bluuebunny/crossref_metadata_2025 huggingface dataset:
An efficient ship autopilot design using observer-based model predictive control
Authors: Wang Wenxin , Liu Cheng
Published: June 2020

An efficient model predictive control design for ship autopilot, which is a representative marine application, is proposed based on projection neural network in this article. Ship motion control at sea exhibits the characteristics of large inertia, strong nonlinearity, and large delay; furthermore, it is frequently influenced by the external disturbances, leading to a complex uncertain problem. In addition, the amplitude of control input—the rudder is constrained. Given the mechanism of on-line computing and the advantages of handling constraints, the model predictive control is one of the most favorable solutions for this problem. Nevertheless, the major challenge of the implementation of traditional model predictive control in application is the computation intensity. In this article, the capability of parallel computation of projection neural network is employed to optimize the objective function formulated by traditional model predictive control method, aiming to improve the computational efficiency. The overall information of ship motion is normally difficult to be obtained; therefore, a state observer should be also included. Extensive studies are conducted to illustrate the effectiveness of the proposed control design.
Microbiome as a Target for Cancer Therapy
Authors: Suraya Ratoe , Nagano Tatsuya , Kobayashi Kazuyuki , Nishimura Yoshihiro
Published: June 2020

Recently, the microbiome has been gaining traction as a major player regulating various functions that correlate with many pathological conditions, including cancer. The central gut microbiota population has the capability to regulate normal inflammatory, immune, and metabolic functions, and disturbance in the balance of the normal microbiota population can subsequently induce pathological responses that closely relate with the mechanistic development and progression of cancer in various forms and sites. As a disease with major socioeconomic burden partly due to its current therapeutic options, modulating the imbalanced gut microbiota represents a novel option not only as an adjuvant therapy to relieve cancer treatment–related symptoms but also to influence cancer progression itself. In this review, we will discuss how the microbiome, specifically the gut microbiota, could affect cancer pathogenesis and what the effect of gut microbiota–targeting treatment options have on the many aspects of cancer pathologies based on the knowledge of recent years.
Associations Between Global Mental Health and Response to an App-Based Meditation Intervention in Myeloproliferative Neoplasm Patients
Authors: Puzia Megan E. , Huberty Jennifer , Eckert Ryan , Larkey Linda , Mesa Ruben
Published: June 2020

Background: Depression, anxiety, and sleep disturbance are common problems that greatly affect quality of life for many myeloproliferative neoplasm (MPN) patients. App-based mindfulness meditation is a feasible nonpharmacologic approach for managing symptoms. However, previous research has not considered how patients’ overall mental health may influence their responsiveness to these interventions. Objective: The purpose of this study was to conduct an exploratory, secondary analysis of the effects of a smartphone meditation app, Calm, on depression, anxiety, and sleep disturbance in MPN patients based on patients’ baseline levels of Global Mental Health (GMH). Methods: Participants (N = 80) were a subset of MPN patients from a larger feasibility study. Patients were enrolled into an intervention (use Calm for 10 minutes daily for 4 weeks) or educational control group. Results: In multilevel models, there were significant 3-way interactions between time, group, and baseline GMH for depression and anxiety symptoms, with participants in the meditation intervention who reported the poorest baseline GMH experiencing the greatest reduction in symptoms over time. For both intervention and control participants, poorer initial GMH was associated with increases in sleep disturbance symptoms over time. Conclusions: Mindfulness meditation apps, such as Calm, may be effective in reducing depression and anxiety symptoms in MPN patients, particularly for those experiencing mental health difficulties. Given the need for accessible tools to self-manage chronic cancer–related symptoms, especially strong negative emotions, these findings warrant larger efficacy studies to determine the effects of app-based meditation for alleviating depression and anxiety in cancer populations.
Review and performance evaluation of FIFO, PQ, CQ, FQ, and WFQ algorithms in multimedia wireless sensor networks
Authors: Attar Hani , Khosravi Mohammad R , Igorovich Shmatkov Sergiy , Georgievan Kuchuk Nina , Alhihi Mohammad
Published: June 2020

The best service mechanism in multimedia wireless sensor networks can be achieved based on the multimedia traffic flow by developing a proper simulation algorithm process model, to be a trustable indication for real implementations, which is proposed in this article, together with the algorithm model outcome analysis. The quality estimation of the proposed mechanism is investigated by simulating real data transmission and obtaining the integral criterion of the processed mechanism, to determine the queue formation and loading control. Accordingly, it was proved that the first-in first-out algorithm is not useful as a flow algorithm; however, it is regarded as suitable to be considered as the benchmark algorithm when compared with the other algorithms such as priority queue, custom queue, fair queuing, and weighted fair queuing algorithms. Finally, each algorithm’s advantages and disadvantages were verified and the best usage conditions according to certain parameters, such as packet loss probability, average time delay, and jitter, were declared.
DQN-based energy-efficient routing algorithm in software-defined data centers
Authors: Yao Zan , Wang Ying , Qiu Xuesong
Published: June 2020

With the rapid development of data centers in smart cities, how to reduce energy consumption and how to raise economic benefits and network performance are becoming an important research subject. In particular, data center networks do not always run at full load, which leads to significant energy consumption. In this article, we focus on the energy-efficient routing problem in software-defined network–based data center networks. For the scenario of in-band control mode of software-defined data centers, we formulate the dual optimal objective of energy-saving and the load balancing between controllers. In order to cope with a large solution space, we design the deep Q-network-based energy-efficient routing algorithm to find the energy-efficient data paths for traffic flow and control paths for switches. The simulation result reveals that the deep Q-network-based energy-efficient routing algorithm only trains part of the states and gets a good energy-saving effect and load balancing in control plane. Compared with the solver and the CERA heuristic algorithm, energy-saving effect of the deep Q-network-based energy-efficient routing algorithm is almost the same as the heuristic algorithm; however, its calculation time is reduced a lot, especially in a large number of flow scenarios; and it is more flexible to design and resolve the multi-objective optimization problem.
Informing Informed Consent for HIV Research
Authors: Campbell Laura M. , Paolillo Emily W. , Bryan Robert , Marquie-Beck Jennifer , Moore David J. , Nebeker Camille , Moore Raeanne C.
Published: June 2020

“Respect for Persons” is an ethical principle demonstrated through the informed consent process. Participants at a large HIV research center were surveyed to identify important aspects of the consent process. Persons with and without HIV ( n = 103) completed a short pre/post questionnaire with both open-ended and forced choice response options. Qualitative analysis resulted in eleven themes about the most important consent elements which did not differ by HIV serostatus. Overall, participants rated the informed consent content and presentation by research staff as “extremely informative” and found the consent information to be “extremely consistent” with their study experience. Study results support the value of an interactive process and can be used to inform the design of a standardized, digital consent process.
How do police officers talk about their encounters with ‘the public’? Group interaction, procedural justice and officer constructions of policing identities
Authors: Radburn Matthew , Savigar-Shaw Leanne , Stott Clifford , Tallent Deborah , Kyprianides Arabella
Published: June 2020

Despite widespread empirical support for Procedural Justice Theory, understanding the role of police psychology in shaping encounters with ‘citizens’ is relatively opaque. This article seeks to address this gap in the literature by exploring how officers talk about themselves and their colleagues and deploy social categories to understand their interactions with ‘the public’. The qualitative thematic analysis draws upon 22 semi-structured interviews conducted with officers in various roles and teams within a large metropolitan police force in England. Our thematic analysis demonstrates the centrality of procedural fairness in officers’ talk (in terms of internal relations with colleagues and external relations with ‘the public’). Interviewees described complex internalised theories of social relations, differentially positioning themselves in relation to other colleagues and multiple ‘publics’ often depicted along socioeconomic and geographical lines. Officers described their interactions with ‘the public’ in sequential and historical terms with complex and changing (often intergroup) power dynamics. Implications of the analysis for understanding the role of social identity processes among police officers and how this underlying conceptualisation might shape police–‘citizen’ encounters are discussed.
‘Just give up the ball’: In search of a third space in relationships between male youth workers and young men involved in violence
Authors: Harris Pete
Published: June 2020

This article critically examines the employment of male youth workers in the field of youth crime prevention. It focuses on how their relationships with young men involved in violence might (or might not) support young men and promote desistance. It does this via the presentation of a single psychosocial case study that examines the relationship between a Black male youth worker and a young Black man who becomes involved in violence and then falls victim to violence to other young men in his neighbourhood. It illuminates how some male workers’ resources of masculine and street capital may be advantageous in terms of reaching some young men, but may also create barriers to reaching others. The study focuses on how both men in the case struggle to ‘give up the ball’ – a metaphor the article adopts for the act of conceding masculine capital in the street field. I suggest that for the relationship to provide the support this young man needed, it required the creation of a third space between him and his youth worker, that is, a vantage point from where they could both examine their masculinity and how this was related to their respective psychic vulnerabilities. I argue that the two men’s investments in different discourses of masculinity were more significant (in terms of the desistance-promoting potential of their relationship) than the similarity in their racial or class backgrounds. The case highlights the need for a more nuanced understanding of youth work relationships and for provision of adequate support and supervision for all male workers that incorporates thorough consideration of their personal and professional identity formation, especially the most heavily gendered aspects.
Darwin and the Situation of Emotion Research
Authors: Gross Daniel M. , Preston Stephanie D.
Published: June 2020

This article demonstrates how researchers from both the sciences and the humanities can learn from Charles Darwin’s mixed methodology. We identify two basic challenges that face emotion research in the sciences, namely a mismatch between experiment design and the complexity of life that we aim to explain, and problematic efforts to bridge the gap, including invalid inferences from constrained study designs, and equivocal use of terms like “sympathy” and “empathy” that poorly reflect such methodological constraints. We argue that Darwin’s mixed methodology is a model for addressing these challenges even in laboratory work on emotion, because it shows how close observation of emotional phenomena makes sense only within broader historical contexts. The article concludes with 5 practical research recommendations.
Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature
Authors: Li Anxin , Jiang Xiaoyan , Zhong Miao , Li Ning , Tao Yang , Wu Wenxun , Yang Cheng , Wang Hongyan , Min Le , Ma Yu , Deng Wuquan
Published: June 2020

Diabetic ketoacidosis (DKA) and thyroid storm (TS) are severe metabolic and endocrine disorders. Both usually manifest with multiple systemic clinical signs and symptoms, and digestive symptoms, such as nausea and vomiting, are most common in these patients. Moreover, the presence of a concurrent severe or rare complication may worsen the condition or even cause death due to misdiagnosis, delayed diagnosis, or inappropriate treatment. The identification of these symptoms is usually closely related to the severity and prognosis of the disease. Although clinical prognosis might be improved by prompt diagnosis and aggressive treatment, some rare and insidious metabolic complications are difficult to identify early. Moreover, life-threatening gastrointestinal symptoms are very rare in patients with DKA and TS. Here, we report an inpatient diagnosed with DKA and Graves’ disease who developed life-threatening intractable hiccups resulting in TS and respiratory failure during the treatment of DKA. In addition, we review the literature to discuss the possible underlying mechanism of intractable hiccups in the development of TS.
Identifying vaccination rates of adult patients in ambulatory care clinics
Authors: Darr Amber Y , Gottfried Sarah
Published: June 2020

Background:

While pharmacists have provided vaccinations to patients in the community pharmacy setting, pharmacist involvement within the medical office setting is not well documented in the literature. The American Society of Health-System Pharmacists reports that ambulatory care pharmacists are screening for and administering vaccinations at a declining rate, despite standards of practice. Vaccination rates for adults 19–64 years of age remain low, based on Healthy People 2020 goals, putting them at risk for vaccine-preventable diseases.

Objectives:

The aim of the study was to assess vaccination rates of ambulatory care pharmacy clinic patients aged 19–64 years and to compare the rates between three clinics and to Healthy People 2020 goals.

Methods:

This was a baseline retrospective analysis of vaccination rates for patients aged 19–64 years who attended at least one pharmacy clinic visit at one of the three medical office practices. Age, sex, medical conditions, cigarette or alcohol use, immunosuppressive medications, and vaccines recommended and received were recorded. Vaccination status was assessed according to the Advisory Committee for Immunization Practices recommendations. Data were collected from January 2016 to March 2017. The percentage of eligible patients who received each vaccine was determined overall and for each clinic.

Results:

There were 240 patients who met the inclusion criteria, with a mean age of 52.8 years. The percentage of patients with vaccination documented in the medical record was 25% for pneumococcal conjugate, 35.7% for pneumococcal polysaccharide, 26.9% for zoster vaccine live, 6.4% for hepatitis B, and 50.6% for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Vaccination rates for pneumococcal conjugate, pneumococcal polysaccharide, and zoster vaccine live were below established Healthy People 2020 goals.

Conclusion:

Vaccination rates remain low in adults 19–64 years of age. Ambulatory care pharmacists should consider assessing vaccination status during clinic visits as a component of comprehensive vaccination programs.
Markers of Online Privacy Marginalization: Empirical Examination of Socioeconomic Disparities in Social Media Privacy Attitudes, Literacy, and Behavior
Authors: Epstein Dmitry , Quinn Kelly
Published: June 2020

This study explores how traditional socioeconomic markers of the digital divide interact with new markers of marginalization when it comes to online privacy protecting behaviors. To do this, we analyze data from a representative sample of social media users in the United States. Using hierarchical linear regression, we explore the relationships between established components of the digital divide, antecedents of privacy concerns, privacy-protecting behaviors, and privacy literacy. Our analysis highlights privacy literacy as a potentially understudied dimension of the digital divide and unpacks how traditional markers of marginalization explain distinct dimensions of privacy-protecting behaviors. Moreover, our findings suggest that the privacy literacy divide can amplify aspects of the second- and third-level digital divides, when translated into privacy-protecting behaviors.
The Patient-Centered Medical Home: Mental Health and Parenting Stress in Mothers of Children With Autism
Authors: Limbers Christine A. , Gutierrez Abbi , Cohen L. Adelyn
Published: June 2020

Objective: This study examined the correlations between receiving care in patient-centered medical home and maternal reports of their mental health and parenting stress in a national sample of mothers of children with autism spectrum disorder (ASD). Method: Participants were 1108 mothers of children with ASD (average age = 10.6 years; 81% male) from the 2011-2012 National Survey of Children’s Health. Multiple linear regression analysis and polynomial logistic regression analysis were used to evaluate if having a child with ASD cared for in a patient-centered medical home was significantly associated with maternal reports of their parenting stress and mental health. We also assessed whether 5 indicators of the American Academy of Pediatrics medical home definition were differentially associated with maternal outcomes. Results: Receiving care in a patient-centered medical home was associated with maternal reports of less parenting stress (standardized β = −0.201; P < .001) and better mental health (odds ratios range from 0.204 to 0.360; P < .001) after controlling for sociodemographic variables. Of the 5 indicators of the medical home definition, only effective care coordination was significantly associated with maternal perceptions of their parenting stress and mental health. Conclusion: Future longitudinal studies are needed to assess the temporal associations between patient-centered medical home status and maternal perceptions of their mental health and parenting stress in mothers of children with ASD.
Self-Service Technology Service Quality: Building Loyalty and Intention Through Technology Trust in Pakistani Service Sector
Authors: Ul Hassan Masood , Iqbal Muhammad Shahid , Habibah Ume
Published: June 2020

Self-service technologies (SSTs) fervently impact customer’s interaction with service firms to foster positive outcomes. This study intends to inspect the impact of SSTs service quality on loyalty and behavioral intention of Pakistani SSTs users directly and indirectly through technology trust. By using an anonymous survey questionnaire, this study collected the data from a sample of 421 mobile banking application users. This study applied structural equation modeling (SEM) by using the AMOS. Results revealed the partial mediation of technology trust between SSTs service quality and behavioral intention and loyalty. Finally, this study also provided theoretical and practical implications as well as limitations and directions for future research.
Investigating the Influence of International Tourism in Pakistan and Its Linkage to Economic Growth: Evidence From ARDL Approach
Authors: Rehman Abdul , Ma Hengyun , Irfan Muhammad , Ahmad Munir , Traore Ousmane
Published: June 2020

Tourism is a key source of income and employment today, and different parts of the world are heavily dependent on it. The main purpose of this article was to demonstrate the consequences of long-run and short-run relationship on international tourism in Pakistan and its impact on economic growth by applying an autoregressive distributed lag (ARDL) bounds testing approach. Augmented Dickey–Fuller unit root test was employed to check the stationarity of the variables, while an ARDL bounds testing approach was used to measure the long-run and short-run dynamics linkage among the study variables. The results show that international tourism and expenditures for passenger transport items have a positive impact on economic growth. Similarly, long-run dynamics also revealed that international tourism expenditures for travel items and international tourism expenditures, international tourism receipts for passenger transport items and international tourism receipts for travel items also had a positive impact on the economic growth. The present analysis of the long-run suggested better policies should be implemented to attract more international tourists to the country.
Building Typologies in Between the Vernacular and the Modern: Antakya (Antioch) in the Early 20th Century
Authors: Mihçioğlu Bilgi Elif , Uluca Tümer Ege
Published: June 2020

Antakya, also known as Antioch, is a special historic city for many reasons. It has maintained a unique blend of authentic values that result from a deep historical background, a rich culture, and a diverse religious population living together with tolerance and in peace for centuries. As a city in the southeastern corner of Turkey near Syria, its rich cultural identity is reflected in various aspects and parts of the city. Kurtuluş Avenue is one of the major urban axes of Antakya and is a remarkable case. It stands out from other parts of the city for having a unique architectural style that is defined by an interesting group of buildings with characteristics between vernacular and modern. Kurtuluş Avenue, a version of the ancient Herod Road, was widened and redirected during the French Mandate Period. Half of its buildings were demolished and renewed and the other half were renovated and reused, creating this particular group of buildings that define this new main artery with a new Western architectural style. The buildings are the products of a nuanced synthesis with common references to vernacular and modern architecture. Kurtuluş Avenue can be considered as a good example for the reflections of the transformations from vernacular to modern architecture and can help to understand this process from a different perspective. With the aim of analyzing, defining, and presenting the reflections of the transformations of urban and architectural characteristics of the buildings located along Kurtuluş Avenue, urban morphology and typo-morphological methods are used.
The Fragmentation of Identity Formation in the Age of Glocalization
Authors: Belamghari Mohamed
Published: June 2020

Although the issue of identity has been a concern since the dawn of time, the globalizing drive has triggered more interest in the phenomenon, quite often leading to geopolitical and social crises. As a matter of fact, with the advent of a new age of glocalization—generally characterized by its deterritorializing tendencies—identity construction has proven to be fraught with a number of fragmentations, only to suggest that our understanding of how our identities are co-construed is still way too far to be accounted for in its entirety. This study argues that identity is a process of becoming rather than being, and it is thus formed in compliance with the exigencies of each and every time. While accompanied in theoretical perspectives, the study attempts to lay bare the different processes involved in one’s identity construction as it has been negotiated in the “pre-modern,” “modern,” and now “(late-)post-modern” ages. Such genealogical perspective paves the way to uncover the contentions inherent in the phenomenon, especially as we are nearing times where the blend of the local and the global has been exacerbated today more.
Concomitants of Gynaecological Problem: A Study on Young Married Women of Rural West Bengal
Authors: Bhattacharyya Nandini , Dasgupta Doyel , Roy Subho
Published: June 2020

Gynaecological problem makes up a sizable proportion of disease burden in women. Majority of these problems remain unaddressed as cultural and gender norms make women silent to report these problems. Undiagnosed and untreated gynaecological problems at young age may have physical and psychological consequences in later life. This article aims to understand the prevalence of gynaecological problems and its concomitants among young married women of rural West Bengal. We collected data on 1,107 young married women, aged 24 years or below, inhabiting the rural areas of three districts of West Bengal with at least one child of five years or below. A pretested structured schedule was used to collect data on socio-demographic variables and symptoms related to gynaecological problems and their management. Focus group discussions (FGDs) were conducted to get an in-depth understanding of the participants towards gynaecological problems and management. Around 41 per cent of women reported at least one of the gynaecological problems. Excessive vaginal discharge with bad odour, pain or burning sensation while passing urine, itching at vagina, lower abdominal pain, menstrual irregularities and painful menstruation were the most reported problems. Only 22 per cent of participants sought medical advice. FGDs reveal that there is a variation among the participants regarding the perception and awareness of gynaecological problems. Sexual activity, early marriage and menstrual hygiene were perceived to be the causes of gynaecological problems. The local healers were consulted at the initial stage of the problem; qualified medical practitioners were consulted when the problem persisted. We conclude from this study that socio-cultural factors remain the primary reason behind the high prevalence of gynaecological problem among the study participants.
Elementary Music Teachers’ Experiences Training and Collaborating With Paraprofessionals
Authors: Majerus Claire , Taylor Donald M.
Published: June 2020

The purpose of this study was to investigate elementary music teachers’ perceptions of paraprofessional participation in the classroom and to examine the extent to which instructors provided preparation for their paraprofessional colleagues. Five hundred and four members of the National Association for Music Education completed a 32-item survey utilizing a 3-point Likert-type scale ( strongly agree = 3, neither agree nor disagree = 2, strongly disagree = 1). Music teachers indicated that they need help with behavioral reinforcements and transitions in the classroom (e.g., entering, exiting, and moving between activities). They also needed paraprofessionals to adapt music activities for students spontaneously during class, but they provided little to no guidance or training for their colleagues. Out of 504 participants, only 8 (1.6%) indicated any kind of regular meetings with paraprofessionals and special education teachers outside the music classroom to discuss goals and strategies.
Influence of Load and Transducer Bandwidth on the Repeatability of In Vivo Tendon Stiffness Evaluation Using Shear Wave Elastography
Authors: Obuchowicz Rafał , Ambrozinski Lukasz , Kohut Piotr
Published: June 2020

Objective:

To determine how different examination protocols with the use of transducers, of different bandwidths, and applied with varied tension to tendons would influence the sonographic study results.

Methods:

Thirty-one participants were divided into two groups, with one subject used for theoretical investigation (A) and the remaining participants (B = 30) forming the study cohort. Both sets of participants were examined with three different transducers (SL10–3, SL15–4, and SL18–7) as well as with variable loading on the Achilles tendon (relaxed, tensed, and loaded). The resulting coverage of the color map provided qualitative tendon stiffness and quantitative tendon stiffness values.

Results:

The estimated mean coverage extent, using elastographic color maps, produced by the three transducers was 98%, 98%, and 99%, respectively, in the relaxed state. Likewise, in the tensed state, mean coverage was 85%, 82%, and 77% in group A and 91%, 78%, and 71% in group B, respectively. Examining tendons that were loaded, the mean coverage was 68%, 42%, and 41%, respectively. The quantitative relaxed mean tendon elasticity values were 323, 366, and 393 kPa, respectively, in group A. Likewise, the relaxed mean values were 329, 341, and 358 kPa, respectively, in group B. The quantitative tensed mean tendon elasticity values were 413, 460, and 426 kPa, respectively, in group A. Likewise the tensed mean values were 412, 440, and 436 kPa, respectively, in group B.

Conclusions:

Varying the tendon loading significantly influenced the color map coverage, which governs the most reliable quantitative measurements on relaxed tendons. The best color map coverage was achieved using the transducer with the lowest frequency, regardless of the tension applied.
Comparing clinical outcomes of piperacillin-tazobactam administration and dosage strategies in critically ill adult patients: a systematic review and meta-analysis
Authors: Fawaz Sarah , Barton Stephen , Nabhani-Gebara Shereen
Published: June 2020

Background

Recently, continuous administration of piperacillin-tazobactam has been proposed as a valuable alternative to traditional intermittent administration especially in critically ill patients. However, antibiotic dosing remains a challenge for clinicians as antibiotic dosing regimens are usually determined in non-critically ill hospitalized adult patients. The aim was to conduct a systematic review to identify and highlight studies comparing clinical outcomes of piperacillin tazobactam dosing regimens, continuous/prolonged infusion vs intermittent infusion in critically ill patients. Meta-analyses were performed to assess the overall effect of dosing regimen on clinical efficacy.

Methods

Studies were identified systematically through searches of PubMed and Science Direct, in compliance with PRISMA guidelines. Following the systematic literature review, meta-analyses were performed using Review Manager.

Results

Twenty-three studies were included in the analysis involving 3828 critically ill adult participants in total (continuous/prolonged infusion = 2197 and intermittent infusion = 1631) from geographically diverse regions. Continuous/prolonged resulted in significantly: higher clinical cure rates (Odds Ratio 1.56, 95% Confidence Interval 1.28–1.90, P = 0 .0001), lower mortality rates (Odds Ratio 0.68, 95% Confidence Interval 0.55–0.84, P = 0 .0003), higher microbiological success rates (Odds Ratio 1.52, 95% Confidence Interval 1.10–2.11, P = 0.01) and decreasing the length of hospital stay (Mean Difference − 1.27, 95% Confidence Interval − 2.45—0.08, P = 0.04) in critically ill patients.

Conclusion

Results from this study show that there is a significant level of evidence that clinical outcome in critically ill patients is improved in patients receiving piperacillin-tazobactam via continuous/prolonged infusion. However, more rigorous scientific studies in critically ill patients are warranted to reach a sufficient level of evidence and promote further implementation of C/PI as a dosing strategy.
Correlation of internal carotid artery diameter and carotid flow with asymmetry of the circle of Willis
Authors: Wu Te-Chang , Chen Tai-Yuan , Ko Ching-Chung , Chen Jeon-Hor , Lin Ching-Po
Published: June 2020

Background

The purpose of this study was to clarify the effect of asymmetric COW variants on carotid flow changes, and proposed an easy estimate of the representative carotid flow volume for accurate numerical simulation.

Methods

A total of 210 healthy adults receiving magnetic resonance angiography and carotid duplex sonography were included. Three anterior cerebral artery asymmetry (AA) groups were defined based on the diameter ratio difference (DRD) of bilateral A1 segments: AA1 group, one-side A1 aplasia; AA2, A1 DRD ≥ 50%; AA3, A1 DRD between 10 and 50%. Similarly, 3 posterior communicating artery (PcomA) asymmetry (PA) groups were defined: PA1 group, one fetal-origin posterior cerebral artery and absent contralateral PcomA; PA2, PcomA DRD ≥ 50%; PA3, PcomA DRD between 10 and 50%.

Results

With A1 asymmetry, the ICA diameter of the dominant A1 is significantly greater than the contralateral side. Significant differences of bilateral ICA flow were present in the AA1 and AA2 groups (mean flow difference 42.9 and 30.7%, respectively). Significant bilateral ICA diameter and flow differences were only found in the PA1 group. Linear regression analysis of ICA diameter and flow found a moderately positive correlation between ICA diameter and flow in all AA groups, with a 1 mm increment in vessel diameter corresponding to a 62.6 ml increment of flow volume. The product of bilateral ICA diameter and flow volume difference (ICA-PDF) could be a potential discriminator with a cutoff of 4.31 to predict A1 asymmetry ≥50% with a sensitivity of 0.81 and specificity of 0.76.

Conclusions

The study verifies that A1 asymmetry causes unequal bilateral carotid inflow, and consequently different bilateral ICA diameters. Adjustment of the inflow boundary conditions according to the COW variants would be necessary to improve the accuracy of numerical simulation.
Plasma omega-3 polyunsaturated fatty acids and recurrence of endometrial cancer
Authors: Li Peiqin , Shan Boer , Jia Keyu , Hu Fan , Xiao Ying , Zheng Jusheng , Gao Yu-Tang , Wang Huaying , Gao Ying
Published: June 2020

Background

Omega-3 polyunsaturated fatty acids (PUFAs) were proposed to have potential effects against inflammation and cancer. However, results from epidemiology studies remain inconsistent. We aimed to explore the associations of plasma PUFAs with EC recurrence and all-cause mortality.

Method

Women diagnosed with endometrial cancer (EC) between 2008 and 2013 and underwent surgery at Fudan University Shanghai Cancer Center of China were recruited. Survival status was followed up through September 2017. EC recurrence and total cause deaths were identified through medical record and telephone interview. In total, 202 patients with enough plasma samples at time of surgery were included. There were 195 patients who provided baseline plasma and survival information included in the current study. Plasma omega-3 PUFAs were measured by GC-FID. Cox Proportional Hazard model adjusted for potential cofounders was used to estimate HRs and 95% CIs.

Results

Median follow-up time for patients was 58 months after surgery. A total of 13 recurrences and 11 all-cause deaths, of which, 2 deaths from EC, were identified. Level of plasma EPA was higher in recurrent patients than total patients (0.78% vs 0.51%,P = 0.015). Higher plasma eicosapentaenoic acid (EPA) level trended to have positive association with EC recurrence (P-trend = 0.04), although comparing to the lowest tertile, the highest tertile of EPA level was not significantly associated with increased risk of EC recurrence (HRT3vsT1 = 6.02; 95%CI = 0.7–52.06). The association between total omega-3 PUFA and EC recurrence tended to be stronger among patients with deeper myometrial invasion (OR = 3.41; 95%CI = 1.06–10.95;P-interaction = 0.04).

Conclusions

Higher plasma EPA level was significantly associated with EC recurrence. Further studies are warranted to confirm these findings.

Trial registration

ChiCTR1900025418; Retrospectively registered (26 August 2019); Chinses Clinical Trial Registry.
High fetal hemoglobin level is associated with increased risk of cerebral vasculopathy in children with sickle cell disease in Mayotte
Authors: Chamouine Abdourahim , Saandi Thoueiba , Muszlak Mathias , Larmaraud Juliette , Lambrecht Laurent , Poisson Jean , Balicchi Julien , Pissard Serge , Elenga Narcisse
Published: June 2020

Background

Understanding the genetics underlying the heritable subphenotypes of sickle cell anemia, specific to each population, would be prognostically useful and could inform personalized therapeutics.The objective of this study was to describe the genetic modulators of sickle cell disease in a cohort of pediatric patients followed up in Mayotte.

Methods

This retrospective cohort study analyzed clinical and biological data, collected between January1st2007 and December 31st2017, in children younger than 18 years.

Results

We included 185 children with 72% SS, 16% Sβ0-thalassemia and 12% Sβ + thalassemia. The average age was 9.5 years; 10% of patients were lost to follow up. The Bantu haplotype was associated with an increase in hospitalizations and transfusions. The alpha-thalassemic mutation was associated with a decrease of hemolysis biological parameters (anemia, reticulocytes), and a decrease of cerebral vasculopathy. The Single Nucleotide Polymorphisms BCL11A rs4671393, BCL11A rs11886868, BCL11A rs1427407 and HMIP rs9399137 were associated with the group of children with HbF > 10%. Patients with HbF > 10% presented a significant risk of early onset of cerebral vasculopathy.

Conclusions

The most remarkable result of our study was the association of SNPs with clinically relevant phenotypic groups. BCL11A rs4671393, BCL11A rs11886868, BCL11A rs1427407 and HMIP rs9399137 were correlated with HbF > 10%, a group that has a higher risk of cerebral vasculopathy and should be oriented towards the hemolytic sub-phenotype.
Correlation between private education costs and parental depression in South Korea
Authors: Oh Byeong Cheol , Yeon Ji-Yoon , Lee Hyo-Sang , Lee Doo Woong , Park Eun-Cheol
Published: June 2020

Background

In Korea, higher education has rapidly grown influenced by sociocultural tradition. Parents invest a significant portion of their household income in their children’s education. Private education has been considered to greatly affect students’ psychology and behavior. However, past research has largely neglected to study parents who pay these costs. Since household income and education level are important determinants of socioeconomic status (SES), education expenditures are likely to cause depressive symptoms. Therefore, the study aimed to investigate the correlation between private education costs and parental depression in South Korea.

Methods

Data were collected from the Korean Welfare Panel Study (KoWePS, 2015, 2018). The sample analyzed consisted of 397 and 337 fathers and 403 and 370 mothers in 2015 and 2018, respectively. The independent variable in this study was the proportion of private education cost. This proportion was calculated by dividing each household’s private education costs by its equivalized household disposable income (EHDI) and multiplying this number by 100. The main dependent variable was parental responses to the Center for Epidemiologic Studies Depression Scale-11 (CESD-11). Using a generalized linear model, we investigated the effects of the proportion of private education cost on parental depression.

Results

The results showed that fathers with higher proportions of private education cost exhibited higher CESD-11 scores compared to fathers with lower proportions cost (moderate: β = 0.419, S. E = 0.164, p = 0.0105; high: β = 0.476, S. E = 0.178, p = 0.0076), indicating that a higher ratio of private education cost may negatively affect depression in fathers. However, there was no discernable correlation between mothers’ CESD-11 scores and the proportion of private education cost (moderate: β = − 0.078, S. E = 0.250, p = 0.7555; high: β = 0.003, S. E = 0.215, p = 0.9882).

Conclusions

These results may be explained by the tendency for fathers to experience greater economic burdens than mothers in patriarchal Korean society.
Choosing and Doing wisely: triage level I resuscitation a possible new field for starting palliative care and avoiding low-value care – a nationwide matched-pair retrospective cohort study in Taiwan
Authors: Lin Chih-Yuan , Lee Yue-Chune
Published: June 2020

Background

The association between palliative care and life-sustaining treatment following emergency department (ED) resuscitation is unclear. This study aims to analyze the usage of palliative care and life-sustaining treatments among ED triage level I resuscitation patients based on a nationally representative sample of patients in Taiwan.

Methods

A matched-pair retrospective cohort study was conducted to examine the association between palliative care and outcome variables using multivariate logistic regression and Kaplan–Meier survival analyses. Between 2009 and 2013, 336 ED triage level I resuscitation patients received palliative care services (palliative care group) under a universal health insurance scheme. Retrospective cohort matching was performed with those who received standard care at a ratio of 1:4 (usual care group). Outcome variables included the number of visits to emergency and outpatient departments, hospitalization duration, total medical expenses, utilization of life-sustaining treatments, and duration of survival following ED triage level I resuscitation.

Results

The mean survival duration following level I resuscitation was less than 1 year. Palliative care was administered to 15% of the resuscitation cohort. The palliative care group received significantly less life-sustaining treatment than did the usual care group.

Conclusion

Among patients who underwent level I resuscitation, palliative care was inversely correlated with the scope of life-sustaining treatments. Furthermore, triage level I resuscitation status may present a possible new field for starting palliative care intervention and reducing low-value care.
Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: a retrospective study
Authors: Hung Yi-Chih , Chiu Lu-Ting , Huang Hung-Yu , Bau Da-Tian
Published: June 2020

Background

Studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian patients with type 2 DM without established CV diseases but with risk factors for CV diseases.

Methods

Between 2000 and 2012, we enrolled patients aged ≥ 18 years, who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension and hyperlipidemia. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone and non-pioglitazone groups based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. The subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. Chi square test, Student’s t-test, competing risk regression models, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted.

Results

A total of 13 078 patients were included in the pioglitazone and non-pioglitazone groups. Compared with patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.78; 95% confidence interval: 0.62–0.95). The subgroup analyses defined by different baseline features did not reveal significant alterations in the observed effect of pioglitazone. Moreover, a significant decreasing trend in ischemic stroke risk with an increase in pioglitazone dose (p-value for trend = 0.04) was observed.

Conclusion

Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.

Trial registration number CMUH104-REC2-115-CR4
Sociodemographic factors associated with low intake of bioavailable iron in preschoolers: National Health and Nutrition Survey 2012, Mexico
Authors: Venegas-Aviles Yazmín , Rodríguez-Ramírez Sonia , Monterrubio-Flores Eric , García-Guerra Armando
Published: June 2020

Background

Children < 5 years of age are at risk of developing an iron deficiency due to a low intake of bioavailable iron (FeBio). Few studies have estimated dietary FeBio in children at a national level in relation to sociodemographic characteristics. This study aimed to estimate FeBio intake and its association with sociodemographic factors among Mexican children aged 12–59 months.

Methods

A cross-sectional study was carried out. Information on serum ferritin and diet was obtained from a national survey and representative sample of 1012 Mexican children aged 12–59 months. We used a 24-h recall to estimate total iron, heme and non-heme iron, vitamin C, phytates, calcium, and meat intake. We calculated FeBio intake using an algorithm. Differences in FeBio intake were analyzed by area of residence (rural/urban), country region (north, center, south), and socioeconomic status (SES), using linear regression models by age subgroups (12–23 and 24–59 months) and total population, while adjusting for study design.

Results

Total iron intake was 9.2 ± 6.7 mg/d. The estimated average of total FeBio fluctuated between 0.74–0.81 mg/d, with a bioavailability of 9.15–12.03% of total iron. Children aged 12–23 months residing in rural areas consumed less FeBio than those in urban areas (β = − 0.276) (p < 0.05). Children aged 24–59 months with high SES consumed more FeBio (β = 0.158 mg/d) than those of a low SES (p < 0.05).

Conclusions

FeBio is low in Mexican preschoolers. Being from a rural area and having low SES were negatively associated with FeBio intake. These results can benefit interventions seeking to improve iron status.