bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Relevance of Tubular Breast Carcinoma: Large Retrospective Study and Meta-Analysis
Authors: Metovic Jasna , Bragoni Alberto , Osella-Abate Simona , Borella Fulvio , Benedetto Chiara , Gualano Maria Rosaria , Olivero Elena , Scaioli Giacomo , Siliquini Roberta , Ferrando Pietro Maria , Bertero Luca , Sapino Anna , Cassoni Paola , Castellano Isabella
Published: April 2021

Background:Tubular carcinoma (TC) is a low proliferative grade 1 (G1) breast cancer (BC). Despite its favorable outcome and allegedly lower aggressiveness, patients are treated like other luminal G1 BC, with radiotherapy (RT) and hormonal therapy (HT). We performed: (1) a retrospective study comparing a TC cohort and a control series of luminal G1 BC and (2) a systematic review and meta-analysis focused on TC outcome.

Materials and Methods:We selected a series of 572 G1 luminal BC patients [111 TC, 350 not otherwise specified (NOS), and 111 special-type (ST) BC] with follow-up and clinico-pathological data, who underwent local excision followed by RT at Città della Salute e della Scienza Hospital, Turin. Moreover, 22 and 13 studies were included in qualitative and quantitative meta-analysis, respectively.

Results:TCs were generally smaller (≤10 mm) (P< 0.001), with lower lymph node involvement (P< 0.001). TCs showed no local and/or distant recurrences, while 16 NOS and 2 ST relapsed (P= 0.036). Kaplan–Meier curves confirmed more favorable TC outcome (DFI: log-rank testP= 0.03). Meta-analysis data, including the results of our study, showed that the pooled DFI rate was 96.4 and 91.8% at 5 and 10 years, respectively. Meta-regression analyses did not show a significant influence of RT nor HT on the DFI at 10 years.

Conclusions:Compared to the other G1 BCs, TCs have an excellent outcome. The meta-analysis shows that TC recurrences are infrequent, and HT and RT have limited influence on prognosis. Hence, accurate diagnosis of TC subtype is critical to ensuring a tailored treatment approach.
Image-Guided Robotic Radiosurgery for the Management of Spinal Ependymomas
Authors: Ehret Felix , Kufeld Markus , Fürweger Christoph , Haidenberger Alfred , Windisch Paul , Senger Carolin , Kord Melina , Träger Malte , Kaul David , Schichor Christian , Tonn Jörg-Christian , Muacevic Alexander
Published: April 2021

Background

Ependymomas are rare neoplasms of the central nervous system (CNS), usually localized intracranially and most commonly diagnosed in children. Spinal ependymomas are more frequent in young adults. They are either primary lesions or manifest as disseminated seeding of cranial tumors. Data on the management of spinal ependymoma lesions remain scarce, especially concerning stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). The purpose of this study is to report the treatment outcomes of two institutions using robotic radiosurgery (RRS) for the treatment of spinal ependymomas.

Materials and Methods

All patients with a histopathologically confirmed diagnosis of an ependymoma WHO grade II or III who were treated with RRS for one or more spinal lesions were included in this analysis.

Results

Twelve patients underwent RRS for the treatment of 32 spinal ependymoma lesions between 2005 and 2020. Two patients were below the age of 18 when treated, whereas nine patients (75%) suffered from a primary spinal ependymoma. The median dose was 15 Gy prescribed to a median isodose of 70%, with 27 lesions (84%) receiving a single-session treatment. The local control (LC) after a median follow-up of 56.7 months was 84%. LC rates at 1, 3, and 5 years were 92, 85, and 77%, respectively. The Kaplan-Meier estimated overall survival after 1, 3, and 5 years were 75, 75, and 64%, respectively. Five patients died, all of them suffering from an anaplastic ependymoma, with widespread CNS tumor progression being the reason for death in four patients. The majority of patients (58%) showed a stable neurological status at the last available follow-up. Overall, the treatment was well tolerated.

Conclusion

RRS appears to be a safe and efficient treatment modality for managing primary and secondary spinal ependymal tumors in patients with multiple lesions and local recurrences.
Ginsenoside Rh7 Suppresses Proliferation, Migration and Invasion of NSCLC Cells Through Targeting ILF3-AS1 Mediated miR-212/SMAD1 Axis
Authors: Chen Xiangbo , Liu Wenguang , Liu Bao
Published: April 2021

It is reported that ginsenosides have a significant anti-tumor effect on a variety of tumors. However, the role and mechanism of Rh7 in non-small cell lung cancer (NSCLC) are unclear. In this study, we aimed to study the anti-tumor effect of Rh7 on the proliferation and progression of NSCLC. Bioinformatics analysis showed that ILF3-AS1 was regulated by ginsenoside Rh7 in NSCLC. Down-regulation of ILF3-AS1 could significantly inhibit the proliferation, metastasis and invasion of NSCLC. In addition, ILF3-AS1 negatively controlled miR-212, which in turn targeted SMAD1 expression, thereby regulating NSCLC cell viability and apoptosis. Our results indicate that ILF3-AS1 can be used as a diagnostic and therapeutic target for non-small cell lung cancer. It is discovered for the first time that ginsenoside Rh7 inhibits the expression of ILF3-AS1 and exerts antitumor effects.
Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report
Authors: Dominguez-Riscart Jesus , Buero-Fernandez Nuria , Garcia-Zarzuela Ana , Marmolejo-Franco Fernando A. , Perez-Guerrero Ana C. , Lechuga-Sancho Alfonso M.
Published: April 2021

The goal in type 1 diabetes (T1D) therapy is to maintain optimal glycemic control under any circumstance. Diabetes technology is in continuous development to achieve this goal. The most advanced Food and Drug Administration- and European Medicines Agency-approved devices are hybrid closed-loop (HCL) systems, which deliver insulin subcutaneously in response to glucose levels according to an automated algorithm. T1D is frequently encountered in the perioperative period. The latest international guidelines for the management of children with diabetes undergoing surgery include specific adjustments to the patient's insulin therapy, hourly blood glucose monitoring, and intravenous (IV) insulin infusion. However, these guidelines were published while the HCL systems were still marginal. We present a case of a 9-year-old boy with long-standing T1D, under HCL system therapy for the last 9 months, and needing surgery for an appendectomy. We agreed with the family, the surgical team, and the anesthesiologists to continue HCL insulin infusion, without further adjustments, hourly blood glucose checks or IV insulin, while monitoring closely. The HCL system was able to keep glycemia within range for the total duration of the overnight fast, the surgery, and the initial recovery, without any external intervention or correction bolus. This is, to the best of our knowledge, the first reported pediatric case to undergo major surgery using a HCL system, and the results were absolutely satisfactory for the patient, his family, and the medical team. We believe that technology is ripe enough to advocate for a “take your pump to surgery” message, minimizing the impact and our interventions. The medical team may discuss this possibility with the family and patients.
Clinical Characterization of Anti-GQ1b Antibody Syndrome in Childhood
Authors: Cai Lianhong , Hu Zhanqi , Liao Jianxiang , Hong Siqi , Kong Lingyu , Chen Li , Luo Yetao , Li Tingsong , Jiang Li
Published: April 2021

Objective: To delineate the comprehensive clinical features of anti-GQ1b antibody syndrome in childhood.

Methods: The clinical data of children diagnosed with anti-GQ1b antibody syndrome at two Chinese tertiary pediatric neurology centers were collected and analyzed. We also conducted a systematic literature review on anti-GQ1b antibody syndrome in children.

Results: This study included 78 children with anti-GQ1b antibody syndrome, consisting of 12 previously unreported cases from the two Chinese centers. The median onset age was 10 years (range, 2–18 years). The most common phenotype was acute ophthalmoparesis (32%), followed by classic Miller Fisher syndrome (15%), and Bickerstaff brainstem encephalitis (12%). External ophthalmoplegia (48%), sensory disturbance (9%), and bulbar palsy (9%) were the three most frequent onset symptom manifestations. Brain or spinal lesions on MRI and abnormal recordings by nerve conduction study were present in 18% (12/68) and 60% (27/45) of cases, respectively. There was CSF albuminocytologic dissociation in 34% of the patients (23/68). IV immunoglobulin alone or combined with steroids or plasma exchange was administered to 58% of patients (42/72). We did not find a significant correlation between early improvement up to 3 months and age onset and phenotype. All patients showed different degrees of recovery, and 81% (57/70) had complete recovery within 1 year.

Conclusions: Acute ophthalmoparesis and classic Miller Fisher syndrome are the most common phenotypes of anti-GQ1b antibody syndrome in childhood. The majority of patients show good response to immunotherapy and have favorable prognosis.
Targeting Premature Renal Aging: from Molecular Mechanisms of Cellular Senescence to Senolytic Trials
Authors: Franzin Rossana , Stasi Alessandra , Ranieri Elena , Netti Giuseppe Stefano , Cantaluppi Vincenzo , Gesualdo Loreto , Stallone Giovanni , Castellano Giuseppe
Published: April 2021

The biological process of renal aging is characterized by progressive structural and functional deterioration of the kidney leading to end-stage renal disease, requiring renal replacement therapy. Since the discovery of pivotal mechanisms of senescence such as cell cycle arrest, apoptosis inhibition, and the development of a senescence-associated secretory phenotype (SASP), efforts in the understanding of how senescent cells participate in renal physiological and pathological aging have grown exponentially. This has been encouraged by both preclinical studies in animal models with senescent cell clearance or genetic depletion as well as due to evidence coming from the clinical oncologic experience. This review considers the molecular mechanism and pathways that trigger premature renal aging from mitochondrial dysfunction, epigenetic modifications to autophagy, DNA damage repair (DDR), and the involvement of extracellular vesicles. We also discuss the different pharmaceutical approaches to selectively target senescent cells (namely, senolytics) or the development of systemic SASP (called senomorphics) in basic models of CKD and clinical trials. Finally, an overview will be provided on the potential opportunities for their use in renal transplantation during ex vivo machine perfusion to improve the quality of the graft.
Effect of Huang-Lian Jie-Du Decoction on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Authors: Hu Zhipeng , Yang Maoyi , Liu Ya , Yang Qiyue , Xie Hongyan , Peng Sihan , Gao Juan , Xie Chunguang
Published: April 2021

Background: Type 2 diabetes mellitus (T2DM) is a heterogeneous disease characterized by persistent hyperglycemia. Huang-Lian Jie-Du decoction (HLJDD) is a traditional Chinese medicine formula which is widely used in treating T2DM in China. A thorough understanding of current body of evidence is needed.

Objective: this study aims to summarize the clinical evidence of HLJDD for T2DM to provide an up-to-date and accurate understanding of this issue for research and clinical practice.

Methods: Six databases were searched from inception to June 27, 2020 without language and publication status restrictions and randomized controlled trials about HLJDD on T2DM were included. Two evaluators searched and screened citations independently. Risk of bias was assessed by 2019 version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB2). Risk ratio (RR) with 95% confidence interval (CI) was used as an effect measure for dichotomous outcomes and mean difference (MD) with 95% CI was used for continuous outcomes. Subgroup analyses and sensitivity analyses were carried out.

Results: Nine studies including 811 participants were included in this study. The overall risk of bias was high risk. Compared with metformin alone, combination treatment of HLJDD and metformin may result in a reduction in HbA1c, FBG, 2hPG, HOMA-IR and an improved lipid metabolism. Evidence comparing HLJDD and metformin or no intervention or placebo was insufficient. The quality of evidence was low.

Conclusions: Current evidence about HLJDD on T2DM is still uncertain and more high-quality studies are needed to firmly establish the clinical efficacy and safety of HLJJD.
Mechanical and Dimensional Investigation of Additive Manufactured Multimaterial Parts
Authors: Königshofer Markus , Stoiber Martin , Unger Ewald , Grasl Christian , Moscato Francesco
Published: April 2021

Additive manufacturing machines, based on the multimaterial jetting technology, are widely used for three-dimensional (3D) printing of sophisticated medical models, which are aimed to be used for preoperative planning and surgical training. Gaining knowledge of process-related influences on mechanical and dimensional properties of 3D-printed parts makes up an essential basis for the design and manufacture of medical models. There are few studies on characterization of multimaterial parts, and those are limited to tests that are not based on standardized methods. Within the scope of this work, mechanical and dimensional investigations were performed on multimaterial parts that were printed using an Objet500–Connex3 3D printer (Stratasys Ltd., Minnesota, Eden Prairie, MN, USA). Among test methods listed in DIN EN ISO 17296-3, tensile tests were chosen for mechanical characterization. In the tensile tests, combinations of four different materials (Tango+, VeroClear, VeroPureWhite, MED610) were tested in three build orientations (XY, YX, ZX). To investigate the orientation-dependent printing accuracy, the tensile specimens were further checked for their dimensional accuracy. Statistically significant variations in the mechanical properties were found between different orientation levels. In general, specimens printed in XY orientation show higher tensile strength than YX- and ZX-oriented specimens. The tensile moduli determined are in the range from 0.2 to 2,500 MPa and compare well with the tensile moduli found in soft biological tissues. Dimensional deviations were found highest for the length of ZX-oriented tensile specimens. For this orientation level, it could be observed that multimaterial specimens, which contain higher percentage of the soft material Tango+, are characterized by higher shrinkage. For tensile specimens printed from the pure photopolymer Tango+, a shrinkage of 4.6% in length was determined. In summary, it was found that with multimaterial jetting technology, the increased shrinkage and lower mechanical strength in the ZX direction must be considered in the design process.
Single-Shot Through-Focus Image Acquisition and Phase Retrieval From Chromatic Aberration and Multi-Angle Illumination
Authors: Zhou Guocheng , Zhang Shaohui , Zhai Yayu , Hu Yao , Hao Qun
Published: April 2021

Phase recovery from a stack of through-focus intensity images is an effective non-interference quantitative phase imaging strategy. Nevertheless, the implementations of these methods are expensive and time-consuming because the distance between each through-focus plane has to be guaranteed by precision mechanical moving devices, and the multiple images must be acquired sequentially. In this article, we propose a single-shot through-focus intensity image stack acquisition strategy without any precision movement. Isolated LED units are used to illuminate the sample in different colors from different angles. Due to the chromatic aberration characteristics of the objective, the color-channel defocus images on the theoretical imaging plane are mutually laterally shifted. By calculating the shift amount of each sub-image area in each color channel, the distances between each through-focus image can be obtained, which is a critical parameter in transport of intensity equation (TIE) and alternating projection (AP). Lastly, AP is used to recover the phase distribution and realize the 3D localization of different defocus distances of the sample under test as an example. Both simulation and experiments are conducted to verify the feasibility of the proposed method.
Role of Mixed-Species Stands in Attenuating the Vulnerability of Boreal Forests to Climate Change and Insect Epidemics
Authors: Chavardès Raphaël D. , Gennaretti Fabio , Grondin Pierre , Cavard Xavier , Morin Hubert , Bergeron Yves
Published: April 2021

We investigated whether stand species mixture can attenuate the vulnerability of eastern Canada’s boreal forests to climate change and insect epidemics. For this, we focused on two dominant boreal species, black spruce [Picea mariana (Mill.) BSP] and trembling aspen (Populus tremuloides Michx.), in stands dominated by black spruce or trembling aspen (“pure stands”), and mixed stands (M) composed of both species within a 36 km2 study area in the Nord-du-Québec region. For each species in each stand composition type, we tested climate-growth relations and assessed the impacts on growth by recorded insect epidemics of a black spruce defoliator, the spruce budworm (SBW) [Choristoneura fumiferana (Clem.)], and a trembling aspen defoliator, the forest tent caterpillar (FTC; Malacosoma disstria Hübn.). We implemented linear models in a Bayesian framework to explain baseline and long-term trends in tree growth for each species according to stand composition type and to differentiate the influences of climate and insect epidemics on tree growth. Overall, we found climate vulnerability was lower for black spruce in mixed stands than in pure stands, while trembling aspen was less sensitive to climate than spruce, and aspen did not present differences in responses based on stand mixture. We did not find any reduction of vulnerability for mixed stands to insect epidemics in the host species, but the non-host species in mixed stands could respond positively to epidemics affecting the host species, thus contributing to stabilize ecosystem-scale growth over time. Our findings partially support boreal forest management strategies including stand species mixture to foster forests that are resilient to climate change and insect epidemics.
Mutual (Mis)understanding: Reframing Autistic Pragmatic “Impairments” Using Relevance Theory
Authors: Williams Gemma L. , Wharton Tim , Jagoe Caroline
Published: April 2021

A central diagnostic and anecdotal feature ofautismis difficulty with socialcommunication. We take the position that communication is a two-way,intersubjectivephenomenon—as described by thedouble empathy problem—and offer uprelevance theory(a cognitive account of utterance interpretation) as a means of explaining such communication difficulties. Based on a set of proposed heuristics for successful and rapid interpretation of intended meaning, relevance theory positions communication as contingent on shared—and, importantly,mutuallyrecognized—“relevance.” Given that autistic and non-autistic people may have sometimes markedly different embodied experiences of the world, we argue that what is most salient to each interlocutor may be mismatched. Relevance theory would predict that where this salient information is not (mutually) recognized or adjusted for, mutual understanding may be more effortful to achieve. This paper presents the findings from a small-scale, linguistic ethnographic study of autistic communication featuring eight core autistic participants. Each core autistic participant engaged in three naturalistic conversations around the topic of loneliness with: (1) a familiar, chosen conversation partner; (2) a non-autistic stranger and (3) an autistic stranger. Relevance theory is utilized as a frame for the linguistic analysis of the interactions. Mutual understanding was unexpectedly high across all types of conversation pairings. In conversations involving two autistic participants, flow, rapport and intersubjective attunement were significantly increased and in three instances, autistic interlocutors appeared to experience improvements in their individual communicative competence contrasted with their other conversations. The findings have the potential to guide future thinking about how, in practical terms, communication between autistic and non-autistic people in both personal and public settings might be improved.
A Systematic Review of Electrophysiological Findings in Binge-Purge Eating Disorders: A Window Into Brain Dynamics
Authors: Hiluy Joao C. , David Isabel A. , Daquer Adriana F. C. , Duchesne Monica , Volchan Eliane , Appolinario Jose C.
Published: April 2021

Binge-purge eating disorders (BP-ED), such as bulimia nervosa and binge eating disorder, may share some neurobiological features. Electroencephalography (EEG) is a non-invasive measurement modality that may aid in research and diagnosis of BP-ED. We conducted a systematic review of the literature on EEG findings in BP-ED, seeking to summarize and analyze the current evidence, as well as identify shortcomings and gaps to inform new perspectives for future studies. Following PRISMA Statement recommendations, the PubMed, Embase, and Web of Science databases were searched using terms related to “electroencephalography” and “binge-purge” eating disorders. Of 555 articles retrieved, 15 met predefined inclusion criteria and were included for full-text analysis. Eleven studies investigated EEG by means of event-related potentials (ERP) in BP-ED individuals: 7 using eating disorder-related stimuli (i.e., food, body image) and 4 using non-eating disorder-related stimuli (i.e., facial expressions or auditory clicks). These studies found significant differences in the N200, P200, P300, and LPP components in BP-ED participants compared to controls, indicating that this population exhibits impairments in selective attention, attentional allocation/processing, and allocation of motivational or emotion-based attention. Five studies investigated EEG using frequency analysis; reporting significant differences in beta activity in fronto-temporal and occipito-temporo-parietal areas in BP-ED individuals compared to controls, revealing a dysfunctional brain network. However, the small number of studies, the heterogeneity of samples, study paradigms, stimulus types, and the lack of an adequate assessment of neuropsychological parameters are some limitations of the current literature. Although some EEG data are promising and consistent with neuroimaging and neuropsychological findings in individuals with BP-ED, future studies need to overcome current methodological shortcomings.
An Evaluation of the Rabies Surveillance in Southern Vietnam
Authors: Pham Quang Duy , Phan Lan Trong , Nguyen Thuy Phuong Thi , Doan Quan Minh Ngoc , Nguyen Hai Duc , Luong Quang Chan , Nguyen Thuong Vu
Published: April 2021

Introduction: Rabies is endemic in Vietnam and has been a statutory notifiable infectious disease since 1998. We, herein, assessed the performance of rabies surveillance in Southern Vietnam and identified areas for improvement.

Materials and Methods: We analyzed data on human rabies cases reported during 1991–2018. We adapted guidelines from the U.S. Centers for Disease Control and Prevention to evaluate attributes of surveillance. Between June and November 2018, we interviewed a total of 145 staff from hospitals, preventive medicine centers, and animal health offices at provincial and district levels in five southern provinces.

Results: Between 2009 and 2018, an average of nine cases of human rabies (range: 4–20 cases) was reported annually in Southern Vietnam, representing an incidence of 2.7 cases per 10 million population. The highest incidence was observed in 2018 (5.5 cases per 10 million population). Survey data suggested that only 24% (13/53) of participants agreed that the monthly report template was easy to complete and that 42% (23/55) indicated that the change from the paper-based to the electronic case notification systems was easy. Only 7% (2/29) of human rabies cases were reported timely, and 65% (13/20) successfully collected specimens. Approximately 39% (56/144) of staff were aware of turning surveillance data into prevention activities, and 21% (31/145) witnessed data used for strategic program decision making.

Conclusions: Although rabies surveillance was quite simple, flexible, and accepted in southern Vietnam, simplifying the report forms, training staff, and improving the timeliness of reporting and data usage are highly recommended for a better implementation of rabies surveillance.
Determinants of Confidence in Overall Knowledge About COVID-19 Among Healthcare Workers in South Africa: Results From an Online Survey
Authors: Manyaapelo Thabang , Mokhele Tholang , Sifunda Sibusiso , Ndlovu Philisiwe , Dukhi Natisha , Sewpaul Ronel , Naidoo Inbarani , Jooste Sean , Tlou Boikhutso , Moshabela Mosa , Mabaso Musawenkosi , Zuma Khangelani , Reddy Priscilla
Published: April 2021

Background: Adequate information and knowledge about COVID-19 has been shown to induce the confidence and positive performance among healthcare workers (HCWs). Therefore, assessing the relationship between confidence in knowledge and associated factors among HCWs is vital in the fight against COVID-19. This paper investigates factors associated with HCWs' confidence in their overall knowledge about COVID-19 in South Africa in the early stages of the epidemic.

Methods: Data utilized in this paper were from an online survey conducted among HCWs using a structured questionnaire on a data free online platform. The study population were all the medical fraternity in South Africa including medical and nurse practitioners as well as other healthcare professionals. Bivariate and multivariate logistic regression models were performed to examine the factors associated with confidence in HCWs' overall knowledge about COVID-19.

Results: Overall, just below half (47.4%) of respondents indicated that they had confidence in their overall knowledge about COVID-19. Increased odds of having confidence in the knowledge about COVID-19 were significantly associated with being male [aOR = 1.31 95% CI (1.03–1.65), p < 0.05], having a doctorate degree [aOR = 2.01 (1.23–3.28), p < 0.05], being satisfied with the information about COVID-19 guidelines [aOR = 6.01 (4.89–7.39), p < 0.001], having received training in 6–8 areas [aOR = 2.54 (1.89–3.43), p < 0.001] and having received training in 9–11 areas [aOR = 5.33 (3.81–7.47), p < 0.001], and having already treated COVID-19 patients [aOR = 1.43 (1.08–1.90), p < 0.001]. Those who were highly concerned with the levels of training of HCWs [aOR = 0.47 (0.24–0.92), p < 0.05] had decreased odds of having confidence in their overall knowledge about COVID-19.

Conclusion: This study sheds light on the importance of capacitating HCWs with knowledge and adequate relevant training as part of infection prevention control measures during pandemics. Future training and information sharing should be sensitive to knowledge gaps by age, gender, qualifications, professional categories, and experience.
An Innovative Approach for Decision-Making on Designing Lifestyle Programs to Reduce Type 2 Diabetes on Dutch Population Level Using Dynamic Simulations
Authors: Sluijs Teun , Lokkers Lotte , Özsezen Serdar , Veldhuis Guido A. , Wortelboer Heleen M.
Published: April 2021

The number of individuals suffering from type 2 diabetes is dramatically increasing worldwide, resulting in an increasing burden on society and rising healthcare costs. With increasing evidence supporting lifestyle intervention programs to reduce type 2 diabetes, and the use of scenario simulations for policy support, there is an opportunity to improve population interventions based upon cost–benefit analysis of especially complex lifestyle intervention programs through dynamic simulations. In this article, we used the System Dynamics (SD) modeling methodology aiming to develop a simulation model for policy makers and health professionals to gain a clear understanding of the patient journey of type 2 diabetes mellitus and to assess the impact of lifestyle intervention programs on total cost for society associated with prevention and lifestyle treatment of pre-diabetes and type 2 diabetes in The Netherlands. System dynamics describes underlying structure in the form of causal relationships, stocks, flows, and delays to explore behavior and simulate scenarios, in order to prescribe intervention programs. The methodology has the opportunity to estimate and simulate the consequences of unforeseen interactions in order to prescribe intervention programs based on scenarios tested through “what-if” experiments. First, the extensive knowledge of diabetes, current available data on the type 2 diabetes population, lifestyle intervention programs, and associated cost in The Netherlands were captured in one simulation model. Next, the relationships between leverage points on the growth of type 2 diabetes population were based upon available data. Subsequently, the cost and benefits of future lifestyle intervention programs on reducing diabetes were simulated, identifying the need for an integrated adaptive design of lifestyle programs while collecting the appropriate data over time. The strengths and limitations of scenario simulations of complex lifestyle intervention programs to improve the (cost)effectiveness of these programs to reduce diabetes in a more sustainable way compared to usual care are discussed.
Importance of Work-Related Psychosocial Factors in Exertion Perception Using the Borg Scale Among Workers Subjected to Heavy Physical Work
Authors: Sala Emma , Lopomo Nicola Francesco , Tomasi Cesare , Romagnoli Francesco , Morotti Alberto , Apostoli Pietro , De Palma Giuseppe
Published: April 2021

Objective: This study aimed to analyse the role of several environmental and time variables, as well as individual and psychosocial factors, on the perception of exertion, expressed by using the Borg scale, on logistics workers performing heavy manual tasks.

Materials and Methods: We enrolled 56 subjects working in logistics sector that were interviewed on the perceived exertion required to execute a task of manual lifting of heavy loads, by using the Borg scale. The interviews were carried out during different shifts, at different times during the shifts and during several different months of the year. We also assessed the workers' anthropometric characteristics, length of service, any musculoskeletal diseases, and physical activity outside work. Workers were also interviewed using the structured OREGE questionnaire, in order to evaluate the main symptoms of stress and work-related psychosocial risk factors.

Results: Overall, the subjective perception of the strength exerted by the workers exposed to a high risk of manual handling of loads was moderate. The rating attributed using the Borg scale showed no correlation with any of the investigated variables. 100% of the workers denied to suffer from symptoms of stress, whereas in terms of psychosocial factors, the workload was globally perceived as positive.

Conclusion: The study results support the hypothesis that optimal work conditions—from a psychosocial point of view—reduce the subjective perception of exertion by workers even if exposed to a high risk of biomechanical overload.
FedPARL: Client Activity and Resource-Oriented Lightweight Federated Learning Model for Resource-Constrained Heterogeneous IoT Environment
Authors: Imteaj Ahmed , Amini M. Hadi
Published: April 2021

Federated Learning (FL) is a recently invented distributed machine learning technique that allows available network clients to perform model training at the edge, rather than sharing it with a centralized server. Unlike conventional distributed machine learning approaches, the hallmark feature of FL is to allow performing local computation and model generation on the client side, ultimately protecting sensitive information. Most of the existing FL approaches assume that each FL client has sufficient computational resources and can accomplish a given task without facing any resource-related issues. However, if we consider FL for a heterogeneous Internet of Things (IoT) environment, a major portion of the FL clients may face low resource availability (e.g., lower computational power, limited bandwidth, and battery life). Consequently, the resource-constrained FL clients may give a very slow response, or may be unable to execute expected number of local iterations. Further, any FL client can inject inappropriate model during a training phase that can prolong convergence time and waste resources of all the network clients. In this paper, we propose a novel tri-layer FL scheme, Federated Proximal, Activity and Resource-Aware 31 Lightweight model (FedPARL), that reduces model size by performing sample-based pruning, avoids misbehaved clients by examining their trust score, and allows partial amount of work by considering their resource-availability. The pruning mechanism is particularly useful while dealing with resource-constrained FL-based IoT (FL-IoT) clients. In this scenario, the lightweight training model will consume less amount of resources to accomplish a target convergence. We evaluate each interested client's resource-availability before assigning a task, monitor their activities, and update their trust scores based on their previous performance. To tackle system and statistical heterogeneities, we adapt a re-parameterization and generalization of the current state-of-the-art Federated Averaging (FedAvg) algorithm. The modification of FedAvg algorithm allows clients to perform variable or partial amounts of work considering their resource-constraints. We demonstrate that simultaneously adapting the coupling of pruning, resource and activity awareness, and re-parameterization of FedAvg algorithm leads to more robust convergence of FL in IoT environment.
Dimensions of Migrant Integration in Western Europe
Authors: Heath Anthony F. , Schneider Silke L.
Published: April 2021

The integration of immigrant minorities is a major concern for diverse societies–with major implications for the well-being of those affected, social cohesion and group relations, and economic and social progress. In this paper, we give a comprehensive description of long-term migrant integration in Western Europe to investigate theories of migrant assimilation and integration. We take a multidimensional approach, looking at 10 indicators measuring social, structural, political, civic and cultural integration. We take an innovative approach to measuring minority background by using two complementary measures: generational status, distinguishing first and second-generation migrants from the third and higher up ‘natives,’ and self-reported ancestry, separating those with autochthonous-only ancestry from those with various kinds of allochthonous ancestry. Using interaction effects between these measures, we can test whether generational change is faster or slower for some ethnic groups than for others, i.e. whether different groups integrate at differing speeds. Using the pooled samples of all Western European countries included in the European Social Survey rounds 7 and 8, we run multivariate regression analyses to estimate the effects of migrant background on the 10 indicators of integration. Compared to migrants with autochthonous ancestry, respondents of Middle Eastern, North African & Central Asian as well as Sub-Saharan African ancestry are less integrated on all dimensions of integration except the political and civic ones. The South & South-East Asian group is also substantially less assimilated socially and culturally, but not so much structurally. They are closely followed by the South East and East European groups, following the same pattern except that the latter are less integrated politically as well. We only find substantial interaction effects between ethnic group and migrant generation for two integration indicators, namely citizenship and homophobia, for which speed of integration thus appears to differ across ethnic groups. For all other indicators, integration speed does not appear to differ across ethnic groups, supporting straight line assimilation theory, with social integration in terms of interethnic friendship potentially rather following a ‘bumpy-line’ pattern.
A Nomogram to Predict Long-Term Survival Outcomes of Patients Who Undergo Pneumonectomy for Non-small Cell Lung Cancer With Stage I-IIIB
Authors: Wu Lei-Lei , Chen Wu-Tao , Liu Xuan , Jiang Wen-Mei , Huang Yang-Yu , Lin Peng , Long Hao , Zhang Lan-Jun , Ma Guo-Wei
Published: April 2021

Background: In this study, we aim to establish a nomogram to predict the prognosis of non-small cell lung cancer (NSCLC) patients with stage I-IIIB disease after pneumonectomy.

Methods: Patients selected from the Surveillance, Epidemiology, and End Results (SEER, N = 2,373) database were divided into two cohorts, namely a training cohort (SEER-T, N = 1,196) and an internal validation cohort (SEER-V, N = 1,177). Two cohorts were dichotomized into low- and high-risk subgroups by the optimal risk prognostic score (PS). The model was validated by indices of concordance (C-index) and calibration plots. Kaplan-Meier analysis and the log-rank tests were used to compare survival curves between the groups. The primary observational endpoint was cancer-specific survival (CSS).

Results: The nomogram comprised six factors as independent prognostic indictors; it significantly distinguished between low- and high-risk groups (all P < 0.05). The unadjusted 5-year CSS rates of high-risk and low-risk groups were 33 and 60% (SEER-T), 34 and 55% (SEER-V), respectively; the C-index of this nomogram in predicting CSS was higher than that in the 8th TNM staging system (SEER-T, 0.629 vs. 0.584, P < 0.001; SEER-V, 0.609 vs. 0.576, P < 0.001). In addition, the PS might be a significant negative indictor on CSS of patients with white patients [unadjusted hazard ration (HR) 1.008, P < 0.001], black patients (unadjusted HR 1.007, P < 0.001), and Asian or Pacific Islander (unadjusted HR 1.008, P = 0.008). In cases with squamous cell carcinoma (unadjusted HR 1.008, P < 0.001) or adenocarcinoma (unadjusted HR 1.008, P < 0.001), PS also might be a significant risk factor.

Conclusions: For post-pneumonectomy NSCLC patients, the nomogram may predict their survival with acceptable accuracy and further distinguish high-risk patients from low-risk patients.
Angle Magnetization Rotation Method for Characterizing Co-Rich Amorphous Ferromagnetic Microwires
Authors: Gudoshnikov Sergey , Grebenshchikov Yury , Popova Anastasya , Tarasov Vadim , Gorelikov Evgeny , Liubimov Boris
Published: April 2021

A low-frequency model of the magnetization reversal of a microwire is developed for those cases when the microwire magnetization response can go beyond the linear approximation. The analysis of the influence of external magnetic fields on the process of magnetization reversal of the microwire, including the hysteresis mode, was performed. The characteristic dependences of the amplitude of the electromotive force, U2f, arising in the pick-up coil wound around the microwire are obtained. It was established that, in the region of relatively small-acting circular and longitudinal magnetic fields, the U2f signal could have a region with the opposite sign. An extended small-angle magnetization rotation method was used to verify the proposed model and test glass-coated, amorphous, Co-rich microwires. During the experiments, the amplitude of the second harmonic, U2f, arising in the pick-up coil when an alternating electric current with the frequency f flows through the microwire, was measured as a function of the applied longitudinal magnetic field at various mechanical tensile stresses. The effective anisotropy field, the magnetostriction constant, and the residual quenching stress of the investigated microwires were determined by comparing the theoretical and experimental data.
Multi-Environment Screening of Durum Wheat Genotypes for Drought Tolerance in Changing Climatic Events
Authors: Ayed Sourour , Othmani Afef , Bouhaouel Imen , Teixeira da Silva Jaime A.
Published: April 2021

Durum wheat is the most widely grown cereal in Tunisia, but its production is threatened by drought, which is exacerbated by climate change. This study aimed to identify drought-tolerant durum wheat genotypes from five modern varieties and six landraces in a multi-environment trial at two sites (Kef and Siliana, Tunisia) during three growing seasons under rainfed and irrigated conditions. Six drought tolerance indices (mean productivity (MP), geometric mean productivity (GMP), stress susceptibility index (SSI), tolerance index (TOL), stress tolerance index (STI), and yield stability index (YSI)) were used to evaluate the 11 genotypes. The environment was the dominant source of variation for grain yield (GY; 94.27%), followed by the environment × genotype interaction (4.06%) and genotype (1.65%). Cluster analysis based on GY identified four environment-based groups with distinct water treatments, extreme minimum/maximum temperatures, and rainfall. Principal component analysis and a correlation matrix revealed that drought tolerance indices significantly correlated with GY in non-stressed and stressed conditions and could be separated into four groups. Based on STI, MP, and GMP, G6 and G8 (landraces) were the most drought-tolerant genotypes attaining high GY in both conditions. TOL was able to discriminate G1, G3, and G5 (modern varieties) as well as drought-susceptible genotypes, all of which were suitable for irrigation. Genotypes G7, G9, G10, and G11 (landraces), which had high SSI and lowest STI, MP, GMP, and YSI values, were susceptible to drought and were thus not suitable for cultivation in both conditions. Finally, G2 and G4 (modern varieties), which had an intermediate rank for different indices, were classified as semi-tolerant or sensitive genotypes. Drought tolerance indices and genotype ranks were helpful tools to screen drought-tolerant genotypes with a large adaptation to a range of environments, namely irrigated and rainfed conditions (landraces G6 and G8), or genotypes with the ability to adapt (modern varieties G1, G3, and G5) to irrigated conditions.
Life Cycle Assessment to Highlight the Environmental Burdens of Early Potato Production
Authors: Timpanaro Giuseppe , Branca Ferdinando , Cammarata Mariarita , Falcone Giacomo , Scuderi Alessandro
Published: April 2021

Climate change, food security, and the protection of the planet’s resources require the adoption of sustainable production models. Achieving sustainable development in the agri-food sector enables the creation of new opportunities for operators, guiding farmers towards more environmentally friendly practices and offering cost-effective results. Organic farming paradigms are promoted by the transformation of some harmful practices of conventional agriculture, such as the wide use of chemical products of synthesis, the deep workings that favor the erosive processes, the excessive use of nitrogenous fertilizers. There are still gaps in the knowledge of the real performance of some products that strongly support the local economic system of Sicily (Italy). The research aims to highlight the differences in environmental impact caused by the cultivation of organic early potatoes compared to the conventional regime and the same per kg of product obtained. To this end, the widely used methodology for comparing the environmental impacts of agricultural production systems is the Life Cycle Assessment, which allows us to highlight the phases in which environmental criticalities are most concentrated. An interesting agroecological picture of knowledge emerges, since organic farming is by definition an ecological model that supports the principles of the Green Deal, it often requires interventions to improve the yields obtained in order to achieve a positive result both in terms of cultivated surface and kg of product obtained.
The Effect of Different Fertilization Regimes on Yield, Selected Nutrients, and Bioactive Compounds Profiles of Onion
Authors: Kazimierczak Renata , Średnicka-Tober Dominika , Barański Marcin , Hallmann Ewelina , Góralska-Walczak Rita , Kopczyńska Klaudia , Rembiałkowska Ewa , Górski Jan , Leifert Carlo , Rempelos Leonidas , Kaniszewski Stanisław
Published: April 2021

Here we report the results of a three-year replicated field trial on the effects of novel clover- and alfalfa-based fertilizer products (Ekofert® K and Ekofert® L), with the input levels equivalent to 120, 180, or 240 kg N ha−1, on the yield and selected sensory and nutritional quality parameters of onion. The study showed that Ekofert fertilizer applied at all three levels produced similar or higher yields than the standard fertilization regimes used in conventional farming in all three seasons. Significant differences in onion composition profiles between fertilization treatments were detected within individual seasons; however, due to substantial interseasonal variation, no consistent differences could be detected between (i) mineral N and Ekofert fertilizer treatments, (ii) the two different Ekofert products, and (iii) contrasting Ekofert input levels. Results demonstrate that clover- and alfalfa-based pelleted organic fertilizer products are a suitable alternative for intensive organic field vegetable production.
The Effect of Foliar Putrescine Application, Ammonium Exposure, and Heat Stress on Antioxidant Compounds in Cauliflower Waste
Authors: Collado-González Jacinta , Piñero Maria Carmen , Otálora Ginés , López-Marín Josefa , Amor Francisco M. del
Published: April 2021

This work has been focused on the study of how we can affect the short heat stress on the bioactive compounds content. Some recent investigations have observed that management of nitrogen fertilization can alleviate short-term heat effects on plants. Additionally, the short-term heat stress can be also ameliorated by using putrescine, a polyamine, due to its crucial role in the adaptation of plants to heat stress Therefore, different NO3−/NH4+ ratios and a foliar putrescine treatment have been used in order to increase tolerance to thermal stress in order to take advantage of the more frequent and intense heat waves and make this crop more sustainable. So, other objective of this work is to make the cauliflower waste more attractive for nutraceutical and pharmaceutical preparations. Thus, the effect of a thermal stress combined with a 50:50 NO3−/NH4+ ratio in the nutrient solution, and the foliar application of 2.5 mM putrescine increased in the content of various sugars (inositol, glucose, and fructose), total phenolic compounds and polyamines, as well as in the antioxidant activity. The greatest accumulation of these compounds was observed in young leaves. Our results show from a physiological and agronomic point of view, that the foliar application of putrescine and the 50:50 NO3−/NH4+ treatment managed to alleviate the negative effects of the abiotic stress suffered at high temperature, yielding plants with higher antioxidant compounds content.