bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of smoking on clinical presentation and expression of TLR-2 and CD34 in Oral lichen Planus patients: clinical and immunohistochemical study
Authors: Amin Nermine Raouf , Yussif Nermin , Ahmed Enji
Published: April 2020

Background

Oral lichen planus is a chronic inflammatory disease which is considered as a potential precancerous condition. Numerous studies have confirmed that inflammation is a strong risk factor for cancer development. Smoking is associated with potentially malignant disorders of the oral and oropharyngeal mucosa. The adverse consequences of smoking in various pathologies are mediated by its effects on the immune-inflammatory system. Little is known about the influence of cigarette smoke content on the course of OLP and inflammatory response.

Methods

Twenty oral lichen planus smoker patients, 20 oral lichen planus non-smoker patients and 20 control patients were included in this work. Pain and clinical scores were calculated for each patient. Image analysis to calculate area percent for TLR-2 and CD34 immuno-expression was performed. Data was tabulated and statistically analyzed.

Results

The present study showed no statistically significant difference in clinical and pain scores between the smoker and non-smoker groups. However, there was a significant difference in area percent values for TLR-2 and CD34 immuno-expression between the smoker and the non-smoker groups.

Conclusion

Smoking enhanced TLR-2 and CD34 expression in OLP which are considered as inflammatory mediators and are contributing factors in the pathogenesis of oral lichen planus.
Correlates of use of withdrawal for contraception among women in Vietnam
Authors: Nguyen Nghia , Nguyen Linh , Nguyen Hoai , Gallo Maria F.
Published: April 2020

Background

Despite its relatively low effectiveness, withdrawal is a common contraceptive practice. In Vietnam, health concerns about hormonal contraception are strong and account for substantial method discontinuation. Given the paucity of evidence on withdrawal, our objective was to identify correlates of using withdrawal among women not desiring pregnancy.

Methods

We conducted a secondary analysis of data from a cross-sectional study of sexually-active adult women attending a public hospital in Hanoi, who did not desire pregnancy. We enrolled a stratified sample of women using the intrauterine device, combination oral contraception, or neither method. Participants completed a questionnaire on demographics and reproductive history and behaviors. We used multinomial logistic regression to evaluate correlates of using a tier 3 contraception method (without withdrawal) and using withdrawal (alone or with a tier 3 method) compared to the referent category of using a tier 1 or 2 method (without withdrawal).

Results

Of the 489 participants in the analysis, 52.3% reported using tier 1 or 2 method (without withdrawal); 19.8% reported tier 3 contraception (without withdrawal) and 27.9% reported using withdrawal (alone or with a tier 3 method). Compared to those using a tier 1 or 2 method, women using withdrawal had lower odds of reporting that avoiding pregnancy was very important or important to them (aOR, 0.4; 95% CI, 0.3–0.7). Women using withdrawal had higher odds of reporting that their husband/partner refuses to give them money for household expenses, even when he has the money (aOR, 2.8; 95% CI, 1.4–5.6).

Conclusions

Women using withdrawal might have less relationship power than nonusers. They also might rely on the practice because they are more ambivalent about pregnancy.
Hospital doctors’ attitudes to brief educational messages that aim to modify diagnostic test requests: a qualitative study
Authors: Young Ben , Fogarty Andrew W. , Skelly Rob , Shaw Dominick , Sturrock Nigel , Norwood Mark , Thurley Peter , Lewis Sarah , Langley Tessa , Cranwell Jo
Published: April 2020

Background

Avoidable use of diagnostic tests can both harm patients and increase the cost of healthcare. Nudge-type educational interventions have potential to modify clinician behaviour while respecting clinical autonomy and responsibility, but there is little evidence how this approach may be best used in a healthcare setting. This study aims to explore attitudes of hospital doctors to two nudge-type messages: one concerning potential future cancer risk after receiving a CT scan, another about the financial costs of blood tests.

Methods

We added two brief educational messages to diagnostic test results in a UK hospital for one year. One message on the associated long-term potential cancer risk from ionising radiation imaging to CT scan reports, and a second on the financial costs incurred to common blood test results. We conducted a qualitative study involving telephone interviews with doctors working at the hospital to identify themes explaining their response to the intervention.

Results

Twenty eight doctors were interviewed. Themes showed doctors found the intervention to be highly acceptable, as the group had a high awareness of the need to prevent harm and optimise use of finite resources, and most found the nudge-type approach to be inoffensive and harmless. However, the messages were not seen as personally relevant because doctors felt they were already relatively conservative in their use of tests.

Cancer risk was important in decision-making but was not considered to represent new knowledge to doctors. Conversely, financial costs were considered to be novel information that was unimportant in decision-making. Defensive medicine was commonly cited as a barrier to individual behaviour change. The educational cancer risk message on CT scan reports increased doctors’ confidence to challenge decisions and explain risks to patients and there were some modifications in clinical practice prompted by the financial cost message.

Conclusion

The nudge-type approach to target avoidable use of tests was acceptable to hospital doctors but there were barriers to behaviour change. There was evidence doctors perceived this cheap and light-touch method can contribute to culture change and form a foundation for more comprehensive educational efforts to modify behaviour in a healthcare environment.
Publicly available machine learning models for identifying opioid misuse from the clinical notes of hospitalized patients
Authors: Sharma Brihat , Dligach Dmitriy , Swope Kristin , Salisbury-Afshar Elizabeth , Karnik Niranjan S. , Joyce Cara , Afshar Majid
Published: April 2020

Background

Automated de-identification methods for removing protected health information (PHI) from the source notes of the electronic health record (EHR) rely on building systems to recognize mentions of PHI in text, but they remain inadequate at ensuring perfect PHI removal. As an alternative to relying on de-identification systems, we propose the following solutions: (1) Mapping the corpus of documents to standardized medical vocabulary (concept unique identifier [CUI] codes mapped from the Unified Medical Language System) thus eliminating PHI as inputs to a machine learning model; and (2) training character-based machine learning models that obviate the need for a dictionary containing input words/n-grams. We aim to test the performance of models with and without PHI in a use-case for an opioid misuse classifier.

Methods

An observational cohort sampled from adult hospital inpatient encounters at a health system between 2007 and 2017. A case-control stratified sampling (n = 1000) was performed to build an annotated dataset for a reference standard of cases and non-cases of opioid misuse. Models for training and testing included CUI codes, character-based, and n-gram features. Models applied were machine learning with neural network and logistic regression as well as expert consensus with a rule-based model for opioid misuse. The area under the receiver operating characteristic curves (AUROC) were compared between models for discrimination. The Hosmer-Lemeshow test and visual plots measured model fit and calibration.

Results

Machine learning models with CUI codes performed similarly to n-gram models with PHI. The top performing models with AUROCs > 0.90 included CUI codes as inputs to a convolutional neural network, max pooling network, and logistic regression model. The top calibrated models with the best model fit were the CUI-based convolutional neural network and max pooling network. The top weighted CUI codes in logistic regression has the related terms ‘Heroin’ and ‘Victim of abuse’.

Conclusions

We demonstrate good test characteristics for an opioid misuse computable phenotype that is void of any PHI and performs similarly to models that use PHI. Herein we share a PHI-free, trained opioid misuse classifier for other researchers and health systems to use and benchmark to overcome privacy and security concerns.
The role of complement immune response on artemisinin-based combination therapy in a population from malaria endemic region of Western Kenya
Authors: Wanjala Christine N. L. , Bergmann-Leitner Elke , Akala Hoseah M. , Odhiambo Geoffrey , Ogutu Bernhards R. , Andagalu Ben , Kamau Edwin , Ochiel Daniel
Published: April 2020

Background

Naturally acquired immunity (NAI), which is characterized by protection against overt clinical disease and high parasitaemia, is acquired with age and transmission intensity. The role of NAI on the efficacy of anti-malarial drugs, including artemisinin-based combinations used as the first-line treatment for uncomplicatedPlasmodium falciparum,has not been fully demonstrated. This study investigated the role of NAI in response to artemisinin-based combination therapy (ACT), in symptomatic patients living in western Kenya, a high malaria transmission area.

Methods

Sera samples from malaria immune participants (n = 105) in a therapeutic efficacy study were assessed for in vitro growth inhibitory activity against the 3D7 strain ofP. falciparumusing a fluorescent-based growth inhibition assay (GIA). Participants’ age and parasite clearance parameters were used in the analysis. Pooled sera from malaria naïve participants (n = 6) with noPlasmodiuminfection from malaria non-endemic regions of Kenya was used as negative control.

Results

The key observations of the study were as follows: (1) Sera with intact complement displayed higher GIA activity at lower (1%) serum dilutions (p < 0.0001); (2) there was significant relationship between GIA activity, parasite clearance rate (p = 0.05) and slope half-life (p = 0.025); and (3) age was a confounding factor when comparing the GIA activity with parasite clearance kinetics.

Conclusion

This study demonstrates for the first time there is synergy of complement, pre-existing immunity, and drug treatment in younger patients with symptomatic malaria in a high-transmission area.
Utilization profile of emergency department by irregular migrants and hospitalization rates: lessons from a large urban medical center in Tel Aviv, Israel
Authors: Shachaf S. , Davidovitch N. , Halpern P. , Mor Z.
Published: April 2020

Background

Irregular migrants (IMM) are excluded from the National health insurance in most developed countries and may use the emergency department (ED) as a source for medical care.

This study aims to compare the use of ED by IM with that of Israeli citizens (IC) in a large urban hospital in Tel Aviv, including socio-demographic characteristics, hospitalization proportion and medical conditions on admission.

Methods

This cross-sectional study included all IM and IC patients older than 18 years who attended the ED between 2007 and 2011, and compared their socio-demographic characteristics, the administrative details of the visit and clinical variables upon admission. Hospitalization proportion was calculated by dividing the number of patients who were admitted to the hospital ward by the number of all patients who attended the ED.

Results

IM who attended the ED were younger compared to IC (mean 39 ± 17 versus 52 ± 22 years, respectively), mostly males (1.4 Male/Female ratio) and mainly originated from developing countries. IM were more commonly self-referred, more likely to attend the ED during evening hours and weekends, complained of occupational injuries and frequented the surgical rather the medical ward of the ED compared with IC. IM stayed at the ED for longer periods than IC, yet the proportion of their hospitalization was lower than that of IC (19.4% versus 23.5%, respectively).

Conclusion

IM stayed in the ED for longer periods and were less likely to be admitted to the hospital wards, suggesting presentation of non-severe medical conditions or possible barriers in ensuring care continuity in the community following discharge. Minimizing the barriers of IM to primary care in the community can reduce unnecessary referrals to the ED. Additionally, hospitals managements should respond to the high-volume of IM by shifting staff to busy hours and improving the communication with IM.
Arabidopsis guard cell CO2/HCO3− response mutant screening by an aequorin-based calcium imaging system
Authors: Tang Mengmeng , Zhao Xiaowei , Hu Yinling , Zeng Miaomiao , Wang Kai , Dong Nannan , Ma Xiaonan , Bai Ling , Song Chun-Peng
Published: April 2020

Background

The increase in atmospheric CO2 is causing a number of changes in plant growth such as increases in leaf area and number, branching, plant size and biomass, and growth rate. Despite the importance of stomatal responses to CO2, little is known about the genetic and molecular mechanisms that mediate stomatal development and movement in response to CO2 levels. Deciphering the mechanisms that sense changes in CO2 and/or HCO3− concentration is critical for unraveling the role of CO2 in stomatal development movement. In Arabidopsis, CO2-induced stomatal closure is strongly Ca2+-dependent. To further dissect this signaling pathway and identify new components in the CO2 response pathway, we recorded [Ca2+]cyt changes in mutagenized Arabidopsis leaves and screened for mutants with abnormal guard cell behavior in response to CO2/HCO3−.

Results

We observed that 1 mM HCO3− induces [Ca2+]cys transient changes in guard cells and stomatal closure both in light and darkness. The changes in [Ca2+]cys induced by HCO3− could be detected by an aequorin-based calcium imaging system. Using this system, we identified a number of Arabidopsis mutants defective in both [Ca2+]cyt changes and the stomatal response to CO2/HCO3−.

Conclusions

We provide a sensitive method for isolating stomatal CO2/HCO3− response genes that function early in stomatal closure and that have a role in regulating [Ca2+]cyt. This method will be helpful in elucidating the Ca2+-dependent regulation of guard cell behavior in response to CO2/HCO3−.
Increasing uptake of evidence-based screening services though a community health worker-delivered multimodality program: study protocol for a randomized pragmatic trial
Authors: Carrasquillo Olveen , Seay Julia , Jhaveri Vasanti , Long Timothy , Kenya Sonjia , Thomas Emmanuel , Sussman Daniel , Trevil Dinah , Koru-Sengul Tulay , Kobetz Erin
Published: April 2020

Background

Underserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality. Much of the excess burden of these diseases among underserved communities is due to lack of preventive care, including screening. Barriers to disease screening include low awareness, lack of access to care and health insurance, and cultural beliefs regarding disease prevention. Our current trial aims to examine community health worker (CHW)-delivered, home-based multi-modality screening for HIV, HCV, CRC, and cervical cancer simultaneously.

Design

We are conducting a randomized pragmatic trial among 900 Haitian, Hispanic, and African-American participants from diverse underserved communities in South Florida. People between the ages of 50 and 65 who have not had appropriate HIV, HCV, CRC, and cervical cancer screening per United States Preventive Services Task Force (USPSTF) recommendations are eligible for the study. Participants are recruited by CHWs and complete a structured interview to assess multilevel determinants of disease risk. Participants are then randomized to receive HIV, HCV, CRC, and cervical cancer screening via navigation to care by a CHW (Group 1) or via CHW-delivered home-based screening (Group 2). The primary outcome is completion of screening for each of these diseases within 6 months post-enrollment.

Discussion

Our trial is among the first to examine the effectiveness of a CHW-delivered, multimodality, home-based disease-screening approach. If found to be effective, this approach may represent a cost-effective strategy for disease screening within underserved and underscreened minority groups.

Trial registration

Clinical Trials.gov # NCT02970136, registered November 21, 2016.
Adipose tissue gene expression of long non-coding RNAs; MALAT1, TUG1 in obesity: is it associated with metabolic profile and lipid homeostasis-related genes expression?
Authors: Ebrahimi Reyhane , Toolabi Karamollah , Jannat Ali Pour Naghmeh , Mohassel Azadi Samaneh , Bahiraee Alireza , Zamani-Garmsiri Fahimeh , Emamgholipour Solaleh
Published: April 2020

Background

Recent studies point toward the possible regulatory roles of two lncRNAs; metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and taurine upregulated gene 1 (TUG1) in the pathogenesis of obesity-related disorders and regulation of lipogenesis and adipogenesis. In an attempt to understand the molecules involved in human obesity pathogenesis, we aimed to evaluate the expression of MALAT1 and TUG1 in visceral adipose tissues (VAT) and subcutaneous adipose tissues (SAT) of obese women, as compared to normal-weight women. The mRNA expression of possible target genes including peroxisome proliferator-activated receptor gamma (PPARγ), PPARγ coactivator-1 alpha (PGC1α), sterol regulatory element-binding protein-1c (SREBP-1c), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC) which are involved in adipogenesis and lipogenesis were also examined.

Methods

This study was conducted on 20 obese [body mass index (BMI) ≥ 30 kg/m 2] female participants and 19 normal-weight (BMI < 25 kg/m 2) female participants. Real-time PCR was performed to investigate the mRNA expression of the above-mentioned genes in VAT and SAT from all participants.

Results

The results showed lower mRNA levels of TUG1 in both the VAT and SAT of obese women, compared to normal-weight women. Furthermore, TUG1 expression in SAT positively correlated with BMI, waist circumference (WC), hip circumference, HOMA-IR, and insulin levels, eGFR value, creatinine levels, and hs-CRP in all participants independent of age and HOMA-IR. However, VAT mRNA expression of TUG1 had a positive correlation with obesity indices and HOMA-IR and insulin levels in the whole population. Moreover, SAT mRNA level of TUG1 was positively correlated with SAT gene expression of PGC1α, SREBP-1c, FAS, and ACC independent of age and HOMA-IR. Although mRNA expression of MALAT1 did not differ between two groups for any tissue, it was positively correlated with SAT mRNA levels of SREBP-1c, PPARγ, and their targets; FAS and ACC, as well as with VAT mRNA levels of PGC1α.

Conclusions

It seems likely that TUG1 with distinct expression pattern in VAT and SAT are involved in the regulation of lipogenic and adipogenic genes and obesity-related parameters. However, more studies are necessary to establish this concept.
Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results
Authors: Achille Christal , Taggart Tenille , Eaton Nicholas R. , Osipoff Jennifer , Tafuri Kimberly , Lane Andrew , Wilson Thomas A.
Published: April 2020

Background/aims

Transgender youths experience high rates of depression and suicidal ideation compared to cisgender peers. Previous studies indicate that endocrine and/or surgical interventions are associated with improvements to mental health in adult transgender individuals. We examined the associations of endocrine intervention (puberty suppression and/or cross sex hormone therapy) with depression and quality of life scores over time in transgender youths.

Methods

At approximately 6-month intervals, participants completed depression and quality of life questionnaires while participating in endocrine intervention. Multiple linear regression and residualized change scores were used to compare outcomes.

Results

Between 2013 and 2018, 50 participants (mean age 16.2 + 2.2 yr) who were naïve to endocrine intervention completed 3 waves of questionnaires. Mean depression scores and suicidal ideation decreased over time while mean quality of life scores improved over time. When controlling for psychiatric medications and engagement in counseling, regression analysis suggested improvement with endocrine intervention. This reached significance in male-to-female participants.

Conclusion

Endocrine intervention may improve mental health in transgender youths in the US. This effect was observed in both male-to-female and female-to-male youths, but appears stronger in the former.
Well-posedness for 3D nematic liquid crystal flows with damping
Authors: Liu Hui , Sun Chengfeng , Xin Jie
Published: April 2020

The three-dimensional nematic liquid crystal flows with damping are considered in this paper. The existence and uniqueness of strong solutions for the 3D nematic liquid crystal flows with damping are proved for $\beta\geq4$β≥4 with any $\alpha>0$α>0.
Solvability and optimal stabilization controls of discrete-time mean-field stochastic system with infinite horizon
Authors: Song Teng , Liu Bin
Published: April 2020

The paper addresses the optimal control and stabilization problems for the indefinite discrete-time mean-field system over infinite horizon. Firstly, we show the convergence of the generalized algebraic Riccati equations (GAREs) and establish their compact form GARE. By dealing with the GARE, we derive the existence of the maximal solution to the original GAREs along with the fact that the maximal solution is the stabilizing solution. Then, the maximal solution is employed to design the linear-quadratic (LQ) optimal controller and the optimal value of the control problem. Specifically, we deduce that under the assumption of exact observability, the mean-field system is$L^{2}$L2-stabilizable if and only if the GAREs have a solution, which is also the maximal solution. By semi-definite programming (SDP) method, the solvability of the GAREs is discussed. Our results generalize and improve previous results. Finally, some numerical examples are exploited to illustrate the validity of the obtained results.
A maximum principle for fully coupled controlled forward–backward stochastic difference systems of mean-field type
Authors: Song Teng , Liu Bin
Published: April 2020

In this paper, we consider the optimal control problem for fully coupled forward–backward stochastic difference equations of mean-field type under weak convexity assumption. By virtue of employing a suitable product rule and formulating a mean-field backward stochastic difference equation, we establish the stochastic maximum principle and also derive, under additional assumptions, that the stochastic maximum principle is also a sufficient condition. As an application, a Stackelberg game of mean-field backward stochastic difference equation is presented to demonstrate our results.
Compact finite difference method to numerically solving a stochastic fractional advection-diffusion equation
Authors: Sweilam N. H. , El-Sakout D. M. , Muttardi M. M.
Published: April 2020

In this paper, a stochastic space fractional advection diffusion equation of Itô type with one-dimensional white noise process is presented. The fractional derivative is defined in the sense of Caputo. A stochastic compact finite difference method is used to study the proposed model numerically. Stability analysis and consistency for the stochastic compact finite difference scheme are proved. Two test examples are given to test the performance of the proposed method. Numerical simulations show that the results obtained are compatible with the exact solutions and with the solutions derived in the literature.
A balancing act: a window into online student engagement experiences
Authors: Farrell Orna , Brunton James
Published: April 2020

This article reports on a qualitative study which explored online student engagement experiences in a higher education institution. There are very few studies providing in-depth perspectives on the engagement experiences of online students. The project adopted a case study approach, following 24 online students over one academic year. The setting for the study was an undergraduate online Humanities programme at Dublin City University. The research question for the study was:What themes are central to online student engagement experiences?Data was collected from participant-generated learning portfolios and semi-structured interviews and analysed following a data-led thematic approach. The five central themes that make up the study’s findings highlight key issues of students’ sense of community, their support networks, balancing study with life, confidence, and their learning approaches. The findings of this study indicate that successful online student engagement was influenced by a number of psychosocial factors such as peer community, an engaging online teacher, and confidence and by structural factors such as lifeload and course design. One limitation of the study is that it is a relatively small, qualitative study, its findings provide insights into how online degrees can support online students to achieve successful and engaging learning experiences.
Long-term effect of cognitive–behavioural therapy in patients with Hypochondriacal Disorder
Authors: Veddegjærde Kari-Elise Frøystad , Sivertsen Børge , Skogen Jens Christoffer , Smith Otto Robert Frans , Wilhelmsen Ingvard
Published: April 2020

Background

Cognitive–behavioural therapy (CBT) is an effective treatment for Hypochondriacal Disorder, but the long-term effect has not been examined extensively.

Aims

To investigate the long-term effect of CBT on Hypochondriacal Disorder using several mental health measures. Follow-up time was at least 10 years.

Method

A total of 50 patients with a long history of Hypochondriacal Disorder, diagnosed according to ICD-10, received 16 sessions of individual CBT and were followed up with an uncontrolled design. All participants were assessed before and after the intervention period, and 10 years later. Intention-to-treat mixed-model repeated-measures analysis were conducted. The study has been registered at clinicaltrials.gov: NCT00959452.

Results

Patients displayed significant improvements across all outcomes, including level of health anxiety, somatisation, symptoms of anxiety and depression, quality of life, somatisation at treatment completion. Treatment gains were well maintained 10 years later.

Conclusions

This uncontrolled treatment study suggests that patients treated with CBT for Hypochondriacal Disorder have significantly reduced health anxiety 1 year after treatment completion and the results are maintained 10 years later. The results indicate that CBT has a lasting effect, but the lack of a control group and use of only one therapist, means that care should be taken when generalising the findings.
Expanding Access to Chimeric Antigen Receptor T-Cell Therapies: Challenges and Opportunities
Authors: Kansagra Ankit , Farnia Stephanie , Majhail Navneet
Published: April 2020

Chimeric antigen receptor (CAR) T‐cell therapy is a major advancement in the treatment of lymphoid malignancies, especially diffuse large B‐cell lymphoma and acute lymphoblastic leukemia (ALL). Since the U.S. Food and Drug Administration (FDA) approval of two CAR T-cell therapies, axicabtagene ciloleucel and tisagenlecleucel, experience has highlighted various barriers to their broader access and use, including challenges related to manufacturing a patient-specific product, high costs and inadequate reimbursement, incomplete or nonsustained disease responses, and potential for causing life-threatening toxicities. Research on disparities, application, and practice of hematopoietic cell transplantation (HCT) can inform opportunities to address similar barriers to use of CAR T-cell therapies that are currently available as well as other cellular therapies that are expected to become available in the near future. To ensure optimal patient outcomes, these therapies should preferably be administered at centers that have experience and established quality processes and practices. We review opportunities for centers, manufacturers, payers, and policy makers to address barriers to care. We also provide a summary of available and alternative payments models for commercial CAR T-cell and other cellular therapies.
Low Overall Survival in Women With De Novo Metastatic Breast Cancer: Does This Reflect Tumor Biology or a Lack of Access to Health Care?
Authors: Soares Leonardo R. , Freitas-Junior Ruffo , Curado Maria P. , Paulinelli Regis R. , Martins Edesio , Oliveira José C.
Published: April 2020

PURPOSE

As a result of its epidemiologic and therapeutic aspects, metastatic breast cancer (MBC) is a highly relevant clinical condition. This study aimed to estimate overall survival (OS) in women with de novo MBC in a Brazilian population.

PATIENTS AND METHODS

Patients were identified in the Goiânia population-based cancer registry between 1995 and 2011. All women with metastatic disease at diagnosis were included in the study. OS was analyzed at 5 and 10 years of follow-up. We used the Kaplan-Meier estimator and Cox regression for statistical analysis.

RESULTS

Over the 16-year period covered by the study, 5,289 women were diagnosed with breast cancer in Goiânia. Of these, 277 women (5.2%) had MBC. OS rates at 5 and 10 years were 19.9% and 7.3%, respectively. The mean OS time of women treated in the public health system was 7.5 months shorter than in women who had private health care (19.7 v 27.2 months, respectively). In the univariable analysis, the following factors were statistically significant for OS: T3/4 staging, histologic grade 3, progesterone receptor status, tumor phenotype, breast surgery, CNS metastasis at initial presentation, and surgery for resection of metastasis. In multivariable analysis, initial CNS metastasis (hazard ratio, 3.09; 95% CI, 1.16 to 8.19) and breast surgery (hazard ratio, 0.45; 95% CI, 0.25 to 0.78) remained independent prognostic factors.

CONCLUSION

OS was lower than rates found in specialist centers in Brazil and in developed countries. Several intrinsic and extrinsic factors were significant in predicting OS. Despite the difference in the 5-year survival rate, the type of access to health care was not significant in the multivariable analysis of the entire period.
Zebrafish as a tool to study schizophrenia-associated copy number variants
Authors: Campbell Philip D. , Granato Michael
Published: April 2020

Schizophrenia remains one of the most debilitating human neurodevelopmental disorders, with few effective treatments and striking consequences felt by individuals, communities and society as a whole. As such, there remains a critical need for further investigation into the mechanistic underpinnings of schizophrenia so that novel therapeutic targets can be identified. Because schizophrenia is a highly heritable disorder, genetic risk factors remain an attractive avenue for this research. Given their clear molecular genetic consequences, recurrent microdeletions and duplications, or copy number variants (CNVs), represent one of the most tractable genetic entry points to elucidating these mechanisms. To date, eight CNVs have been shown to significantly increase the risk of schizophrenia. Although rodent models of these CNVs that exhibit behavioral phenotypes have been generated, the underlying molecular mechanisms remain largely elusive. Over the past decades, the zebrafish has emerged as a powerful vertebrate model that has led to fundamental discoveries in developmental neurobiology and behavioral genetics. Here, we review the attributes that make zebrafish exceptionally well suited to investigating individual and combinatorial gene contributions to CNV-mediated brain dysfunction in schizophrenia. With highly conserved genetics and neural substrates, an ever-expanding molecular genetic and imaging toolkit, and ability to perform high-throughput and high-content genetic and pharmacologic screens, zebrafish is poised to generate deep insights into the molecular genetic mechanisms of schizophrenia-associated neurodevelopmental and behavioral deficits, and to facilitate the identification of therapeutic targets.
Expectations, Fears and Perceptions of doctors during Covid-19 Pandemic
Authors: Urooj Uzma , Ansari Asma , Siraj Asifa , Khan Sumaira , Tariq Humaira
Published: April 2020

Objectives: The aim of this study was to explore the expectations and fears faced by doctors during Covid-19 Pandemic.

Methods: This is a mixed method exploratory survey. A questionnaire exploring expectations of doctors from administration and seniors as well as their fears while working during pandemic, was developed on Google survey Forms. It included eight closed ended questions and four open ended questions. Data was collected through online Google survey Forms during month of March and April 2020. Doctors were approached through email and WhatsApp group.

Results: The mean age of participants was 33.58±4.21 years. Female 150(67.5%) and Male 72(32.4%) participated. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. 134(60.3%) doctors were working in hospitals which were not dealing with Covid-19. Fear included, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. More than 80% expected from seniors and administration, of providing PPE, facilitation, continue chain of supply of essential items, ensuring doctor safety, avoiding exposure of all doctors and keeping reserve workforce, limiting routine checkups, avoid panic and 20% had no expectations.

Conclusion: It was concluded that doctors had their fears and perceptions regarding pandemic which need to be addressed while policy making. They fear wellbeing of their families and contacting Covid-19, if not provided proper PPE. Our study provides insight of expectations, fears and perceptions of our frontline which invariably gives insight of the views of healthcare workers.

doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2643

How to cite this:Urooj U, Ansari A, Siraj A, Khan S, Tariq H. Expectations, Fears and Perceptions of doctors during Covid-19 Pandemic. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S37-S42. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2643

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Japanese Self-Image in Opposition to the Idea of Modern Europe and the Rise of Nationalism in Japan
Authors: Kawate Keiichi
Published: April 2020

This paper attempts to explain the political and social context of the recent nationalistic trend in Japan in connection with the historical development of Japanese self-image. In Japanese modern history this self-image was formed in relation to modern Europe due to the fact that modern Japan first pursued the modernization of Europe and then tried to overtake it. The first goal of this paper is to provide an analysis of the formation process of Japanese self-image from a historical perspective. This process was divided in three phases which were connected with a changing understanding of Japanese modernity. It started with the criticism of the idea of European modernity in the 1940s and led, through the theory of modernization, to the development of the “theory of Japanese culture” (Nihonbunkaron) in the 1980s. The second goal of this paper is to conduct an analysis of the features of Japan’s society, economy, and politics since the 1990s. The links between the collapse of the “Bubble Economy” and a rise in nationalism are shown. Although the article focuses on the domestic issues of Japan, it also reflects Japanese understanding of modern Europe and contributes to the understanding of cultural exchange between Europe and Japan.
Costume Art in the Noh Theater Community
Authors: Rybalko Svetlana
Published: April 2020

The article examines costumes in the context of the Noh theater community. The author proposes an understanding of these costumes as part of theatrical practice, as well as a means of sociocultural self-identification, and analyzes representative samples; the most typical motifs, compositional schemes, design approaches are determined. The article also focuses on accessories that make up the ensemble, both for the stage (mask, fan) and off-stage (netsuke, fan, obidome).
Eastern Cultures Enter Hyperspace
Authors: Kupis Marta
Published: April 2020

The article discusses inspirations from Far Eastern cultures present in George Lucas’ Star Wars saga. This cinematic story is treated as a postmodernist text, in which references to earlier cultural works appear. More attention is given to the sequel trilogy, not explored in academic circles as much as the two earlier trilogies. These inspirations are analysed through the lens of Edward Said’s concept of orientalism, with additional focus on the specific ways in which it was employed in the United States of America. In the conclusion, some reflections are devoted to audience reactions to the newest trilogy and the Eastern elements present therein.
Interweaving Conceptual and Substantial Problems of Writing Instruction: Socio Reflective on Exploring Hortatory and Analytical Exposition
Authors: Afifah Wiwiek , Sarudin Anida
Published: April 2020

This paper explores interweaving conceptual and substantial problems of teaching writing skills for analytical and hortatory exposition texts. Under the narrative inquiry, five English teachers’ personal life experiences were analyzed. Having been analyzed, the findings reveal: (1) students were still weak in understanding the concept of the two texts (social function, generic structure, and lexicogrammatical features of the text). (2) Students’ confusion to distinguish the two genres is supported by the condition that they do not learn the genres in their primary language. (3) The students are not accustomed to expressing their arguments whereas in analytical and hortatory texts the main points are presenting sequences of arguments in the body of the text. (4) Students have low motivation to read therefore it is hard for them to propose the suggestion and make reiteration in the end of hortatory and analytical exposition texts, and (5) lexicogrammatical features or the grammar that are commonly used in those texts are complex for the students in that level.
Combining Ability Analysis for Yield and Processing Qualities in White Onion (Allium cepa L.)
Authors: Patil D. G. , Subramaniam V. R.
Published: April 2020

Eight diverse white onions parents were selected and crossed in half diallel fashion in order to determine the combining ability to identify promising hybrids for nine traits including yield and processing quality. Analysis of variance for general and specific combining ability revealed that GCA and SCA variances were significant (p<0.05) for all characters. Among the parents exotics JV16 and JV12 was proved to be a good general combiner for yield and processing quality characters. Among the crosses AF x JV12, was best specific combination for bulb weight, bulb diameter, total soluble solids, per cent bolting, per cent doubles, pungency and yield. It is evident from present investigation that the hybrids combinations AF x JV12, PW x JV12, J16 x JV12 and PS x JV12 exhibited the high per se performance and SCA effect for bulb yield and processing quality characters could be advanced by selecting desirable segregants and recombinants in each generation for funneling the new genotype or using further advanced breeding programme.
Water Quality Assessment using Environmetrics and Pollution Indices in a Tropical River, Kerala, SW Coast of India
Authors: Sukanya S , Joseph Sabu
Published: April 2020

Envirometrics and pollution indices are proxies to assess water quality of a wetland ecosystem. Hence, the present study is focused on establishing water quality and elucidating the pollution status of Karamana River (KR) in Kerala, SW coast of India. The Karamana River Basin – KRB (n=6th; L= 68 km, A=695 km2), is the main source of water for domestic and drinking purpose in Thiruvananthapuram city. The Killi River (n= 5th; L= 24 km, A= 102 km2), the largest tributary of KR, carry heavy load of pollutants mainly from city and joins KR towards its downstream side. For this study, about 12 sampling stations were selected along the KR from upstream to downstream (interval= ~3km), and water samples (n=12x2= 24) were collected during non-monsoon (NON) and monsoon (MON) of 2015 to assess the variability and sourcing of key hydrochemical variables. Environmetric methods, viz., Pearson Correlation and Principal Component Analysis (PCA) were applied for apportionment of pollution sources significantly responsible for the surface water quality. It was found that sewage effluents and seawater intrusion were the primary factors deteriorating water quality in downstream. Further, the results of water quality analyses and Pollution Indices, viz., Organic Pollution Index (OPI), Eutrophication Index (EI) and Comprehensive Pollution Index (CPI) indicate that lower reaches (L= ~4 km) of KR is seriously polluted. A distinct Zone of Pollution Influence (ZPI) has been delineated based on the indices and this attempt is first of its kind in KR. The present study provides several noteworthy contributions to the existing knowledge on the factors influencing surface water quality and serves as a baseline data for watershed managers and administrators.
Sanitation Park Nathuwawala, Dehradun: A Study of Solid Waste Management in Uttarakhand
Authors: Joshi Anita , Joshi Neeraj ,   Department of B. Ed, M. B. Govt. P. G. College Haldwani, Nainital, Uttarakhand India,   Directorate of Urban Development, Uttarakhand India
Published: April 2020

Uttarakhand is a hilly state which consists of 90 urban local bodies, facing the problem of Solid Waste Management. There are only two solid waste plants in the state. Solid Waste Management process in decentralised method has recently been started at Nathuawala ward in Dehradun, having a population of 13000. The solid waste processing area has been named “Sanitation Park”. The researchers have found that the waste is disposed systematically in a scientific manner in this area, as per Solid Waste Rules 2016. There is no eyesore in this area. All the community members participating in this project have appreciated the work of the leading NGO “Feedback Foundation”. It is a combined effort of Nagar Nigam, Feedback Foundation and Community of Nathuawala ward. It may be concluded that decentralized method is economically sustainable and can be adopted by Urban Local Bodies of Uttarakhand for Solid Waste Management process. This project can turn out to be a role model for other Urban Local Bodies all over India.
A desmilitarização e a unificação das instituições militares estaduais e a polícia civil no Brasil: reflexos na segurança pública estadual
Authors: Oliveira Márcio Luís de , Oliveira Edson Rodrigues  de
Published: April 2020

A pesquisa em tela propõe uma visão jurídica constitucional e holística organizacional da prestação da segurança pública pelas Instituições Militares Estaduais e pela Polícia Civil, bem como os efeitos estimativos da Unificação na esfera estadual. A segurança pública é dever do Estado, direito e responsabilidade de todos, direito fundamental individual e coletivo, tão relevante, com sua capitulação própria, conforme a sintonia dos arts. 5º, 6º e 144 da Constituição da República Federativa do Brasil – CRFB (BRASIL, 1988). O objeto da segurança pública está dividido na preservação da ordem, predominantemente afeto à Polícia Militar, e, na preservação da incolumidade das pessoas e do patrimônio, cabível ao Corpo de Bombeiros Militar, enquanto a Polícia Civil exerce a polícia judiciária em ambas as searas. Estas atribuições têm lastro estratégico na soberania nacional, com fulcro na eficiente fluência organizacional, paz social e bem comum de todos, sendo de responsabilidade da União, compartilhada aos Estados-membros (e não cabendo subdelegação aos Municípios). O modelo brasileiro de segurança pública tem origem no paradigma francês da "gendarmaria", com instituições militares e civis, atuando, respectivamente, como força física preventiva, repressiva e reativa do Estado, e na investigação criminal. As instituições militares têm características próprias, como uniformidade, solenidade, estrita impessoalidade, seleção rígida e devoção ao princípio de hierarquia e disciplina, e também força auxiliar do Exército brasileiro. Os excessos burocráticos, as deficiências gerenciais, os resultados trágicos das ações policiais e a comparação com a proposta do ciclo completo da polícia, bem como a racionalização econômica e administrativa, consolidam os argumentos da unificação paramilitar "anglo-saxã". Atualmente, essas múltiplas instituições são Secretarias de Estado-membro, mas não perderam o elo constitucional nacional.
Educação ambiental: um itinerário para a preservação do meio ambiente e a qualidade de vida nas cidades
Authors: Monteiro Adriana Roseno
Published: April 2020

O presente artigo faz uma discussão acerca da utilização da educação ambiental para a sustentabilidade do meio ambiente e a qualidade de vida da população, tendo em vista, que desvendar a dinâmica ambiental através das múltiplas ações dos atores envolvidos é essencial neste processo. Portanto, os estudos acerca do meio ambiente, em particular, inserem-se de modo especialmente relevante no debate contemporâneo. Por conseguinte, esta pesquisa teve como objetivo principal enfocar a importância da utilização da educação ambiental para  a preservação do meio ambiente e para a qualidade de vida nas cidades. Com vistas a alcançar o objetivo proposto, esta pesquisa está alicerçada  em um viés qualitativo em que os procedimentos metodológicos adotados foram a revisão bibliográfica e documental, que são essenciais para  subsidiar todas as etapas de um trabalho científico. Desse modo, esta pesquisa permitiu percebermos que é prioritária as mudanças de posturas, de hábitos e de costumes em relação aos problemas ambientais e que a educação ambiental se projeta como um mecanismo de grande relevância para a formação de sociedades ecologicamente equilibradas e em harmonia com meio ambiente.