bluuebunny/crossref_metadata_2025 huggingface dataset:
Status of maternal serum B vitamins and pregnancy outcomes: New insights from in vitro fertilization and embryo transfer (IVF-ET) treatment
Authors: Zhang Ling , Wu Li-mei , Xu Wei-hai , Tian Yu-qing , Liu Xu-ling , Xia Chen-yun , Zhang Lin , Li Shi-shi , Jin Zhen , Wu Xiang-li , Shu Jing
Published: November 2022

The influence of B vitamins on human fertility and infertility treatments remains elusive. Therefore, this study investigated the association of most B vitamins with IVF-ET outcomes. A total of 216 subjects aged <35 year in their first oocyte retrieval cycle were recruited. Blood samples from the participants were collected before the oocyte pick-up procedure, and serum levels of riboflavin, niacin, pantothenic acid, vitamin B6 (including PA and PLP), folate, and methylmalonic acid (MMA) were detected using high-performance liquid chromatography–tandem mass spectrometry (HPLC-MS/MS). Endpoints were classified into three groups according to tertiles (lower, middle, and upper) of each vitamin index, and the association of the serum vitamin status with intermediate and clinical outcomes was analyzed using a generalized estimating equation model. Higher riboflavin levels were associated with elevated probabilities of high-quality embryos, as well as clinical pregnancy after embryo transfer. A greater likelihood of transferable embryos was found in the middle tertile of serum folate. Similarly, a negative correlation of serum MMA, a marker of vitamin B12 deficiency, with high-quality embryos was identified. No significance was observed for other vitamins in terms of all endpoints. Therefore, sufficient levels of pre-conception riboflavin, folate, and vitamin B12 are recommended for successful infertility treatment and pregnancy planning; further evidence is needed to confirm our conclusion.
A ferroptosis-related gene signature associated with immune landscape and therapeutic response in osteosarcoma
Authors: Wang Xinxing , Xia Guang , Xiao Shilang , Wu Song , Zhang Lina , Huang Junjie , Zhang Wenxiu , Cao Xu
Published: November 2022

Background

The role of ferroptosis in tumor progression and immune microenvironment is extensively investigated. However, the potential value of ferroptosis regulators in predicting prognosis and therapeutic strategies for osteosarcoma (OS) patients remains to be elucidated.

Methods

Here, we extracted transcriptomic and survival data from Therapeutically Applicable Research to Generate Effective Treatments (TARGET) and Gene Expression Omnibus (GEO) to investigate the expression and prognostic value of ferroptosis regulators in OS patients. After comprehensive analyses, including Gene set variation analysis (GSVA), single-sample gene-set enrichment analysis (ssGSEA), Estimated Stromal and Immune cells in Malignant Tumor tissues using Expression (ESTIMATE), single-cell RNA sequencing, and biological experiments, our constructed 8-ferroptosis-regulators prognostic signature effectively predicted the immune landscape, prognosis, and chemoradiotherapy strategies for OS patients.

Results

We constructed an 8-ferroptosis-regulators signature that could predict the survival outcome of OS. The signature algorithm scored samples, and high-scoring patients were more prone to worse prognoses. The tumor immune landscape suggested the positive relevance between risk score and immunosuppression. Interfering HILPDA and MUC1 expression would inhibit tumor cell proliferation and migration, and MUC1 might improve the ferroptosis resistance of OS cells. Moreover, we predicted chemoradiotherapy strategies of cancer patients following ferroptosis-risk-score groups.

Conclusion

Dysregulated ferroptosis gene expression can affect OS progression by affecting the tumor immune landscape and ferroptosis resistance. Our risk model can predict OS survival outcomes, and we propose that HILPDA and MUC1 are potential targets for cancer therapy.
Utilization of functional MRI in the diagnosis and management of cervical cancer
Authors: Matani Hirsch , Patel Ankur K. , Horne Zachary D. , Beriwal Sushil
Published: November 2022

Introduction

Imaging is integral part of cervical cancer management. Currently, MRI is used for staging, follow up and image guided adaptive brachytherapy. The ongoing IQ-EMBRACE sub-study is evaluating the use of MRI for functional imaging to aid in the assessment of hypoxia, metabolism, hemodynamics and tissue structure. This study reviews the current and potential future utilization of functional MRI imaging in diagnosis and management of cervical cancer.

Methods

We searched PubMed for articles characterizing the uses of functional MRI (fMRI) for cervical cancer. The current literature regarding these techniques in diagnosis and outcomes for cervical cancer were then reviewed.

Results

The most used fMRI techniques identified for use in cervical cancer include diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE). DCE-MRI indirectly reflects tumor perfusion and hypoxia. This has been utilized to either characterize a functional risk volume of tumor with low perfusion or to characterize at-risk tumor voxels by analyzing signal intensity both pre-treatment and during treatment. DCE imaging in these situations has been associated with local control and disease-free survival and may have predictive/prognostic significance, however this has not yet been clinically validated. DWI allows for creation of ADC maps, that assists with diagnosis of local malignancy or nodal disease with high sensitivity and specificity. DWI findings have also been correlated with local control and overall survival in patients with an incomplete response after definitive chemoradiotherapy and thus may assist with post-treatment follow up. Other imaging techniques used in some instances are MR-spectroscopy and perfusion weighted imaging. T2-weighted imaging remains the standard technique used for diagnosis and radiation treatment planning. In many instances, it is unclear what additional information functional-MRI techniques provide compared to standard MRI imaging.

Conclusions

Functional MRI provides potential for improved diagnosis, prediction of treatment response and prognostication in cervical cancer. Specific sequences such as DCE, DWI and ADC need to be validated in a large prospective setting prior to widespread use. The ongoing IQ-EMBRACE study will provide important clinical information regarding these imaging modalities.
Collimating individual beamlets in pencil beam scanning proton therapy, a dosimetric investigation
Authors: Holmes Jason , Shen Jiajian , Patel Samir H. , Wong William W. , Foote Robert L. , Bues Martin , Liu Wei
Published: November 2022

The purpose of this work is to investigate collimating individual proton beamlets from a dosimetric perspective and to introduce a new device concept, the spot scanning aperture (SSA). The SSA consists of a thin aperture with a small cylindrical opening attached to a robotics system, which allows the aperture to follow and align with individual beamlets during spot delivery. Additionally, a range shifter is incorporated (source-side) for treating shallow depths. Since the SSA trims beamlets spot by spot, the patient-facing portion of the device only needs to be large enough to trim a single proton beamlet. The SSA has been modelled in an open-source Monte-Carlo-based dose engine (MCsquare) to characterize its dosimetric properties in water at depths between 0 and 10 cm while varying the following parameters: the aperture material, thickness, distance to the water phantom, distance between the aperture and attached range shifter, and the aperture opening radius. Overall, the SSA greatly reduced spot sizes for all the aperture opening radii that were tested (1 – 4 mm), especially in comparison with the extended range shifter (ranger shifter placed at 30 cm from patient); greater than 50% when placed less than 10 cm away from the patient at depths in water less than 50 mm. The peak to entrance dose ratio and linear energy transfer was found to depend on the thickness of the aperture and therefore the aperture material. Neutron production rates were also investigated and discussed.
A hybrid breast cancer classification algorithm based on meta-learning and artificial neural networks
Authors: Han Luyao , Yin Zhixiang
Published: November 2022

The incidence of breast cancer in women has surpassed that of lung cancer as the world’s leading new cancer case. Regular screening and measures become an effective way to prevent breast cancer and also provide a good foundation for later treatment. Women should receive regular checkups in the hospital after reaching a certain age. The use of computer-aided technology can improve the accuracy and efficiency of physicians’ decision-making. Data pre-processing is required before data analysis, and 16 features are selected using a correlation-based feature selection method. In this paper, meta-learning and Artificial Neural Networks (ANN) are combined to create a hybrid algorithm. The proposed hybrid algorithm for predicting breast cancer was attempted to achieve 98.74% accuracy and 98.02% F1-score by creating a combination of various meta-learning models whose output was used as input features for creating ANN models. Therefore, the hybrid algorithm proposed in this paper can obtain better prediction results than a single model.
Development and Validation of a nomogram for forecasting survival of alcohol related hepatocellular carcinoma patients
Authors: Yan Tao , Huang Chenyang , Lei Jin , Guo Qian , Su Guodong , Wu Tong , Jin Xueyuan , Peng Caiyun , Cheng Jiamin , Zhang Linzhi , Liu Zherui , Kin Terence , Ying Fan , Liangpunsakul Suthat , Li Yinyin , Lu Yinying
Published: November 2022

Background

With the increasing incidence and prevalence of alcoholic liver disease, alcohol-related hepatocellular carcinoma has become a serious public health problem worthy of attention in China. However, there is currently no prognostic prediction model for alcohol-related hepatocellular carcinoma.

Methods

The retrospective analysis research of alcohol related hepatocellular carcinoma patients was conducted from January 2010 to December 2014. Independent prognostic factors of alcohol related hepatocellular carcinoma were identified by Lasso regression and multivariate COX proportional model analysis, and the nomogram model was constructed. The reliability and accuracy of the model were assessed using the concordance index(C-Index), receiver operating characteristic (ROC) curve and calibration curve. Evaluate the clinical benefit and application value of the model through clinical decision curve analysis (DCA). The prognosis was assessed by the Kaplan-Meier (KM) survival curve.

Results

In sum, 383 patients were included in our study. Patients were stochastically assigned to training cohort (n=271) and validation cohort (n=112) according to 7:3 ratio. The predictors included in the nomogram were splenectomy, platelet count (PLT), creatinine (CRE), Prealbumin (PA), mean erythrocyte hemoglobin concentration (MCHC), red blood cell distribution width (RDW) and TNM. Our nomogram demonstrated excellent discriminatory power (C-index) and good calibration at 1-year, 3-year and 5- year overall survival (OS). Compared to TNM and Child-Pugh model, the nomogram had better discriminative ability and higher accuracy. DCA showed high clinical benefit and application value of the model.

Conclusion

The nomogram model we established can precisely forcasting the prognosis of alcohol related hepatocellular carcinoma patients, which would be helpful for the early warning of alcohol related hepatocellular carcinoma and predict prognosis in patients with alcoholic hepatocellular carcinoma.
A joint transcriptional regulatory network and protein activity inference analysis identifies clinically associated master regulators for biliary atresia
Authors: Sun Panpan , Xiao Manhuan , Chen Huadong , Zhong Zhihai , Jiang Hong , Feng Xuyang , Luo Zhenhua
Published: November 2022

Biliary atresia (BA) is a devastating cholangiopathy in neonate. Transcription factors (TFs), a type of master regulators in biological processes and diseases, have been implicated in pathogenesis of BA. However, a global view of TFs and how they link to clinical presentations remain explored. Here, we perform a joint transcriptional regulatory network and protein activity inference analysis in order to investigate transcription factor activity in BA. By integration of three independent human BA liver transcriptome datasets, we identify 22 common master regulators, with 14 activated- and 8 repressed TFs. Gene targets of activated TFs are enriched in biological processes of SMAD, NF-kappaB and TGF-beta, while those of repressed TFs are related to lipid metabolism. Mining the clinical association of TFs, we identify inflammation-, fibrosis- and survival associated TFs. In particular, ZNF14 is predictive of poor survival and advanced live fibrosis. Supporting this observation, ZNF14 is positively correlated with T helper cells, cholangiocytes and hepatic stellate cells. In sum, our analysis reveals key clinically associated master regulators for BA.
The effect of sodium-glucose cotransporter 2 inhibitors on biomarkers of inflammation: A systematic review and meta-analysis of randomized controlled trials
Authors: Wang Dongmei , Liu Jieying , Zhong Ling , Li Shunhua , Zhou Liyuan , Zhang Qian , Li Ming , Xiao Xinhua
Published: November 2022

Aims: Inflammatory biomarkers may play vital roles in the pathophysiology of diabetes and diabetic cardiorenal complications. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have a potential cardiovascular and renal protective effect in type 2 diabetes. The aim of this meta-analysis was to quantify the effects of SGLT2 inhibitors on biomarkers of inflammation in randomized controlled trials (RCTs).

Methods: PubMed, Cochrane Library, EMBASE, and Web of Science were searched for eligible RCTs of adults with type 2 diabetes (T2D) with no time limit (updated to 12 October 2022). The biomarkers selected included C-reactive protein (CRP), interleukin-6, tumor necrosis factor-alpha, leptin, adiponectin, ferritin, plasminogen activator inhibitor (PAI)-1, and vascular cell adhesion molecule-1. Data were analyzed using a random-effect model in Review Manager 5.4.

Results: Thirty-four studies with 6,261 patients (68.6% male) were eligible for this meta-analysis. The mean age of the participants was 62.57(±11.13) years old, and the median treatment duration length with follow-up was 24 weeks. Generally, the included trials were of good methodological quality. The meta-analysis revealed that ferritin levels were significantly reduced in SGLT2 inhibitor treatment groups versus placebo or standard diabetes therapies (SMD: −1.21; 95% CI: −1.91, −0.52, p < 0.001). The effects of CRP (SMD: 0.25; 95% CI: −0.47, −0.03, p = 0.02) and leptin (SMD: −0.22; 95% CI: −0.43, −0.01, p = 0.04) were reduced, and the effects of adiponectin were improved (SMD: 0.28; 95% CI: 0.15, 0.41, p < 0.001) in placebo-controlled studies. PAI-1 levels were significantly reduced in studies controlled for diabetes therapies (SMD: −0.38; 95% CI: −0.61, −0.15, p = 0.001).

Conclusion: This analysis provides strong evidence supporting anti-inflammatory effects of SGLT2 inhibitors in T2D subjects. The mechanisms and possible targets for the inflammation reducing and cardiorenal protective properties of SGLT2 inhibitors remain to be explored.
Core-middle-periphery network model for China banking system
Authors: Chen Na , Liu Jianguo , Chen Yihui , Tu Ding , Ou Yang , Jiang Mingzhu
Published: November 2022

The banking system could be mapped by the network model to generate the structural properties of evolution dynamics. In this study, we empirically investigate the evolution properties of the China bank network from 2008 to 2019 where the banks and lending relationships are set as the nodes and links. By introducing the middle layer into the core–periphery (CP) model, we present the core–middle–periphery (CMP) model where the nodes belonging to the core layer are fully connected and the ones belonging to the middle layer connect the core and periphery layer. Compared with the traditional CP model, the reconstruction error of the CMP model is decreased by 64% compared with the one obtained by the CP model, and the transition stability probability is enhanced greatly. This work is helpful for deeply understanding the evolution properties of the banking system.
Phytolith occluded organic carbon in Fagopyrum (Polygonaceae) plants: Insights on the carbon sink potential of cultivated buckwheat planting
Authors: Wang Linjiao , Sheng Maoyin
Published: November 2022

Crop cultivation has great potential to result in a phytolith carbon sink and can play important roles in the long-term stable carbon sequestration of terrestrial ecosystems. Buckwheat, an important multigrain crop with a very long cultivation history, is widely planted around the world. The phytolith carbon sink potential of buckwheat planting is still limited in the in-depth understanding of biogeochemical carbon sequestration in croplands. In order to estimate the phytolith carbon sink potential of buckwheat planting, in the present study, six species including 17 populations of Fagopyrum plants were selected as study materials. Firstly, their phytoliths were extracted using the wet oxidation method; then, the phytolith-occluded organic carbon (PhytOC) contents were determined using the spectrophotometry method; finally, the phytolith carbon sink potential of buckwheat planting was estimated. Results showed the following: 1) The PhytOC content range of the six Fagopyrum species studied was 0.006%~0.038%, which was significantly lower than that of rice, wheat, sugarcane, and some cereal and oil crops. There were significant differences in total silicon, phytolith, and PhytOC content of Fagopyrum plants among the different species, different organs (root, stem, and leaf), and different living forms (annual, partly perennial, and completely perennial). There were significant positive relationships between PhytOC and phytolith content and between phytolith and total silicon content. 2) The average phytolith carbon sequestration rate of Fagopyrum esculentum and Fagopyrum tataricum planting was 2.62 × 10-3 and 1.17 × 10-3 t CO2 hm-2·a-1, respectively, being approximately equal to that of terrestrial shrub vegetation. 3) The global total amount of phytolith carbon sequestration of buckwheat planting reached 5,102.09 t CO2 in 2018, and the Chinese total amount of phytolith carbon sequestration of buckwheat cultivation was 624.79 t CO2 in 2020. The phytolith carbon sink of buckwheat planting had significant potential for playing obvious roles in the carbon cycle. The present results are of great significance in crop phytolith studies and provide important references for phytolith carbon sink potential estimation of farmland ecosystems.
Photorespiration in eelgrass (Zostera marina L.): A photoprotection mechanism for survival in a CO2-limited world
Authors: Celebi-Ergin Billur , Zimmerman Richard C. , Hill Victoria J.
Published: November 2022

Photorespiration, commonly viewed as a loss in photosynthetic productivity of C3 plants, is expected to decline with increasing atmospheric CO2, even though photorespiration plays an important role in the oxidative stress responses. This study aimed to quantify the role of photorespiration and alternative photoprotection mechanisms inZostera marinaL. (eelgrass), a carbon-limited marine C3 plant, in response to ocean acidification. Plants were grown in controlled outdoor aquaria at different [CO2]aqranging from ~55 (ambient) to ~2121μM for 13 months and compared for differences in leaf photochemistry by simultaneous measurements of O2flux and variable fluorescence. At ambient [CO2], photosynthesis was carbon limited and the excess photon absorption was diverted both to photorespiration and non-photochemical quenching (NPQ). The dynamic range of NPQ regulation in ambient grown plants, in response to instantaneous changes in [CO2]aq, suggested considerable tolerance for fluctuating environmental conditions. However, 60 to 80% of maximum photosynthetic capacity of ambient plants was diverted to photorespiration resulting in limited carbon fixation. The photosynthesis to respiration ratio (PE: RD) of ambient grown plants increased 6-fold when measured under high CO2because photorespiration was virtually suppressed. Plants acclimated to high CO2maintained 4-fold higherPE: RDthan ambient grown plants as a result of a 60% reduction in photorespiration. The O2production efficiency per unit chlorophyll was not affected by the CO2environment in which the plants were grown. Yet, CO2enrichment decreased the light level to initiate NPQ activity and downregulated the biomass specific pigment content by 50% and area specific pigment content by 30%. Thus, phenotypic acclimation to ocean carbonation in eelgrass, indicating the coupling between the regulation of photosynthetic structure and metabolic carbon demands, involved the downregulation of light harvesting by the photosynthetic apparatus, a reduction in the role of photorespiration and an increase in the role of NPQ in photoprotection. The quasi-mechanistic model developed in this study permits integration of photosynthetic and morphological acclimation to ocean carbonation into seagrass productivity models, by adjusting the limits of the photosynthetic parameters based on substrate availability and physiological capacity.
Carbon monoxide promotes stomatal initiation by regulating the expression of two EPF genes in Arabidopsis cotyledons
Authors: Weng Xianjie , Zhu Lingyan , Yu Shuangshuang , Liu Yue , Ru Yanyu , Zhang Zijing , He Zhaorong , Zhou Lijuan , Chen Xiaolan
Published: November 2022

The gaseous molecule carbon monoxide (CO) can freely pass through the cell membrane and participate in signal transduction in the cell to regulate physiological activities in plants. Here, we report that CO has a positive regulatory role in stomatal development. Exogenous CO donor CORM-2 [Tricarbonyldichlororuthenium (II) dimer] treatment resulted in an increase of stomatal index (SI) on the abaxial epidermis of cotyledons in wild-type, which can be reversed by the addition of the CO biosynthesis inhibitor ZnPPIX [Protoporphyrin IX zinc (II)]. Consistent with this result, mutation of the CO biosynthesis gene HY1 resulted in a decrease of SI in hy1-100 plants, while overexpression of HY1 led to an increase of SI. Further investigation revealed that CO acts upstream of SPCH and YDA in the stomatal development pathway, since the loss of function mutants spch-1 and yda-2 were insensitive to CORM-2. The expression of EPF2 was inhibited by CORM-2 treatment in wild type and is lower in hy1 than in wild-type plants. In contrast, the expression of STOMAGEN was promoted by CORM-2 treatment and is higher in HY1-overexpression lines. Loss of function mutants of both epf2 and stomagen are insensitive to CORM-2 treatment. These results indicated that CO positively regulates stomatal initiation and distribution by modulating the expression of EPF2 and STOMAGEN.
Revealing seed color variation and their possible association with yield and quality traits in a diversity panel of flax (Linum Usitatissimum L.)
Authors: Abtahi Mozhgan , Mirlohi Aghafakhr , Sharif-Moghaddam Negar , Ataii Ehsan
Published: November 2022

Seed color is a vital quality determinant of flax, significant for consumers’ acceptability, and determines the commercial values of seeds. Also, seed color as a phenotypic marker may be a convenient way to select the plants with desired traits. This study assessed a diversity panel representing 144 flax genotypes from diverse geographical origins for the existence of genetic variability for luminosity (L*) and chromaticity (a* and b*) seed color parameters, seed yield, and quality traits over two years. The genetic variance was significant for seed color parameters, demonstrating the presence of significant genetic variability, which provides a resource to objectively evaluate and select flax genotypes based on seed color according to the market demand. High heritability combined with the high genotypic coefficient of variation observed for seed yield, oil, and protein content suggested a better genetic gain upon selecting these traits. Seed yield, seed quality traits, and phenological traits showed significant negative correlation with L* and b* parameters and positive correlation with a* suggesting that the seeds’ dark background and brown color can serve as marker characters to prescreen early-flowering, high-yielding and oil and protein-rich genotypes. Interestingly 48 brown-seeded genotypes were identified as early-flowering with short height, large seeds, high thousand seed weight, and capsule diameter. In addition, 34 genotypes were characterized by light-colored yellow seeds, large seeds, late-flowering with shorter height, and high branch numbers. Our results highlighted that North America and Australia-belonged genotypes were lighter yellow-seeded than the ones from other continents. Flax genotypes from South America and Asia were high-yielding, while genotypes from North America were low-yielding genotypes. Moreover, darker brown-seeded genotypes have prevailed in the South American continent.
Identification of GOLDEN2-like transcription factor genes in soybeans and their role in regulating plant development and metal ion stresses
Authors: Alam Intikhab , Manghwar Hakim , Zhang Hanyin , Yu Qianxia , Ge Liangfa
Published: November 2022

The Golden 2-Like (G2-like or GLK) transcription factors are essential for plant growth, development, and many stress responses as well as heavy metal stress. However, G2-like regulatory genes have not been studied in soybean. This study identified the genes for 130 G2-Like candidates’ in the genome of Glycine max (soybean). These GLK genes were located on all 20 chromosomes, and several of them were segmentally duplicated. Most GLK family proteins are highly conserved in Arabidopsis and soybean and were classified into five major groups based on phylogenetic analysis. These GmGLK gene promoters share cis-acting elements involved in plant responses to abscisic acid, methyl jasmonate, auxin signaling, low temperature, and biotic and abiotic stresses. RNA-seq expression data revealed that the GLK genes were classified into 12 major groups and differentially expressed in different tissues or organs. The co-expression network complex revealed that the GmGLK genes encode proteins involved in the interaction of genes related to chlorophyll biosynthesis, circadian rhythms, and flowering regulation. Real-time quantitative PCR analysis confirmed the expression profiles of eight GLK genes in response to cadmium (Cd) and copper (Cu) stress, with some GLK genes significantly induced by both Cd and Cu stress treatments, implying a functional role in defense responsiveness. Thus, we present a comprehensive perspective of the GLK genes in soybean and emphasize their important role in crop development and metal ion stresses.
Exploring the role of digital media dependency on the relationship between personal involvement and flashbulb memory during the pandemic: Empirical evidence from Mainland China
Authors: Ma Xiaoyue , Wan Jing
Published: November 2022

Flashbulb memory (FBM) is viewed as a special type of autobiographical memory due to its richness of individuals’ self-related details when hearing the news and the long duration. It also helps shape people’s impression of public events to some extent. Given that personal involvement is one of the important antecedent variables of FBM, this study proposed to investigate it from spatiotemporal involvement (spatiotemporal distance) and empathic involvement (empathy level) to explore the impact of personal involvement on the formation of FBM during the Covid-19 pandemic. In particular, digital media dependency was considered in the influence of involvement on the FBM since it is a crucial information source for individuals and a path to spread information about their lives and work during the pandemic. In this study, a total of 546 valid questionnaires (from May 1, 2022, to May 7, 2022) and 349 valid questionnaires (from May 10, 2022, to May 17, 2022) were collected through a two-stage online survey in Shanghai, China towards the epidemic wave at the end of March 2022. The mediating mode of digital media dependency was also examined on personal involvement in FBM performance, which consists of FBM specificity, confidence, and consistency. Results showed that empathic involvement had a significant negative influence on FBM specificity, namely the higher the empathy level was, the worse the FBM specificity would be, in which digital media dependency played a suppressing effect. Individuals’ spatiotemporal involvement was proved to have a significant positive influence on FBM specificity and consistency. It was one of the first to investigate the FBM formation process around “small peak” events in the context of the ongoing pandemic. Innovatively, empathy was adopted as the index of memory arousal for empathic involvement, and digital media dependency was considered an important mediator variable in the memory study. The research results have practical significance for promoting the process of epidemic recovery integrated with digital media and can provide a social reference for the shaping process of disaster memory from the perspective of digital information and emotional transmission.
Researching and designing educational games on the basis of “self-regulated learning theory”
Authors: Jiang Feng , Shangguan Dayan
Published: November 2022

As one of the important research fields of educational technology, the potential of educational games has been widely recognized by academic researchers. However, in terms of practical application, it is difficult to balance education and recreation, and problems have also arisen in learners’ cognitive development and skill enhancement. On this basis, this paper initially compares the educational and entertainment aspects of educational games from a learning motivation perspective. It draws on the theory of self-regulated learning and ARCS learning to establish an ARCS learning motivation model and educational game design framework. Finally, it develops a bio evolution education game that is based on this framework, and this verifies that this framework can feasibly guide practice. In drawing on the theory of autonomous learning, this paper discusses the design framework of stimulating and sustaining learning in educational games, and establishes a bridge between user learning behavior and entertainment behavior. This will provide a theoretical and case study reference for the integration of educational purpose and game entertainment into educational games.
A preliminary study of comprehensive behavioral intervention for tics in Chinese children with chronic tic disorder or Tourette syndrome
Authors: Xu Wen , Ding Qiang , Zhao Ying , Jiang Wenqing , Han Jingjing , Sun Jinhua
Published: November 2022

Objective

To investigate the adaptability of Comprehensive Behavioral Intervention for Tics (CBIT) for a Chinese population, and evaluate the efficacy of combined CBIT and pharmacotherapy (CBIT + PT) compared to CBIT or pharmacotherapy (PT) alone for reducing tics and for improving the quality of life (QoL) in a sample of Chinese children with chronic tic disorders (CTD) and Tourette syndrome (TS).

Materials and methods

In this 10-week randomized controlled pilot trial, 37 outpatients aged between 6 and 16 years affected by TS and CTD were randomly assigned to receive CBIT (n = 22) or PT alone (n = 15). Considering the feasibility, the patients allocated to the CBIT treatment group could further choose whether to simultaneously take medicine voluntarily, resulting in a CBIT alone group (n = 12) and a CBIT + PT group (n = 10).

Results

At baseline, no significant difference was found between the three groups in the demographic and clinical characteristics (p > 0.05). All three groups showed a significant reduction in tic severity after treatment assessed by the Yale Global Tic Severity Scale (YGTSS) severity score [F(2,33) = 35.05, p < 0.001, ηp2 = 0.51], the score of the Clinical Global Impression scale for Improvement (CGI-I) [F(1,34) = 13.87, p = 0.001, ηp2 = 0.29], and YGTSS impairment score [F(2,33) = 31.71, p < 0.001, ηp2 = 0.48]. Significant interactions were found between the time-point and group in emotional functioning [F(2,29) = 4.39, p = 0.02, ηp2 = 0.23], psychosocial functioning [F(2,29) = 5.93, p = 0.007, ηp2 = 0.29], and total QoL score [F(1,34) = 3.72, p = 0.04, ηp2 = 0.20] of Pediatric Quality of Life Inventory (PedsQL 4.0) for children suggesting a significantly larger improvement in emotional functioning, psychosocial functioning, and total QoL score of the life quality in the CBIT group for children self-report. PedsQL for proxy report only showed a significant main effect of time-point in physical functioning [F(1,33) = 8.35, p = 0.01, ηp2 = 0.2], emotional functioning [F(1,33) = 10.75, p = 0.002, ηp2 = 0.25], psychosocial functioning [F(1,34) = 11.38, p = 0.002, ηp2 = 0.26], and total Qol score [F(1,34) = 13.21, p = 0.001, ηp2 = 0.29].

Conclusion

CBIT is probably effective in reducing tic severity in Chinese children with tic disorders. CBIT + PT may not be superior to CBIT alone in reducing tic severity and improving quality of life. CBIT alone showed advantages in improving quality of life over CBIT + PT and PT alone. CBIT might be an appropriate treatment option for patients with tic disorder in Chinese mainland.
Budget cap and pay-back model to control spending on medicines: A case study of Bulgaria
Authors: Mitkova Zornitsa , Dimitrova Maria , Doneva Miglena , Tachkov Konstantin , Kamusheva Maria , Marinov Lyubomir , Gerasimov Nikolay , Tcharaktchiev Dimitar , Petrova Guenka
Published: November 2022

Central and Eastern European countries (CEEC) have among the highest rates of increase in healthcare expenditure. External reference pricing, generics and biologics price capping, regressive scale for price setting, health technology assessment (HTA), and positive drug lists for reimbursed medicines are among the variety of implemented cost-containment measures aimed at reducing and controlling the rising cost for pharmaceuticals. The aim of our study was to analyze the influence of a recently introduced measure in Bulgaria—budget capping in terms of overall budget expenditure. A secondary goal was to analyze current and extrapolate future trends in the healthcare and pharmaceutical budget based on data from 2016 to 2021. The study is a retrospective, observational and prognostic, macroeconomic analysis of the National Health Insurance Fund's (NHIF) budget before (2016–2018) and after (2019–2021) the introduction of the new budget cap model. Subgroups analysis for each of the three new budget groups of medicines (group A: medicines for outpatient treatment, prescribed after approval by a committee of 3 specialists; group B: all other medicines out of group A; and group C: oncology and life-saving medicines out of group A) was also performed, and the data were extrapolated for the next 3 years. The Kruskal–Wallis test was applied to establish statistically significant differences between the groups. During 2016–2021, healthcare services and pharmaceutical spending increased permanently, observing a growth of 82 and 80%, respectively. The overall healthcare budget increased from European €1.8 billion to 3.3 billion. The subgroup analysis showed a similar trend for all three groups, with similar growth between them. The highest spending was observed in group C, which outpaced the others mainly due to the particular antineoplastic (chemotherapy) medicines included in it. The rising overall healthcare cost in Bulgaria (from European €1.8 billion to 3.3 billion) reveals that implementation of a mechanism for budget predictability and sustainability is needed. The introduced budget cap is a relatively effective measure, but the high level of overspending and pay-back amount (from European €34 billion to 59 billion during 2019–2021) reveals that the market environmental risk factors are not well foreseen and practically implemented.
Patterns of distress and psychosocial support 2 years post-displacement following a natural disaster in a lower middle income country
Authors: Nzayisenga Emmanuel , Chan Chim W. , Roome Amanda B. , Therrien Ann-Sophie , Sinclair Isabelle , Taleo George , Tarivonda Len , Tosiro Bev , Malanga Max , Tagaro Markleen , Obed Jimmy , Iaruel Jerry , Olszowy Kathryn M. , Dancause Kelsey N.
Published: November 2022

Background

Displacement due to natural disaster exposure is a major source of distress, and disproportionately affects people in low- and middle-income countries (LMICs). Public mental health resources following natural disasters and displacement are often limited in LMICs. In 2017, the population of one island in Vanuatu, a lower-middle income country, was displaced due to volcanic activity. Following the launch of a public mental health policy in 2009, psychosocial support interventions are increasingly available, providing an opportunity to assess relationships with distress following displacement.

Methods

440 people contributed data. We assessed distress using a local adaptation of the Impact of Event Scale-Revised, and types of psychosocial support available and received, including from health professionals, support groups, and traditional networks such as chiefs, traditional healers, and church leaders. We analyzed relationships between distress and psychosocial support, controlling for sociodemographic covariates.

Results

Professional and group support was reported available by 86.8–95.1% of participants. Traditional support networks were widely used, especially by men. Availability of professional support predicted lower distress among men (p < 0.001) and women (p = 0.015) (ηp2 = 0.026–0.083). Consulting church leaders for psychosocial support was associated with higher distress among men (p = 0.026) and women (p = 0.023) (ηp2 = 0.024–0.031). Use of professional and group support was lower than reported availability.

Discussion

Increased collaboration between professional and traditional support networks could help respond to mental health needs following natural disasters in LMICs with limited infrastructure. Providing training and resources to church leaders might be a specific target for improvement. Promoting use of available services represents a continued public health need.
Fractional differential equation modeling of the HBV infection with time delay and logistic proliferation
Authors: Sun Deshun , Liu Jingxiang , Su Xiuyun , Pei Guoxian
Published: November 2022

In this article, a fractional-order differential equation model of HBV infection was proposed with a Caputo derivative, delayed immune response, and logistic proliferation. Initially, infection-free and infection equilibriums and the basic reproduction number were computed. Thereafter, the stability of the two equilibriums was analyzed based on the fractional Routh–Hurwitz stability criterion, and the results indicated that the stability will change if the time delay or fractional order changes. In addition, the sensitivity of the basic reproduction number was analyzed to find out the most sensitive parameter. Lastly, the theoretical analysis was verified by numerical simulations. The results showed that the time delay of immune response and fractional order can significantly affect the dynamic behavior in the HBV infection process. Therefore, it is necessary to consider time delay and fractional order in modeling HBV infection and studying its dynamics.
Identification of high-risk factors for prehospital delay for patients with stroke using the risk matrix methods
Authors: Gao Zihan , Liu Qinqin , Yang Li , Zhu Xuemei
Published: November 2022

Background

Stroke has become a leading cause of mortality and adult disability in China. The key to treating acute ischemic stroke (AIS) is to open the obstructed blood vessels as soon as possible and save the ischemic penumbra. However, the thrombolytic rate in China is only 2.5%. Research has been devoted to investigating the causes of prehospital delay, but the exact controllable risk factors for prehospital delay remain uncertain, and a consensus is lacking. We aimed to develop a risk assessment tool to identify the most critical risk factors for prehospital delay for AIS patients.

Methods

From November 2018 to July 2019, 450 patients with AIS were recruited. Both qualitative and quantitative data were collected. The Delphi technique was used to obtain expert opinions about the importance of the risk indices in two rounds of Delphi consultation. Then, we used the risk matrix to identify high-risk factors for prehospital delay for AIS patients.

Results

The risk matrix identified the following five critical risk factors that account for prehospital delay after AIS: living in a rural area; no bystanders when stroke occurs; patients and their families lacking an understanding of the urgency of stroke treatment; patients and their families not knowing that stroke requires thrombolysis or that there is a thrombolysis time window; and the patient self-medicating, unaware of the seriousness of the symptoms, and waiting for spontaneous remission.

Conclusions

The risk analysis tool used during this study may help prevent prehospital delays for patients with AIS.
A moodle course to substitute resuscitation teaching in a medical curriculum during the COVID-19 pandemic: A prospective pilot study
Authors: Ettl Florian , Schriefl Christoph , Grafeneder Jürgen , Thallner Dominik Gabriel , Mueller Matthias , Fischer Eva , Schlegel Raphael , Sigmund Thorsten , Holzer Michael , Schnaubelt Sebastian
Published: November 2022

Background

Face-to-face medical education was restricted during the COVID-19 pandemic, leading to alternative teaching methods. Moodle® (Modular Object-Oriented Dynamic Learning Environment) – an online course format – has not yet been sufficiently evaluated for its feasibility and effectiveness in teaching cardiopulmonary resuscitation.

Methods

Medical students in the eighth semester took part in a Moodle® course teaching basic life support, the ABCDE-approach, airway management, and advanced life support. The content was presented using digital background information and interactive videos. A multiple-choice test was conducted at the beginning and at the end of the course. Subjective ratings were included as well.

Results

Out of 594 students, who were enrolled in the online course, 531 could be included in this study. The median percentage of correctly answered multiple-choice test questions increased after completing the course [78.9%, interquartile range (IQR) 69.3–86.8 vs. 97.4%, IQR 92.1–100, p < 0.001]. There was no gender difference in the median percentage of correctly answered questions before (female: 79.8%, IQR 70.2–86.8, male: 78.1%, IQR 68.4–86.8, p = 0.412) or after (female: 97.4%, IQR 92.1–100, male: 96.5%, IQR 92.6–100, p = 0.233) the course. On a 5-point Likert scale, 78.7% of students self-reported ≥4 when asked for a subjective increase in knowledge. Noteworthy, on a 10-point Likert scale, male students self-reported their higher confidence in performing CPR [female 6 (5–7), male 7 (6–8), p < 0.001].

Conclusion

The Moodle® course led to a significant increase in theoretical knowledge. It proved to be a feasible substitute for face-to-face courses – both objectively and subjectively.
Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research
Authors: Schwab Sarah M. , Spencer Caroline , Carver Nicole S. , Andrade Valéria , Dugan Sarah , Greve Kelly , Silva Paula L.
Published: November 2022

The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.
Adapting in-person diabetes group visits to a virtual setting across federally qualified health centers
Authors: Nuñez Daisy , Marino-Nuñez Diana , Staab Erin M. , Dinh Tracy , Zhu Mengqi , Wan Wen , Schaefer Cynthia T. , Campbell Amanda , Quinn Michael T. , Baig Arshiya A.
Published: November 2022

Diabetes group visits (GVs) have been shown to improve glycemic control, enrich patient self-care, and decrease healthcare utilization among patients with type 2 diabetes mellitus (T2DM). While telehealth has become routine, virtual GVs remain understudied, especially in federally qualified health centers (FQHCs). We conducted a 5-year cluster randomized trial with a waitlist control group to test the impact of diabetes GVs on patients' outcomes in Midwestern FQHCs. Due to COVID-19, the 6 waitlisted FQHCs adapted to virtual GVs. FQHC staff were provided training and support to implement virtual GVs. The GV intervention included 6 monthly 1–1.5-h long education sessions and appointments with a primary care provider. We measured staff perspectives and satisfaction via GV session logs, monthly webinars, and staff surveys and interviews. Adaptations for implementation of virtual GV included: additional staff training, video conferencing platform use, decreased session length and group size, and adjusting study materials, activities, and provider appointments. Sites enrolled a total of 48 adults with T2DM for virtual GVs. Most FQHCs were urban and all FQHCs predominantly had patients on public insurance. Patients attended 2.1 ± 2.2 GVs across sites on average. Thirty-four patients (71%) attended one or more virtual GVs. The average GV lasted 79.4 min. Barriers to virtual GVs included patient technology issues and access, patient recruitment and enrollment, and limited staff availability. Virtual GV facilitators included providing tablets, internet access from the clinic, and technical support. Staff reported spending on average 4.9 h/week planning and implementing GVs (SD = 5.9). On average, 6 staff from each FQHC participated in GV training and 1.2 staff reported past GV experience. All staff had worked at least 1 year at their FQHC and most reported multiple years of experience caring for patients with T2DM. Staff-perceived virtual GV benefits included: empowered patients to manage their diabetes, provided patients with social support and frequent contact with providers, improved relationships with patients, increased team collaboration, and better patient engagement and care-coordination. Future studies and health centers can incorporate these findings to implement virtual diabetes GVs and promote accessible diabetes care.