overactive bladder in children
Authors: Stemberger Maric Lorna , Kozmar Ana , Lenicek Krleza Jasna , Rogic Dunja , Colic Merima , Abdovic Slaven
Published: September 2022

IntroductionOveractive bladder (OAB) is the most common urinary disorder and the leading cause of functional daytime intermittent urinary incontinence in children. The aim of this study was to determine whether urinary brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) concentrations, normalized to urine creatinine, could be used as biomarkers for diagnosis and treatment monitoring of OAB in children.
Materials and methodsUrine samples of 48 pediatric patients with OAB were collected at the start of anticholinergic therapy (baseline), at follow-up visits (3 and 6 months), and from 48 healthy controls. Urinary BDNF and NGF concentrations were determined by ELISA method (Merck, Darmstadt, Germany) and Luminex method (Thermo Fisher Scientific, Waltham, USA). Differences of frequency between quantifiable analyte concentrations between subject groups were determined using Fisher’s exact test.
ResultsThere was no statistically significant difference between quantifiable analyte concentrations between patients at baseline and the control group for BDNF and NGF by either the ELISA or Luminex method (P = 1.000, P = 0.170, P = 1.000, and P = N/A, respectively). There was a statistically significant difference between quantifiable BDNF by the ELISA method between patients at baseline and complete success follow-up (P = 0.027), while BDNF by Luminex method and NGF by both methods were not statistically significant (P = 0.078, P = 0.519, and P = N/A, respectively).
ConclusionsThis study did not demonstrate that urinary BDNF and NGF concentrations, can be used as biomarkers for diagnosis and therapy monitoring of OAB in children.
It Takes Two Flints to Make a Fire: Multitask Learning of Neural Relation and Explanation Classifiers
Authors: Tang Zheng , Surdeanu Mihai
Published: September 2022

We propose an explainable approach for relation extraction that mitigates the tension between generalization and explainability by jointly training for the two goals. Our approach uses a multi-task learning architecture, which jointly trains a classifier for relation extraction, and a sequence model that labels words in the context of the relations that explain the decisions of the relation classifier. We also convert the model outputs to rules to bring global explanations to this approach. This sequence model is trained using a hybrid strategy: supervised, when supervision from pre-existing patterns is available, and semi-supervised otherwise. In the latter situation, we treat the sequence model’s labels as latent variables, and learn the best assignment that maximizes the performance of the relation classifier. We evaluate the proposed approach on the two datasets and show that the sequence model provides labels that serve as accurate explanations for the relation classifier’s decisions, and, importantly, that the joint training generally improves the performance of the relation classifier. We also evaluate the performance of the generated rules and show that the new rules are a great add-on to the manual rules and bring the rule-based system much closer to the neural models.
‘Activism is not a Crime’: Confronting Counterinsurgency in the Filipino Diaspora
Authors: Sales Joy
Published: September 2022

This article historicizes the transnational counterinsurgency that the U.S.-Philippine governments have conducted against diasporic Filipino/a/x activists. In examining the period of the Cold War to the early 2020s, it makes a case for recognizing existing continuities of counterinsurgency tactics targeted at Filipinos in the United States, such as extradition, deportation, surveillance, and assassination. The Philippine state’s resort to red-baiting during the Cold War and contemporary “red-tagging” has aimed at the elimination of communism and terrorism at home and beyond its national borders, at the expense of human rights. This long history of counterinsurgency also highlights the acceleration and formalization of diasporic Filipino organizations dedicated to promoting democracy in the Philippines during the period of martial law under President Ferdinand E. Marcos, showing how diasporic Filipinos organized opposition not only to dictatorship, but also U.S. support for violent regimes. The transnational opposition against Marcos and then President Rodrigo R. Duterte has characterized diasporic Filipinos as a primary component of democratic movements in both the United States and the Philippines who have linked domestic racial oppression to U.S. imperialism and state fascism in the Philippines.
‘Charging’ a Confirmation Sermon with Suspense
Authors: Norheim Bård Eirik Hallesby
Published: September 2022

The feeling of boredom during a speech is not a new phenomenon, but in a late modern information society this challenge is intensified. This article explores what sort of rhetorical opening strategy which may ‘charge’ a sermon with an appropriate suspense to help the congregation to remain attentive throughout the sermon. The article analyses a selective, digital sample of video recorded confirmation sermons from Church of Norway confirmation services in 2020. Drawing on theories on suspense, attention, and boredom, the article uses classical rhetorical theory on the different styles of speech to suggest three possible rhetorical opening strategies for a preacher who wants to ‘charge’ a (confirmation) sermon with a relevant suspense, that of the teacher, the poet, and the prophet.
The Managed Body and Heart: An Empirical Study on School Management and Teachers’ Emotional Labor in Chinese Counties
Authors: Hu Penghui , Du Shasha
Published: September 2022

County school education has a profound impact on social class upgrading in China’s rural areas, where teachers are the core actors in this field yet have not been paid enough attention. This study, through ethnography, focuses on county teachers as subjective actors who are embedded in the background of Chinese educational bureaucratic management mode and educational marketization. Under a pressure of college enrolment rates and students’ quality degrading in county high schools, the teachers are facing the situation of being managed both mentally and physically. Teachers’ mind has been highly influenced by Daily Performance, College Entrance Examination Quality Assessment and Title Evaluation Systems. Meanwhile, they have to obey the systems of Punching-in and Homework Review Registration & Supervision to maintain physical presence. However, without hope, these lead to the loss of professional passion of teachers, and teachers show a state of negative emotional labor.
The Relationship between Authentic Leadership and Teacher Knowledge Sharing in China: The Mediating Role of Teachers’ Social-Emotional Competence
Authors: Zhang Wangying
Published: September 2022

Knowledge sharing among teachers is a core resource for building the competitiveness of school organizations. At present, school administrators pay more and more attention to building a knowledge-sharing platform for teachers and try to improve the level of knowledge sharing among teachers. However, in reality, the knowledge sharing among teachers in Chinese primary and secondary schools is still at a low level. In the school context, it is worth exploring how to effectively stimulate teachers’ knowledge-sharing. This study builds a research framework based on Bandura’s reciprocal determinism, and the results of an empirical study of 628 teachers in Beijing, China, found that (1) principal authentic leadership significantly positive predicted teacher knowledge sharing; (2) teachers’ social-emotional competence played a significant role in promoting teacher knowledge sharing; (3) teachers’ social-emotional competence played a partially mediating role between authentic leadership and teacher knowledge sharing, the mediating effect was 31.81%.
A new species of the congrid eel genus Bathycongrus (Order Anguilliformes) from eastern Taiwan
Authors: HUANG JIAN-FU , HO HSUAN-CHING , CHEN HONG-MING , CHAN TIN-YAM
Published: September 2022

A new species of the congrid eel genus Bathycongrus is described on the basis of three specimens collected from the deep waters of eastern Taiwan. Bathycongrus melanostomus sp. nov., belongs to the few vertebrae species complex and is distinct in having a short and broad snout; a much reduced caudal fin; abdomen, mouth cavity and gill chamber blackish; small conical blunt teeth on vomer forming an elongate patch; total vertebrae 133–135, and total lateral-line pores 108–109.
Gymnothorax poikilospilus, a new moray eel (Teleostei: Anguilliformes: Muraenidae) from Penghu Islands, western Taiwan
Authors: HUANG WEN-CHIEN , LOH KAR-HOE , CHEN HONG-MING
Published: September 2022

Gymnothorax poikilospilus sp. nov. is described based on two specimens collected from Penghu Islands, western Taiwan. It is a medium-sized brown moray that body covered with several rows of inconspicuous large dark brown patches on the back of body and dorsal fin. It has slightly elongated and arched jaws similar to the common characteristic of the genus Enchelycore Kaup, but the dentition supports it belongs to typical morays of the genus Gymnothorax Bloch. The new species can be distinguished from other similar Indo-Pacific brown morays by the combination of dentition, vertebral formula, and morphometric measurements. Molecular analyses based on 612 bp of mitochondrial COI gene also support it as a distinct species.
Four new species of the frogmouth genus Chaunax (Lophiiformes: Chaunacidae) from Taiwan and the Philippines
Authors: HO HSUAN-CHING , MA WEN-CHUN
Published: September 2022

Four new species of the genus Chaunax found in Taiwan and the Philippines are described. Chaunax albatrossae sp. nov. belongs to the C. abei species group and is distinct from its congeners in having a dark gray mouth cavity, a dark brown to black gill chamber and gill rakers and skin covered with only short, simple spinules. Three new species belong to the C. fimbriatus species group: Chaunax erythraeus sp. nov. is distinct in having a uniformly pinkish-red body and an entirely black gill chamber; Chaunax obscurus sp. nov. is distinct in having a dark gray mouth cavity and orange-red marbling on the dorsal surface that fades after fixation; and Chaunax viridiretis sp. nov. is distinguished by its green reticulate pattern with some small, bright-white patches on the dorsal surface. The diagnostic characters used to identify the chaunacids are summarized and a key to all Chaunax species found in Taiwan and adjacent waters is provided.
Engyprosopon keliaoense, a new lefteye flounder (Teleostei: Bothidae) from Taiwan
Authors: AMAOKA KUNIO , HO HSUAN-CHING
Published: September 2022

A new bothid flounder, Engyprosopon keliaoense sp. nov., is described on the basis of 4 specimens collected from off southwestern Taiwan. The new species belongs to these congeners with a pair of black botches on the caudal fin and is most similar to E. grandisquama (Temminck & Schlegel). It can be separated from the latter by having smaller upper and lower eyes, narrower interorbital width, shorter pectoral fin on the ocular side, and more scales in the lateral line. Investigation on Rhombus grandisquama and its junior synonyms revealed that Rhombodoichthys spilurus Günther and Rhombus poecilurus Bleeker are retained as junior synonyms of E. grandisquama, whereas Rhombodoichthys spiniceps Macleay and Scaeops orbicularis Jordan & Seale are now excluded from the synonymy of E. grandisquama.
A new species of deep-water tonguefish (Pleuronectiformes: Cynoglossidae: Symphurus) from the western North Pacific Ocean
Authors: LEE MAO-YING
Published: September 2022

A new species of symphurine tonguefish, Symphurus oxyrhynchus sp. nov., is described from two specimens captured in deep waters (718–852 m) off Taiwan and Japan. This new species is distinguished from congeners by the following combination of characters: predominant 1–2–2–1–2 pattern of interdigitation of dorsal pterygiophores and neural spines, 14 caudal-fin rays, 93 dorsal-fin rays, 80–81 anal-fin rays, 9 abdominal and 52 total vertebrae, 5 hypurals, small eye (7.5–8.0 % HL) with relatively large pupil (78–85% ED), moderately large scales (87–89 scales in longitudinal series, 31 scales in transverse row), snout square and projecting anteriorly, ocular side uniformly yellow to dark brown with intense pigmentation on body areas overlying dorsal- and anal-fin pterygiophores, outer surface of opercle on both sides bluish black, general background coloration shared the same coloration in blind side, including more intense on body areas overlying dorsal and anal pterygiophores. Symphurus oxyrhynchus sp. nov. is a rare species, only two specimens were retrieved by research vessels. This study provides formal description of this unique new species based on these two specimens. Further investigations and expeditions are necessary for better understanding of the biodiversity of tonguefishes in the western Pacific.
Two new species and four new records of the Sarsia tubulosa group of Sarsia (Cnidaria, Corynidae) from the Bohai Sea of China
Authors: WANG XIAO , CHEN XIAO-YIN , XU ZHEN-ZU
Published: September 2022

Seven species of the Sarsia tubulosa group in the Sarsia genus from the Bohai Sea of China are described in the present paper. These include two new species, namely Sarsia bohaiensis Xu, Wang, & Chen sp. nov. and Sarsia macrogastera Xu, Chen, & Wang sp. nov., and four new records to China, namely Sarsia apicula (Murbach & Shearer, 1902), Sarsia piriforma Edwards, 1983, Sarsia striata Edwards, 1983 and Sarsia viridis Brinckmann-Voss, 1980. In addition, Sarsia tubulosa (M. sars, 1835) is a new record to the Bohai Sea of China. A key to all known species of the Sarsia tubulosa group is provided. The specimens examined in the study have been deposited at the First Institute of Oceanography, Ministry of Nature Resources.
Genetic diversity of the regionally endangered Chinese ricefish (Oryzias sinensis) in Taiwan, with comments on its conservation status
Authors: HUANG SHIH-PIN , WANG TZI-YUAN , LIN TING-YU , HUANG HUI-CHU
Published: September 2022

The Chinese ricefish (Oryzias sinensis) is a freshwater fish that is regionally endangered in Taiwan. To evaluate its conservation status and further formulate conservation plans for this species in Taiwan, this study analyzed the fish collected from all known localities, including a newly discovered population. The phylogenetic trees based on D-loop and COI divided the Chinese ricefish into two major clades: Taiyangpi-Shuanglienpi and Taiping-Gongliao. This study showed that both the Shuanglienpi and Taiyangpi wild populations had significantly higher Hd and π values, while the Shuanglienpi restored population only had one haplotype from the wild. However, their genetic diversity may have decreased over the past few decades. The Gongliao and Taiping populations shared the same haplotype as a population from a previous study. We propose that the Gongliao and Taiping populations were founded by a few individuals and might have originated from a single introduction event from southeastern mainland China. Low genetic diversity was clearly observed in the Taiping, Gongliao and Shuanglienpi restored populations. Based on the present investigation and previous studies, the invasive poeciliid fish (such as mosquitofish and green swordtail) contribute the most to the decline of the Chinese ricefish population and genetic diversity in Taiwan.
A new wriggler of Eleotrid (Teleostei: Xenisthmidae) from Taiwan
Authors: CHEN I-SHIUNG , HAREFA TONISMAN , JIANG GUO-CHEN , CHANG CHIH-WEI
Published: September 2022

A new wriggler of genus Xenisthmus was collected from Taitung and Pingtung Counties, Taiwan, while using SCUBA diving of coral reef fish survey. The new species, Xenisthmus nigrolateralis, can be well distinguished from other congeners by the following unique combination of features: (1) fins: second dorsal fin rays I/13; anal fin rays I/13; pectoral fin rays16; (2) squamation: longitudinal scale series 68-70; perdorsal scales 23; (3) vertebral count 10+16=26; (4) preopercular canal present with rather more, 5 pores γ1, γ, δ, ε, and ε1 and (5) specific colouration: lateral side with broad, deep brown stripe from rear of lateral gill opening to caudal fin base, and caudal fin with median blackish brown mark, and upper and lower regions translucent, the base with a vertical black bar. The comparison of other congeners would be also discussed in this paper.
A new freshwater goby, Rhinogobius lianchengensis (Teleostei: Gobiidae) from the Minjiang river basin, Fujian Province, China
Authors: WANG SHEN-CHIH , CHEN I-SHIUNG
Published: September 2022

A new freshwater goby of Rhinogobius Gill, 1859, were collected from the Minjiang river basin, Fujian Province, PR China. The new goby, Rhinogobius lianchengensis n. sp. can be well distinguished from other congeneric species by the following combination of features: second dorsal fin I/8; anal fin I/6-7; pectoral fin modally 16–17; longitudinal scale rows 33–34; predorsal scales 0–3; vertebral count 27; and specific coloration pattern: scale pocket of lateral body with distal brown to blackish brown mark; cheek deep brown on dorsal half with 7–8 somewhat parallel oblique deep brown bars after the vertical stripe on snout in male; opercle brown to yellowish brown with net-like deep brown marks in both sexes; branchiostegal membrane bright yellow background with 16-19 deep red or brownish red spots in male; first dorsal fin with a black mark in male; pectoral fin base with a median patch of blackish spots surrounding with some irregularly large brown marks; and caudal fin yellow with 3–4 vertical rows of deep brown spots. A diagnostic key to all nominal Rhinogobius species from Fujian Province, PR China is provided.
A Wavenumber–Frequency Spectrum Model for Sheared Convective Atmospheric Boundary Layer Flows
Authors: Ali Naseem , Mellado Juan Pedro , Wilczek Michael
Published: September 2022

Parameterizing turbulence in the atmospheric boundary layer as a function of space and time is essential for weather and climate models. Here, we explore a model for wavenumber–frequency spectra based on a linear random advection approach to characterize sheared convective atmospheric boundary layer flows. Building on previous works, we obtain the wavenumber–frequency spectrum as a product of the wavenumber spectrum and a Gaussian frequency distribution, whose mean and variance are given by the mean advection and random sweeping velocities, respectively. The applicability of the model is tested with direct numerical simulation data in the mixed layer and the entrainment zone for the streamwise and vertical velocity components and buoyancy. To obtain a fully analytical model, we propose using a von Kármán wavenumber spectrum parameterized by the characteristic variances and integral length scales. These parameters are height dependent and vary considerably with the relative balance of buoyancy and shear forces. The introduced analytical model relies on fitting parameters obtained from numerical data in the relevant range of scales. The comparison of the von Kármán–based spectra for velocity and buoyancy to simulation results shows that the main features of the measured spectra are captured by the model.
A Qualitative Exploration of Stressors: Voices of African American Women who have Experienced Each Type of Fetal/Infant Loss: Miscarriage, Stillbirth, and Infant Mortality
Authors: Evans Na’Tasha M. , Hsu Yu-Lin , Kabasele Cedric Mubikayi , Kirkland Chelsey , Pantuso Davida , Hicks Siobhan
Published: September 2022

Historically, African American women have experienced racial disparities in miscarriage, stillbirth, and infant mortality rates. Yet, little attention has been given to stressors that African American women may experience prior to, during, and after experiencing fetal/infant loss. This study provided an opportunity for African American women to describe their lived experiences of stressors prior to, during, and after experiencing each type of fetal/infant loss. Semi-structured interviews were conducted with seven African American women. Each participant experienced miscarriage, stillbirth, and infant mortality and were 18 years of age or older. Recruitment occurred in 2019 in a county in Northeast Ohio and data were analyzed using descriptive coding and thematic analysis. Four themes identified how these African American women navigated stressors prior to, during, and after experiencing each type of fetal/infant loss: (a) social support, (b) grief, (c) internal conflict, and (d) pregnancy, delivery, and death of child. Our findings expand the literature by being an innovative study may bring awareness and influence programs that assist African American women during their experience with fetal/infant loss.
Teachers of Color and Precarious Work: The Inequality of Job Security
Authors: Castro Andrene J.
Published: September 2022

The teacher workforce has undergone macrostructural economic and political changes tied to privatization, deunionization, and deregulation. These forms of neoliberal restructuring have resulted in employment precarity or job insecurity for teachers, but have acutely impacted teachers of color. Drawing on the literature from economic sociology and the sociology of work, this conceptual paper outlines three defining features of precarity in teaching: (1) precarity as a process of neoliberalism; (2) precarity as a socioeconomic condition; and (3) precarity as an ontological experience. By applying these aspects of precarity, this article casts light on the historical and contemporaneous work experiences of teachers of color that render them at risk for job insecurity and social and economic vulnerability.
Go moderate! How hotels' cancellation policies affect their financial performance
Authors: Altin Mehmet , Chen Chih-Chien , Riasi Arash , Schwartz Zvi
Published: September 2022

Hotel cancellation policies have shifted considerably in recent years. This is mainly in response to growing rates of last-minute cancellations and no shows and the resulting negative impact on the hotel’s performance. This study explores how two key policy elements, the penalty and the cancellation window, are likely to benefit the hotel. That is, how the severity of the policies is likely to positively impact the hotel’s financial performance. We developed a mathematical model and used cancellation and performance information data from a random sample of over 500 U.S. hotels to examine the effectiveness of a range of cancellation policies. The empirical findings support the mathematical model’s prediction that moderate cancellation policies are likely to generate better financial performance levels, compared to more lenient or more stringent policies.
Sarcastic and Deviant Trolling in Turkey: Associations With Dark Triad and Aggression
Authors: Manuoğlu Elif , Öner-Özkan Bengi
Published: September 2022

The aim of this study is twofold. First, this study develops a new scale measuring sarcastic trolling and investigates the reliability and validity of the Turkish version of the Troll Deviancy Scale. Second, this study explores the associations among different trolling measures, dark triad, and overt and relational aggression. Eight items measuring sarcasm in trolling were written to develop a Likert type of scale. In total, 809 university students participated in the study and completed an online questionnaire. Findings suggested that both the sarcastic trolling scale and the Turkish version of the Troll Deviancy Scales are valid and reliable. Analyses showed that there were significant associations among trolling measures. Moreover, the differential predictive value of dark personality traits and overt and relational aggression in different forms of trolling were revealed. This study extends the existing literature on linking personality traits and aggression to a new form of trolling. Moreover, this study focused on a non-Western culture to examine different forms of trolling behaviors.
Organizing the bacterial annotation space with amino acid sequence embeddings
Authors: Grigson Susanna R. , McKerral Jody C. , Mitchell James G. , Edwards Robert A.
Published: September 2022

Background

Due to the ever-expanding gap between the number of proteins being discovered and their functional characterization, protein function inference remains a fundamental challenge in computational biology. Currently, known protein annotations are organized in human-curated ontologies, however, all possible protein functions may not be organized accurately. Meanwhile, recent advancements in natural language processing and machine learning have developed models which embed amino acid sequences as vectors in n-dimensional space. So far, these embeddings have primarily been used to classify protein sequences using manually constructed protein classification schemes.

Results

In this work, we describe the use of amino acid sequence embeddings as a systematic framework for studying protein ontologies. Using a sequence embedding, we show that the bacterial carbohydrate metabolism class within the SEED annotation system contains 48 clusters of embedded sequences despite this class containing 29 functional labels. Furthermore, by embedding Bacillus amino acid sequences with unknown functions, we show that these unknown sequences form clusters that are likely to have similar biological roles.

Conclusions

This study demonstrates that amino acid sequence embeddings may be a powerful tool for developing more robust ontologies for annotating protein sequence data. In addition, embeddings may be beneficial for clustering protein sequences with unknown functions and selecting optimal candidate proteins to characterize experimentally.
Exposure to socio-political unrest and wellbeing of older people in Hong Kong
Authors: Lai Daniel W. L. , Liu Emma H. S. , Yan Elsie C. W. , Li Jessica J. , Lee Vincent W. P.
Published: September 2022

Background

The social unrest in the second half of 2019 in Hong Kong came with conflicts, confrontations, and violence which affected almost everyone in the city. The destruction and disruption of the urban facilities have undoubtedly had a significant impact on the lives and mental well-being of the public, and the older people are even more vulnerable. This study examined the impacts of the social unrest on the wellbeing of older people, an area that was seldomly addressed in the public discourse and literature.

Methods

Narrative interviews were conducted to capture older people’s lived experiences and ways of making sense of the unrest in Hong Kong. A total of 63 participants aged 60 and above was recruited through personal networks of the research team, and referrals by participants who took part in the interviews. Qualitative semi-structure interviews was conducted one on one via telephone.

Results

Thirty-three male and 30 female participants took part in the interview. The number of participants from different risk zones affected by political unrest was comparable. Three themes were generated. Participants experienced challenges during the social unrest, including disturbance to family and social life, reduced incomes which affect quality of life, and difficulties in socializing with friends and accessing medical services. The social unrest caused emotional disturbance, giving rise to feelings of panic, fear, insomnia, depression, annoyance, and anger. Participants reported different coping strategies, ranging from moving to other places, to avoiding going to risky areas and watching news.

Conclusion

Social unrest brings emotional distress to older people. In many cases, older people cope with challenges in different ways, whether active or passive. Social workers and other professionals should give more support to older people to encourage them to overcome their difficulties. The stakeholders’ awareness of the problem and mental health promotion is required to alleviate the multiple layers of negative impacts.
Growing old with antiretroviral therapy or elderly people in antiretroviral therapy: two different profiles of comorbidity?
Authors: Maggi Paolo , De Socio Giuseppe Vittorio , Menzaghi Barbara , Molteni Chiara , Squillace Nicola , Taramasso Lucia , Guastavigna Marta , Gamboni Giulia , Madeddu Giordano , Vichi Francesca , Cascio Antonio , Sarchi Eleonora , Pellicanò Giovanni , Martinelli Canio Vito , Celesia Benedetto Maurizio , Valsecchi Laura , Gulminetti Roberto , Cenderello Giovanni , Parisini Andrea , Calza Leonardo , Falasca Katia , Orofino Giancarlo , Ricci Elena , Di Biagio Antonio , Bonfanti Paolo
Published: September 2022

Background

In persons living with HIV (PLWH), the burden of non-communicable chronic diseases increased over time, because of aging associated with chronic inflammation, systemic immune activation, and long-term exposure to the combination antiretroviral therapy (ART).

Methods

To explore the association of chronological age, age at first ART, and exposure to ART with non-communicable chronic diseases, we performed a cross-sectional analysis to evaluate the prevalence of comorbidities in patients enrolled in the SCOLTA Project, stratified by groups of chronological age (50–59 and 60–69 years) and by years of antiretroviral treatment (ART, ≤ 3 or > 3 years).

Results

In 1394 subjects (23.8% women), mean age at enrollment was 57.4 (SD 6.5) years, and at first ART 45.3 (SD 10.7). Men were older than women both at enrollment (57.6 vs 56.8, p = 0.06) and at first ART (45.8 vs 43.6, p = 0.0009). ART duration was longer in women (13.1 vs 11.7 years, p = 0.01). The age- and sex-adjusted rate ratios (aRRs, and 95% confidence interval, CI) showed that longer ART exposure was associated with dyslipidemia (aRR 1.35, 95% CI 1.20–1.52), hypertension (aRR 1.52, 95% CI 1.22–1.89), liver disease (aRR 1.78, 95% CI 1.32–2.41), osteopenia/osteoporosis (aRR 2.88, 95% CI 1.65–5.03) and multimorbidity (aRR 1.36, 95% CI 1.21–1.54). These findings were confirmed in strata of age, adjusting for sex.

Conclusions

Our data suggest that longer ART exposure was associated with increased risk of dyslipidemia, hypertension, and osteopenia/osteoporosis, hence the presence of multimorbidity, possibly due to the exposition to more toxic antiretrovirals. We observed different comorbidities, according to ART exposure and age.
Development and validation of algorithms to identify patients with chronic kidney disease and related chronic diseases across the Northern Territory, Australia
Authors: Chen Winnie , Abeyaratne Asanga , Gorham Gillian , George Pratish , Karepalli Vijay , Tran Dan , Brock Christopher , Cass Alan
Published: September 2022

Background

Electronic health records can be used for population-wide identification and monitoring of disease. The Territory Kidney Care project developed algorithms to identify individuals with chronic kidney disease (CKD) and several commonly comorbid chronic diseases. This study aims to describe the development and validation of our algorithms for CKD, diabetes, hypertension, and cardiovascular disease. A secondary aim of the study was to describe data completeness of the Territory Kidney Care database.

Methods

The Territory Kidney Care database consolidates electronic health records from multiple health services including public hospitals (n = 6) and primary care health services (> 60) across the Northern Territory, Australia. Using the database (n = 48,569) we selected a stratified random sample of patients (n = 288), which included individuals with mild to end-stage CKD. Diagnostic accuracy of the algorithms was tested against blinded manual chart reviews. Data completeness of the database was also described.

Results

For CKD defined as CKD stage 1 or higher (eGFR of any level with albuminuria or persistent eGFR < 60 ml/min/1.732, including renal replacement therapy) overall algorithm sensitivity was 93% (95%CI 89 to 96%) and specificity was 73% (95%CI 64 to 82%). For CKD defined as CKD stage 3a or higher (eGFR < 60 ml/min/1.732) algorithm sensitivity and specificity were 93% and 97% respectively. Among the CKD 1 to 5 staging algorithms, the CKD stage 5 algorithm was most accurate with > 99% sensitivity and specificity. For related comorbidities – algorithm sensitivity and specificity results were 75% and 97% for diabetes; 85% and 88% for hypertension; and 79% and 96% for cardiovascular disease.

Conclusions

We developed and validated algorithms to identify CKD and related chronic diseases within electronic health records. Validation results showed that CKD algorithms have a high degree of diagnostic accuracy compared to traditional administrative codes. Our highly accurate algorithms present new opportunities in early kidney disease detection, monitoring, and epidemiological research.
Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study
Authors: Tavares Victória Brioso , e Souza Josiel de Souza , Affonso Márcio Vinicius de Gouveia , Da Rocha Emerson Souza , Rodrigues Lucio Flavio Garcia , da Costa Moraes Luciana de Fátima , dos Santos Coelho Gabrielly Cristiny , Araújo Sabrina Souza , das Neves Pablo Fabiano Moura , Gomes Fabiana de Campos , de Melo-Neto João Simão
Published: September 2022

Background

The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil.

Methods

This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed.

Results

After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60–6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19–0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU.

Conclusion

In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.
Implementation of a malaria prevention education intervention in Southern Ethiopia: a qualitative evaluation
Authors: Zerdo Zerihun , Anthierens Sibyl , Van geertruyden Jean-Pierre , Massebo Fekadu , Biresaw Gelila , Shewangizaw Misgun , Endashaw Gesila , Tunje Abayneh , Masne Matewos , Bastiaens Hilde
Published: September 2022

Background

Though school-aged children (SAC) are at high risk of malaria, they are the ones that benefit the least from malaria prevention measures. A cluster randomized controlled trial was conducted to evaluate the effect of malaria prevention education (MPE) on insecticide-treated bed net (ITN) utilization and prompt diagnosis, reported incidence and treatment (PDAT) of malaria. Qualitative evaluation of the implementation of such interventions is vital to explain its effectiveness and will serve as guidance for future interventions. Therefore, this study aimed to evaluate the implementation of the MPE in southern Ethiopia. 

Methods

The trial was registered in Pan African Clinical Trials Registry (PACTR202001837195738) on 21/01/2020. A descriptive qualitative study using semi-structured interview with participants of the MPE was conducted in January 2020 and January 2021. The collected data were transcribed verbatim and analyzed thematically. The analysis of the data was supported by NVivo.

Results

The four themes identified after evaluation of MPE training were the setup of the training, challenges for the success of the training, anticipated challenges for practice as per the protocol and experienced immediate influences of the training. Participants appreciated the training: content covered, way of delivery and the mix of the participants. The context specific facilitators to bed net use were the collateral benefits of ITN and perceived at high risk of malaria while its barriers were quality and quantity of the bed nets, bed net associated discomforts, malaria health literacy and housing condition. Severeness of malaria symptoms and malaria health literacy were reported as both barriers and facilitators of the PDAT of malaria. The identified facilitators of PDAT of malaria were health professionals’ attitude and exposure to MPE while its barriers were poverty, use of traditional medicine, health facility problems and Coronavirus Disease 2019 (COVID-19) pandemic.

Conclusion

Low attendance of parents in the training was the major challenge for the success of MPE. National malaria program should ensure the access to malaria prevention measures; and future studies using increased frequency of the intervention embedded with monitoring adherence to the intervention protocol shall be conducted to improve the gains from existing malaria interventions.
Patient characteristics, pain treatment patterns, and incidence of total joint replacement in a US population with osteoarthritis
Authors: Shinde Mayura , Rodriguez-Watson Carla , Zhang Tancy C. , Carrell David S. , Mendelsohn Aaron B. , Nam Young Hee , Carruth Amanda , Petronis Kenneth R. , McMahill-Walraven Cheryl N. , Jamal-Allial Aziza , Nair Vinit , Pawloski Pamala A. , Hickman Anne , Brown Mark T. , Francis Jennie , Hornbuckle Ken , Brown Jeffrey S. , Mo Jingping
Published: September 2022

Background

Currently available medications for chronic osteoarthritis pain are only moderately effective, and their use is limited in many patients because of serious adverse effects and contraindications. The primary surgical option for osteoarthritis is total joint replacement (TJR). The objectives of this study were to describe the treatment history of patients with osteoarthritis receiving prescription pain medications and/or intra-articular corticosteroid injections, and to estimate the incidence of TJR in these patients.

Methods

This retrospective, multicenter, cohort study utilized health plan administrative claims data (January 1, 2013, through December 31, 2019) of adult patients with osteoarthritis in the Innovation in Medical Evidence Development and Surveillance Distributed Database, a subset of the US FDA Sentinel Distributed Database. Patients were analyzed in two cohorts: those with prevalent use of “any pain medication” (prescription non-steroidal anti-inflammatory drugs [NSAIDs], opioids, and/or intra-articular corticosteroid injections) using only the first qualifying dispensing (index date); and those with prevalent use of “each specific pain medication class” with all qualifying treatment episodes identified.

Results

Among 1 992 670 prevalent users of “any pain medication”, pain medications prescribed on the index date were NSAIDs (596 624 [29.9%] patients), opioids (1 161 806 [58.3%]), and intra-articular corticosteroids (323 459 [16.2%]). Further, 92 026 patients received multiple pain medications on the index date, including 71 632 (3.6%) receiving both NSAIDs and opioids. Altogether, 20.6% of patients used an NSAID at any time following an opioid index dispensing and 17.2% used an opioid following an NSAID index dispensing. The TJR incidence rates per 100 person-years (95% confidence interval [CI]) were 3.21 (95% CI: 3.20–3.23) in the “any pain medication” user cohort, and among those receiving “each specific pain medication class” were NSAIDs, 4.63 (95% CI: 4.58–4.67); opioids, 7.45 (95% CI: 7.40–7.49); and intra-articular corticosteroids, 8.05 (95% CI: 7.97–8.13).

Conclusions

In patients treated with prescription medications for osteoarthritis pain, opioids were more commonly prescribed at index than NSAIDs and intra-articular corticosteroid injections. Of the pain medication classes examined, the incidence of TJR was highest in patients receiving intra-articular corticosteroids and lowest in patients receiving NSAIDs.
Which assisted reproductive technology (ART) treatment strategy is the most clinically and cost-effective for women of advanced maternal age: a Markov model
Authors: Lee Evelyn , Zhang Jinhui
Published: September 2022

Objective

To evaluate the clinical and cost-effectiveness of preimplantation genetic testing for aneuploidy, social freezing, donor and autologous assisted reproductive technology (ART) treatment strategies for women aged 35–45 following 6–12 months of infertility.

Methods

Four Markov decision-analytic models comprising: (i) Preimplantation genetic testing for aneuploidy (PGT-A); (ii) autologous ART from age 40 using oocytes cryopreserved at age 32 (social freezing); (iii) ART using donated oocytes (donor ART); (iv) standard autologous ART treatment (standard care) were developed for a hypothetical cohort of 35 to 45 years old ART naïve women with 6–12 months of infertility. Input probabilities for key parameters including live birth rates were obtained from the available literature. Deterministic and probabilistic sensitivity analyses were conducted to address uncertainty in estimating the parameters and around the model’s assumptions. Cost effectiveness was assessed from both societal and patient perspectives .

Result(s)

For infertile women at age 40 and above, social freezing is the most cost-saving strategy with the highest chance of a cumulative live birth at a lowest cost from a societal perspective. PGT-A and donor ART were associated with higher treatment costs and cumulative live-birth rates compared with the autologous ART. Among the four ART strategies, standard autologous ART has the lowest cumulative live birth rate of 45% at age 35 and decreasing to 1.6% by age 45 years. At a willingness-to-pay threshold of Australian dollars (A$)50,000, our model shows all alternative treatment strategies –PGT-A, social freezing and donor ART have a higher probability of being cost-effective compared to the standard autologous ART treatment. However, higher out-of-pocket expenditure may impede their access to these alternate strategies.

Conclusion

Given current evidence, all alternate strategies have a higher probability of being cost-effective compared to the standard autologous ART treatment. Whether this represents value for money depends on societal and individual’s willingness-to-pay for children conceived with ART treatment.
Patients’ self-triage for unscheduled urgent care: a preliminary study on the accuracy and factors affecting the performance of a Belgian self-triage platform
Authors: Gilbert Allison , Diep Anh Nguyet , Boufraioua Maryame , Pétré Benoit , Donneau Anne-Françoise , Ghuysen Alexandre
Published: September 2022

Background

Management of unscheduled urgent care is a complex concern for many healthcare providers. Facing the challenge of appropriately dispatching unscheduled care, primary and emergency physicians have collaboratively implemented innovative strategies such as telephone triage. Currently, new original solutions tend to emerge with the development of new technologies. We created an interactive patient self-triage platform, ODISSEE, and aimed to explore its accuracy and potential factors affecting its performance using clinical case scenarios.

Methods

The ODISSEE platform was developed based on previously validated triage protocols for out-of-hours primary care. ODISSEE is composed of 18 icons leading to algorithmic questions that finally provide an advised orientation (emergency or primary care services). To investigate ODISSEE performance, we used 100 clinical case scenarios, each associated with a preestablished orientation determined by a group of experts. Fifteen volunteers were asked to self-triage with 50 randomly selected scenarios using ODISSEE on a digital tablet. Their triage results were compared with the experts’ references.

Results

The 15 participants performed a total of 750 self-triages, which matched the experts references regarding the level of care in 85.6% of the cases. The orientation was incorrect in 14.4%, with an undertriage rate of 1.9% and an overtriage rate of 12.5%. The tool’s specificity and sensitivity to advise participants on the appropriate level of care were 69% (95% CI: 64—74) and 97% (95% CI: 95—98) respectively. When combined with advice on the level of urgency, the tool only found the correct orientation in 68.4% with 9.2% of undertriages and 22.4% of overtriages. Some participant characteristics and the types of medical conditions demonstrated a significant association with the tool performance.

Conclusion

Self-triage apps, such as the ODISSEE platform, could represent an innovative method to allow patients to self-triage to the most appropriate level of care. This study based on clinical vignettes highlights some positive arguments regarding ODISSEE safety, but further research is needed to assess the generalizability of such tools to the population without equity issues.