bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of dielectric barrier discharge plasma on the wake of a wind turbine blade section oscillating in plunge
Authors: Maleki GH , Davari Ali R , Soltani MR
Published: July 2021

Effects of dielectric barrier discharge plasma have been studied on the wake velocity profiles of a section of a 660 kW wind turbine blade in plunging motion in a wind tunnel. The corresponding unsteady velocity profiles show remarkable improvement when the plasma actuators were operating and the angles of attack of the model were beyond the static stall angles of the airfoil. As a result the drag force was considerably reduced. It is further observed that the plasma-induced flow attenuates the leading edge vortices that are periodically shed into wake and diminishes the large eddies downstream. The favorable effects of the plasma augmentation are shown to occur near the uppermost and lowermost positions of the plunging paths where the wake is primarily dominated by the vortices of the same sign. The wake structure in the presence of the flow induced by the plasma actuators shows that the actual effective angles of attack seen by the plunging airfoil reduces in comparison with that for the case of the plasma augmentation off situation.
Increased burden of rare variants in genes of the endosomal Toll-like receptor pathway in patients with systemic lupus erythematosus
Authors: Lea-Henry Tom N , Chuah Aaron , Stanley Maurice , Athanasopoulos Vicki , Starkey Malcolm R , Christiadi Daniel , Kitching A Richard , Cook Matthew C , Andrews Thomas D , Vinuesa Carola G , Walters Giles D , Jiang Simon H
Published: July 2021

Objective

To compare the frequency of rare variants in genes of the pathophysiologically relevant endosomal Toll-like receptor (eTLR) pathway and any quantifiable differences in variant rarity, predicted deleteriousness, or molecular proximity in patients with systemic lupus erythematosus (SLE) and healthy controls.

Patients and methods

65 genes associated with the eTLR pathway were identified by literature search and pathway analysis. Using next generation sequencing techniques, these were compared in two randomised cohorts of patients with SLE (n = 114 and n = 113) with 197 healthy controls. Genetically determined ethnicity was used to normalise minor allele frequencies (MAF) for the identified genetic variants and these were then compared by their frequency: rare (MAF < 0.005), uncommon (MAF 0.005–0.02), and common (MAF >0.02). This was compared to the results for 65 randomly selected genes.

Results

Patients with SLE are more likely to carry a rare nonsynonymous variant affecting proteins within the eTLR pathway than healthy controls. Furthermore, individuals with SLE are more likely to have multiple rare variants in this pathway. There were no differences in rarity, Combined Annotation Dependent Depletion (CADD) score, or molecular proximity for rare eTLR pathway variants.

Conclusions

Rare non-synonymous variants are enriched in patients with SLE in the eTLR pathway. This supports the hypothesis that SLE arises from several rare variants of relatively large effect rather than many common variants of small effect.
Impact of switching from digital mammography to tomosynthesis plus digital mammography on breast cancer screening in Alberta, Canada
Authors: Pang Jack XQ , Newsome James , Sun Maggie , Chiang Bonnie , Mutti-Packer Seema , McDonald Sheila W , Yang Huiming
Published: July 2021

Objectives

To compare abnormal call rates (ACR), cancer detection rates (CDR), positive predictive values (PPVs), and annual return to screen recommendations after switching from digital mammography (DM) to digital breast tomosynthesis plus DM (DBT + DM) for breast cancer screening.

Setting

The Alberta Breast Cancer Screening Program collects screening data from clinics throughout the province of Alberta, Canada.

Methods

This study retrospectively collected data, between 2015 and 2018, on women aged 40+ who underwent breast cancer screening at two large volume multisite radiology groups to compare metrics one year prior and one year after DBT + DM implementation. Comparisons between modalities were carried out within age groups, within breast density categories, and for initial vs. subsequent screens.

Results

A total of 125,432 DM and 128,912 DBT + DM screening exams were performed. For women aged 50–74, the DBT + DM group had a higher ACR ( p < 0.01) but lower annual return to screens ( p < 0.01). CDR was higher post-DBT + DM implementation for women with scattered (6.0 per 1000 vs. 4.4 per 1000; p = 0.001) or heterogeneously dense breasts (6.5 per 1000 vs. 4.2 per 1000; p < 0.001). PPV was higher with DBT + DM for all age groups, with women 50–74 having a PPV of 8.3% using DBT + DM vs. 7.1% with DM ( p = 0.009).

Conclusion

All metrics improved or stayed the same after switching to DBT + DM except for ACR. However, the increase in ACR could be attributed to a trend already occurring prior to the switch. Longer term monitoring is needed to confirm these findings.
Reimagining Internationalization in Higher Education Through the United Nations Sustainable Development Goals for the Betterment of Society
Authors: Ramaswamy Meghna , Marciniuk Darcy D. , Csonka Viktória , Colò Laura , Saso Luciano
Published: July 2021

Higher education institutions (HEIs) play a critical role in creating and distributing the knowledge required to tackle the complex global challenges faced by society today. This role is frequently linked with the concept of the internationalization of higher education, but this concept in practice is also subject to criticism. This article argues that integrating the United Nations (UN) sustainable development goals (SDGs) into the teaching and learning functions, partnerships, research, and discovery functions of institutions has the potential to transform institutions and improve society through internationalization. In this article, the ideological and practical intersections of internationalization and the SDGs are discussed. Examples of initiatives around the world that have shaped societal discourse through the lens of internationalization and sustainable development are reviewed. The authors posit that integration of both concepts would enable HEIs to rise up to the global challenge of creating a better world for all.
Is trauma informed care possible in the current public mental health system?
Authors: Isobel Sophie
Published: July 2021

Objectives:

As mental health services move towards implementing ‘Trauma-informed care’, there is a need to consider the challenges posed within services and systems. This paper raises some of the challenges associated with integrating TIC into the current public mental health system. .

Conclusion:

The lack of clarity about expectations of trauma-informed approaches causes difficulties for its integration into services, but the wider political context of mental health services is also of relevance. Transparent and ongoing debate is required about approaches to mental health care, to ensure the system meets the needs of those who require it, while questioning what other purposes it may be serving at social and political levels.
Cross-Cultural Interpreting With Aboriginal and Torres Strait Islander Patients
Authors: Karidakis Maria
Published: July 2021

The aim of this study is to investigate ways in which interpreting practice in health care settings can be further developed to better facilitate communication with Aboriginal and Torres Strait Islander patients. Data used include 15 hours of transcribed audio recording from semi-structured interviews with interpreters and Aboriginal Liaison Officers who discuss their perceived experiences of interpreting in medical settings. They offer insights into how language is used to resolve communication differences that may confound the interpreting process and in doing so identify roles interpreters assume and discourse patterns that emerge in interpreting practice. As evidenced through the findings, provisions need to be made for cultural differences. Interpreters report they have to “unpack” medical terminology and explain such terminology and related concepts in tangible terms to ensure patient understanding. Other strategies include talking about taboo topics using culturally appropriate terms, avoiding certain question–answer routines, and being aware of nonverbal aspects of communication.
The Four Faces of a Free, Appropriate Public Education
Authors: Zirkel Perry A.
Published: July 2021

This article delineates the four successive dimensions of the Individuals with Disabilities Education Act’s (IDEA) central obligation of “free appropriation public education” that the courts have developed thus far: (a) procedural, (b) substantive, (c) incomplete implementation of the last Individualized Education Program (IEP), and (d) incomplete implementation of the next IEP. This current snapshot cites illustrative cases and, to the extent available, empirical analyses. The final recommendation warns against lowering practice and policies to the minimum legal standards for each of these four “faces,” instead using them as organizing counter-markers for a proactive professional orientation.
Trajectory following control of lower limb exoskeleton robot based on Udwadia–Kalaba theory
Authors: Tian Jin , Yuan Liang , Xiao Wendong , Ran Teng , He Li
Published: July 2021

The main objective of this article is to solve the trajectory following problem for lower limb exoskeleton robot by using a novel adaptive robust control method. The uncertainties are considered in lower limb exoskeleton robot system which include initial condition offset, joint resistance, structural vibration, and environmental interferences. They are time-varying and have unknown boundaries. We express the trajectory following problem as a servo constraint problem. In contrast to conventional control methods, Udwadia–Kalaba theory does not make any linearization or approximations. Udwadia–Kalaba theory is adopted to derive the closed-form constrained equation of motion and design the proposed control. We also put forward an adaptive law as a performance index whose type is leakage. The proposed control approach ensures the uniform boundedness and uniform ultimate boundedness of the lower limb exoskeleton robot which are demonstrated via the Lyapunov method. Finally, simulation results have shown the tracking effect of the approach presented in this article.
Optimal actuator placement in adaptive optics systems
Authors: Altıner Berk , Erol Bilal , Delibaşı Akın
Published: July 2021

Adaptive optics systems are powerful tools that are implemented to degrade the effects of wavefront aberrations. In this article, the optimal actuator placement problem is addressed for the improvement of disturbance attenuation capability of adaptive optics systems due to the fact that actuator placement is directly related to the enhancement of system performance. For this purpose, the linear-quadratic cost function is chosen, so that optimized actuator layouts can be specialized according to the type of wavefront aberrations. It is then considered as a convex optimization problem, and the cost function is formulated for the disturbance attenuation case. The success of the presented method is demonstrated by simulation results.
Help-Seeking to Cope With Experiences of Violence Among Women Living With HIV in Canada
Authors: Gormley Rebecca , Nicholson Valerie , Parry Rebeccah , Lee Melanie , Webster Kath , Sanchez Margarite , Cardinal Claudette , Li Jenny , Wang Lu , Balleny Rosa , de Pokomandy Alexandra , Loutfy Mona , Kaida Angela , Abdul-Noor Rahma , Anema Aranka , Angel Jonathan , Bakombo Dada Mamvula , Barry Fatimatou , Bauer Greta , Beaver Kerrigan , Boucher Marc , Boucoiran Isabelle , Brophy Jason , Brotto Lori , Burchell Ann , Cardinal Claudette , Carter Allison , Cioppa Lynne , Conway Tracey , Côté José , Cotnam Jasmine , d’Ambrumenil Cori , Dayle Janice , Ding Erin , Dubuc Danièle , Duddy Janice , Fernet Mylène , Fraleigh Annette , Frank Peggy , Gagnier Brenda , Gagnon Marilou , Gahagan Jacqueline , Gasingirwa Claudine , Gataric Nada , Gormley Rebecca , Greene Saara , Groleau Danielle , Guerlotté Charlotte , Hart Trevor , Hankins Catherine , Hawa Roula , Heer Emily , Hogg Robert S. , Howard Terry , Islam Shazia , Jean-Gilles Joseph , Jefferis Hermione , Jones Evin , Kaushic Charu , Kazemi Mina , Kestler Mary , Kiboyogo Maxime , Klein Marina , Kronfli Nadine , Kwaramba Gladys , Lacasse Gary , Lacombe-Duncan Ashley , Lee Melanie , Lee Rebecca , Li Jenny , Lima Viviane , Lloyd-Smith Elisa , Logie Carmen , Maan Evelyn , Martel-Lafrenière Valérie , Martin Carrie , Masching Renee , Massie Lyne , Medjuck Melissa , Ménard Brigitte , Miller Cari L. , Mitchell Judy , Mondragon Gerardo , Money Deborah , Monteith Ken , Muchenje Marvelous , Mukandamutsa Florida , Ndung’u Mary , Nicholson Valerie , O’Brien Kelly , O’Brien Nadia , Ogilvie Gina , Ogunnaike-Cooke Susanna , Otis Joanne , Parry Rebeccah , Patterson Sophie , Paul Angela , Peltier Doris , Pick Neora , Pierre Alie , Powis Jeff , Proulx-Boucher Karène , Quan Corinna , Rana Jesleen , Roth Eric , Rouleau Danielle , Rouleau Geneviève , Rueda Sergio , Salters Kate , Sanchez Margarite , Sandre Roger , Sas Jacquie , Savoie Édénia , Sereda Paul , Smith Stephanie , Summers Marcie , Tharao Wangari , Tom Christina , Tremblay Cécile , Trigg Jason , Trottier Sylvie , Underhill Angela , Wagner Anne , Walmsley Sharon , Wang Clara , Webster Kath , Wobeser Wendy , Wozniak Denise , Yudin Mark , Zhang Wendy , Zhu Julia
Published: July 2021

Using baseline data from a community-collaborative cohort of women living with HIV in Canada, we assessed the prevalence and correlates of help-seeking among 1,057 women who reported experiencing violence in adulthood (≥16 years). After violence, 447 (42%) sought help, while 610 (58%) did not. Frequently accessed supports included health care providers ( n = 313, 70%), family/friends ( n = 244, 55%), and non-HIV community organizations ( n = 235, 53%). All accessed supports were perceived as helpful. Independent correlates of help-seeking included reporting a previous mental health diagnosis, a history of injection drug use, experiencing childhood violence, and experiencing sexism. We discuss considerations for better supporting women who experience violence.
Awareness of pharmacists and consumers towards protective effects of sunscreens against skin cancer
Authors: Ibrahim Nihal Abdalla , Daraz Nada , Ali Zeena Sameer
Published: July 2021

The objective of the present study was to assess the awareness level of individuals on the use of sunscreen products, and pharmacists’ perception of sunscreen safety. A cross-sectional, descriptive study was conducted in the United Arab Emirates (UAE). Participants involved included 224 female undergraduates of Ajman University (aged 18-25 years old), 234 patients visiting numerous pharmacies, and 58 pharmacists from the private sector in Dubai. Questionnaires were designed and distributed to all participants. Data entry and analysis were performed using SPSS (Statistical Program for Social Sciences) version 20. Among female undergraduate students, 94.7% used sun protection, 81.1% understood what is meant by SPF (Sun Protection Factor) Value, and 70.2% used the optimal SPF (15-20). Additionally, 95.2% reported that sunscreens do not have any side effects. Out of the 234 patients who participated in the study, 86.8% used sun protection, 56.8% understood what is meant by SPF, and 43.2% used the optimal SPF. Furthermore, 93.2% stated that sunscreens do not have any side effects. Female patients were found to use sunscreens with higher SPF values (above 50) as compared to male patients (P ≤ 0.024). Patients above the age of 40 also used sunscreens with high SPF (P ≤ 0.001). As for pharmacists, they all agreed that sunscreens have a marked safety profile, with no side effects, and that the optimal SPF for use is 15-20. Most pharmacists (80%) reported that consumers are in fact aware and knowledgeable about the proper use and application of sunscreens. Optimal use of routine sunscreen is of paramount importance to prevent skin damage as well as cancer.
Programmed Death Ligand 1 Expression and Related Markers in Pleuropulmonary Blastoma
Authors: Alipour Zahra , Schultz Kris Ann P , Chen Ling , Harris Anne K , Gonzalez Ivan A , Pfeifer John , Hill D Ashley , He Mai , Dehner Louis P
Published: July 2021

Introduction

Pleuropulmonary blastoma (PPB), a rare childhood neoplasm of the lung, is linked to pathogenic DICER1 variants. We investigated checkpoint inhibitor markers including Programmed Death Ligand 1 (PD-L1), PD1, CD8 and tumor mutational burden (TMB) in PPB.

Material and Methods

Cases were collected from departmental archives and the International PPB/ DICER1 Registry. Immunohistochemistry (IHC) for PD-L1, PD-1, CD8 and DNA mismatch repair (MMR) genes were performed. In addition, normal-tumor paired whole exome sequencing (WES) was performed in two cases.

Results

Twenty-five PPB cases were studied, consisting of Type I (n = 8, including 2 Ir), Type II (n = 8) and Type III (n = 9). PD-L1 combined positive score (CPS) of 1, 4 and 80 was seen in three (3/25, 12.0%) cases of Type II PPB with negative staining in the remaining cases. PD-1 and CD8 stains demonstrated positive correlation ( P < .05). The density of PD1 and CD8 in the interface area was higher than within tumor ( P < .05). The MMR proteins were retained. TMB was 0.65 mutations/Mb in type II PPB with high expression of PD-L1, and 0.94 mutations/Mb in one negative PD-L1 case with metastatic tumor.

Conclusion

A small subpopulation of PPB patient might benefit from checkpoint immunotherapy due to positive PD-L1 staining.
Impacts of the COVID-19 Control Measures on Widening Educational Inequalities
Authors: Darmody Merike , Smyth Emer , Russell Helen
Published: July 2021

COVID-19 has resulted in a global public health crisis. Measures adopted by governments across the world to reduce transmission have resulted in the closure of educational institutions and workplaces and reduced social interaction. The aim of the article is to reflect on the consequences of the COVID-19 global pandemic for the lives of young people from different social groups, with a special focus on education. It is a desk-based review of empirical research that has emerged in the wake of COVID-19 that has explored the impact of the control measures adopted, resulting in ‘learning loss’ and the widening of the ‘learning gap’ among students. The review shows that rather than utilizing the current situation to tackle pre-existing social inequalities in education, current debates often narrowly focus on immediate rather than long-term measures. The article calls for a broader research agenda on the short- and long-term compensatory measures needed to re-engage students, especially those from more disadvantaged backgrounds.
Transepithelial photorefractive keratectomy on the same day of the initial consultation for the correction of myopia
Authors: Reitblat Olga , Gershoni Assaf , Mimouni Michael , Livny Eitan , Nahum Yoav , Bahar Irit
Published: July 2021

Purpose:

To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the first screening visit in comparison with operations scheduled at a following appointment.

Methods:

Data of consecutive patients with myopia of various degrees, who underwent Trans-PRK, were retrospectively analyzed. Findings were compared between patients who underwent Trans-PRK on the same day of first consultation to patients that underwent surgery at subsequent visits, following initial consultation on a different day.

Results:

The study included 599 eyes treated on the initial visit day and 1936 eyes treated on a subsequent visit. Mean final spherical equivalent was close to emmetropia in both groups ( p = 0.183). Efficacy indices were 0.928 ± 0.192 in the initial-visit group and 0.945 ± 0.163 in the second-visit group ( p = 0.152). Safety indices were 0.954 ± 0.156 and 0.955 ± 0.151 ( p = 0.707), respectively. No differences between the groups were seen in uncorrected visual acuity (UDVA) of ⩾20/20, ⩾20/25, and ⩾20/32. Only the sub-analysis of patients reaching UDVA of 20/40 or better was slightly lower in the first-visit (95.5%) compared with the second-visit group (97.9%, p = 0.001). Results of attempted correction within ±0.50 D were: 63.3% and 69.0%, respectively ( p = 0.009). Complications profiles in the two groups were comparable.

Conclusions:

Trans-PRK completed on the day of the first screening appointment demonstrated a similar safety outcome compared with subsequent-visits procedures, and slightly lower, yet comparable, results regarding efficacy and predictability.
Why not both? Rethinking categorical and continuous approaches to bilingualism
Authors: Kremin Lena V. , Byers-Heinlein Krista
Published: July 2021

Aims and Objectives:

Bilingualism is a complex construct, and it can be difficult to define and model. This paper proposes that the field of bilingualism can draw from other fields of psychology, by integrating advanced psychometric models that incorporate both categorical and continuous properties. These models can unify the widespread use of bilingual and monolingual groups that exist in the literature with recent proposals that bilingualism should be viewed as a continuous variable.

Approach:

In the paper, we highlight two models of potential interest: the factor mixture model and the grade-of-membership model. These models simultaneously allow for the formation of different categories of speakers and for continuous variation to exist within these categories. We discuss how these models could be implemented in bilingualism research, including how to develop these models. When using either of the two models, researchers can conduct their analyses on either the categorical or continuous information, or a combination of the two, depending on which is most appropriate to address their research question.

Conclusions:

The field of bilingualism research could benefit from incorporating more complex models into definitions of bilingualism. To help various subfields of bilingualism research converge on appropriate models, we encourage researchers to pre-register their model selection and planned analyses, as well as to share their data and analysis scripts.

Originality:

The paper uniquely proposes the incorporation of advanced statistical psychometric methods for defining and modeling bilingualism.

Significance:

Conceptualizing bilingualism within the context of these more flexible models will allow a wide variety of research questions to be addressed. Ultimately, this will help to advance theory and lead to a fuller and deeper understanding of bilingualism.
Not just a pretty picture: Scientific fact visualisation styles, preferences, confidence and recall
Authors: Walsh Erin I , Sargent Ginny M , Grant Will J
Published: July 2021

Visuals are often used to enhance learning of scientific information. The recent emergence and popularity of comic-style instruction books for adults, such as the ‘manga guide to …’, shows the possibility of comic style visualisations for the communication of science with adults. This study investigates whether the addition and style of visual accompaniment of scientific information, as used in comic books, influences immediate and short-term fact recall in an adult audience. Participants ( n = 310 aged 18–79, 52% identified as female) were presented 20 general science facts in one of five styles: (1) text alone, (2) photo with text caption, (3) cartoon with text caption, (4) photo with explanatory agent and a speech bubble, (5) cartoon with explanatory agent and a speech bubble. Immediate recall, and confidence in that recall, was tested following a brief distractor. Participants indicated their preferred presentation style, and short-term recall was tested by a final quiz of all 20 facts. Overall, the most preferred presentation style was cartoon with explanatory agent and text in a speech bubble (26% preferred). There was no single most effective presentation style; there was no significant difference in immediate recall, short term recall or confidence in answers depending on whether the fact was presented as text, photo or cartoon, or the presence or absence of an explanatory agent. However, immediate recall was significantly better when preference was met ( p < 0.02). We found that the style of visual accompaniment of scientific information in accordance with the ‘manga guide to…’ format influenced immediate, but not short-term, fact recall in an adult audience when written English literacy, scientific literacy and non-verbal intelligence were taken into account. Short term recall of scientific facts may best be served by presenting facts in multiple styles, or enquiring about and then meeting participant preference for visual accompaniment.
What is relationality? Indigenous knowledges, practices and responsibilities with kin
Authors: Tynan Lauren
Published: July 2021

This paper delves into the concept of relationality and pairs academic literature with stories and lessons from Country. Bringing together majority Indigenous scholarship on relationality, the paper describes three main ideas: (1) How does a relational reality operate? (2) Relationality as a living practice and, (3) Relationality as responsibilities with kin. Many examples are provided to explain relationality in practical and concrete ways. As a trawlwulwuy woman, I weave the stories and lessons from Country throughout the paper, with a particular focus on research. I consider an inverse of relationality, extractivism, and identify how many dominant research practices are deeply extractive. The paper concludes with prompts for the reader on how research can be a more relational process. Overall, the paper demonstrates a relational ethos in (and out of) practice.
Competency-based education in the state policy arena: Comparative case study of two neighboring states
Authors: Williams Heather P. , Shoup Kathleen , Diffenbaugh Marita , Brady Kelly
Published: July 2021

Educational leaders and policymakers are reconsidering the role of competency-based education (CBE) to meet the needs of all students, address issues of equity and enduring achievement gaps, and demonstrate college and career readiness outcomes for PK-12 students. This study sought to understand the policy conditions where CBE policies were adopted in two neighboring states as well as describe the two states’ implementation plans for policy diffusion. The study used a comparative case study design to study Idaho and Utah due to their geographic proximity, socioeconomic status, and state legislative structures. We argue that although the policies in both states have many similarities and were passed under similar political conditions within each state’s policy arena, the planned implementation and diffusion of those policies was very different and influenced a divergent population of local education agencies (LEA) in each state. We also explore the role intermediary organizations played in the development and diffusion of policy in both states.
Consumer Journeys of Adolescent Girls and Young Women in South Africa: Implications for Marketing HIV Prevention Products
Authors: Dugas Michelle , Crowley Kenyon , Gao Guodong (Gordon) , McHarry Lorcan , Kenmuir Louise , Piper Jeanna , Veronese Fulvia , Agarwal Ritu
Published: July 2021

Background:

Female-initiated prevention products could reduce HIV infection rates in contexts with pronounced gender inequality like South Africa, but uptake and adherence remain low when available. Insights into the behavior of target consumers are needed to effectively promote these products; however, perceptions of stigma may discourage honest reporting.

Focus of the Article:

To address this need, we examined differences among the consumer journeys of six segments of South African adolescent girls and young women (AGYW), who vary on sexual health beliefs, sexual experience, and self-enhancement, when buying hygiene products.

Research Question:

We hypothesized that segments would differ in what motivated their purchases and in engagement with different touchpoints, reflecting a need for targeted outreach strategies.

Methods:

1,500 low-income, Black South African AGYW (14–25 years of age) were surveyed face-to-face in their homes about their consumer journeys when purchasing deodorant and sanitary products, with the aim of extending the insights obtained to HIV prevention.

Results:

We found notable similarities across segments but also several important differences underscoring the potential for tailored marketing of HIV prevention products. Among some of the segments, differences were found in prepurchase mindsets and touchpoints, retail and brand drivers, and postpurchase feelings.

Recommendations for Research or Practice:

These findings highlight the need for tailored outreach among AGYW and may inform the design of effective, personalized marketing strategies that enhance the appeal of HIV prevention products.

Limitations:

To circumvent potential stigma associated with HIV, survey questions were anchored on personal hygiene products. While this may encourage greater honesty, findings may not fully generalize to HIV prevention products.
Left Subclavian Artery Kinking: An Unusual Cause of Partial Subclavian Steal Syndrome
Authors: Faria Mariana de Gregório , Passos Mauro de Deus , Ferreira Dilson Palhares , Alves Luciano Moreira
Published: July 2021

This report describes the case of a 63-year-old asymptomatic patient presenting findings compatible with partial subclavian steal syndrome on color Doppler ultrasound of the carotid and vertebral arteries. The ultrasonic analysis of the cervical vessels showed no apparent cause to justify the subclavian steal. Computed tomographic angiography of the thoracic aorta showed left subclavian artery kinking proximal to the origin of the vertebral artery, an extremely rare finding that led to the subclavian steal. The patient underwent conservative treatment.
Covariate adjustment in subgroup analyses of randomized clinical trials: A propensity score approach
Authors: Yang Siyun , Li Fan , Thomas Laine E , Li Fan
Published: July 2021

Background:

Subgroup analyses are frequently conducted in randomized clinical trials to assess evidence of heterogeneous treatment effect across patient subpopulations. Although randomization balances covariates within subgroups in expectation, chance imbalance may be amplified in small subgroups and adversely impact the precision of subgroup analyses. Covariate adjustment in overall analysis of randomized clinical trial is often conducted, via either analysis of covariance or propensity score weighting, but covariate adjustment for subgroup analysis has been rarely discussed. In this article, we develop propensity score weighting methodology for covariate adjustment to improve the precision and power of subgroup analyses in randomized clinical trials.

Methods:

We extend the propensity score weighting methodology to subgroup analyses by fitting a logistic regression propensity model with pre-specified covariate–subgroup interactions. We show that, by construction, overlap weighting exactly balances the covariates with interaction terms in each subgroup. Extensive simulations were performed to compare the operating characteristics of unadjusted estimator, different propensity score weighting estimators and the analysis of covariance estimator. We apply these methods to the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training trial to evaluate the effect of exercise training on 6-min walk test in several pre-specified subgroups.

Results:

Standard errors of the adjusted estimators are smaller than those of the unadjusted estimator. The propensity score weighting estimator is as efficient as analysis of covariance, and is often more efficient when subgroup sample size is small (e.g. <125), and/or when outcome model is misspecified. The weighting estimators with full-interaction propensity model consistently outperform the standard main-effect propensity model.

Conclusion:

Propensity score weighting is a transparent and objective method to adjust chance imbalance of important covariates in subgroup analyses of randomized clinical trials. It is crucial to include the full covariate–subgroup interactions in the propensity score model.
Drug labeling changes and pediatric hematology/oncology prescribing: Measuring the impact of U.S. legislation
Authors: Benning Tyler J , Shah Nilay D , Inselman Jonathan W , Van Houten Holly K , Ross Joseph S , Wyatt Kirk D
Published: July 2021

Background/Aims:

The Pediatric Research Equity Act and Best Pharmaceuticals for Children Act are intended to promote the conduct of clinical trials that generate pediatric-specific evidence about drug safety and efficacy. This study assesses the quality of evidence generated through Pediatric Research Equity Act–mandated and Best Pharmaceuticals for Children Act–incentivized clinical trials of hematology/oncology drugs and characterizes subsequent changes in pediatric drug utilization rates.

Methods:

Trial characteristics (blinding, randomization, and comparator group) were determined for clinical trials that supported pediatric label changes. Using data from OptumLabs® Data Warehouse, a de-identified administrative claims database, we calculated pediatric utilization rates for each drug. We calculated monthly utilization rates from January 2003 (or from the first month in which data were available) to December 2018.

Results:

We identified 11 hematology/oncology drugs that underwent pediatric label changes under the Pediatric Research Equity Act Pediatric Research Equity Act and/or Best Pharmaceuticals for Children Act, and we identified 15 trials supporting these changes. Of these trials, 36% (5/14) were randomized, 31% (4/13) were blinded, and 36% (5/14) used a comparator group. A median of 49 children (interquartile range 29.5) received the drug under investigation across these trials. Pediatric label changes were not associated with subsequent changes in pediatric drug utilization. Although some drugs saw increased pediatric use after gaining new pediatric indications, this pattern was not consistently observed. In addition, there was no evidence to suggest that drugs were utilized less frequently after they failed to receive pediatric indications.

Conclusions:

Clinical trials of hematology/oncology drugs conducted under the Pediatric Research Equity Act Pediatric Research Equity Act and Best Pharmaceuticals for Children Act generally have low methodological rigor, and the resulting label changes are not consistently associated with changes in pediatric utilization. Alternative regulatory strategies and study designs may be necessary to maximize the impact of newly generated knowledge on drug utilization.
Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women
Authors: Douglas Pamela
Published: July 2021

Background:

Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications.

Aim:

This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome.

Method:

The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review.

Results:

There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes.

Discussion:

Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance.

Conclusion:

Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.
‘Fed with the Wrong Stuff’: Information overload (?) and the everyday use of the Internet in rural and urban China
Authors: Yan Pu
Published: July 2021

The proliferation of information technologies has changed how Internet users around the world seek information. While information and communication technologies have transformed the structure of the Chinese economy, they have also brought challenges to the informational realms of everyday lives. However, there is a lack of empirical research exploring if users have encountered barriers in seeking online information for daily tasks. This mixed-methods study focuses on the disruptive influence of digital technologies on everyday information seeking practices, namely, the paradoxical co-existence of information overload and the lack of information sources. Results suggest that Chinese Internet users face a dilemma of receiving redundant online information and yet still experience a lack of high-quality information sources online. Findings from this research provide new perspectives of understanding the role of digital technologies in everyday life and also extend the dimensions of digital divides from internet access to disparities in information practices and experiences.
LncRNA CASC2 is involved in the development of chronic obstructive pulmonary disease via targeting miR-18a-5p/IGF1 axis
Authors: Liu Panpan , Zhang Huali , Zeng Haizhu , Meng Yingxia , Gao Hongchang , Zhang Meilan , Zhao Lei
Published: July 2021

Aims:

Chronic obstructive pulmonary disease (COPD) is a systemic disease. Several long non-coding RNAs (lncRNAs) have been identified to be aberrantly expressed in COPD patients. This study investigated the role of lncRNA cancer susceptibility candidate 2 (CASC2) in COPD, as well as its potential mechanism.

Methods:

Fifty smokers with COPD and another 50 smokers without COPD were recruited. Receiver operating characteristic curve was constructed to assess the diagnostic value of CASC2 in COPD patients. 16HBE cells were treated with cigarette smoke extract (CSE) to establish a cell model. qRT-PCR was used for the measurement of mRNA levels. The cell viability and apoptosis were detected by using Cell Counting Kit-8 and flow cytometry assay. Enzyme-linked immunosorbent assay was performed to detect the levels of proinflammatory cytokines. Luciferase reporter assay was performed for the target gene analysis.

Results:

Serum CASC2 was dramatically decreased in COPD patients compared with smokers without COPD, and was positively associated with FEV1 (forced expiratory volume in one second). Serum CASC2 was overexpressed in severe COPD patients, and had the diagnostic accuracy to distinguish COPD patients from smokers. CASC2 overexpression alleviated CSE-induced apoptosis and inflammation in 16HBE cells. CASC2 functions as a ceRNA of miR-18a-5p. Upregulation of miR-18a-5p reversed the influence of CASC2 on cell apoptosis and inflammation in 16HBE cells. IGF1 was the target gene of miR-18a-5p.

Conclusion:

CASC2 was downregulated in COPD patients and it might be a promising biomarker for the disease diagnosis. Overexpression of CASC2 might inhibit the bronchial epithelial cell apoptosis and inflammation via targeting miR-18a-5p/IGF1 axis. The reviews of this paper are available via the supplemental material section.
Predicting conversion to multiple sclerosis in patients with radiologically isolated syndrome: a retrospective study
Authors: Chaloulos-Iakovidis Panagiotis , Wagner Franca , Weber Lea , Diem Lara , Chan Andrew , Salmen Anke , Friedli Christoph , Hoepner Robert
Published: July 2021

Aims:

To retrospectively analyse the Bernese radiologically isolated syndrome (RIS) cohort with the goal of developing a prediction score for conversion to multiple sclerosis (MS).

Methods:

A total of 31 patients with RIS were identified by screening medical records of neurological patients seen at the University Hospital of Bern between 2004 and 2017 for the diagnoses ‘radiologically isolated syndrome’ and ‘RIS’ adhering to 2009 Okuda recommendations. We analysed clinical, paraclinical and magnetic resonance imaging data during a maximum follow-up period of 3 years and identified significant predictors of conversion to MS.

Results:

Data were available for 31 patients meeting 2009 Okuda RIS criteria. During the 3 years of follow up, 5/31 RIS patients converted to relapsing-remitting (RR) MS. In our univariate analysis, gadolinium (Gd) enhancement, brainstem and cerebellar hemisphere lesions, immune cell count and albumin concentration in cerebrospinal fluid (CSF), and anti-nuclear antibody (ANA) positivity in serum were identified as significant predictors of conversion to MS. Integrating these factors into our ‘RIS–MS prediction score’ enabled us to calculate a cut-off for prediction of conversion to MS within 3 years with high specificity [1.0, 95% confidence interval (CI) 0.84–1.00) and acceptable sensitivity (0.6, 95% CI 0.17–0.93)].

Conclusion:

Our RIS–MS prediction score, if validated in an independent cohort, integrating radiological (Gd enhancement, brainstem and cerebellar hemisphere lesions) and paraclinical factors (ANA in serum, cell count and albumin in CSF) could be a useful prognostic tool for early recognition of RIS patients with a high risk of clinical progression to MS.
Energy management in the smart grid: State-of-the-art and future trends
Authors: Meliani Meryem , Barkany Abdellah El , Abbassi Ikram El , Darcherif Abdel Moumen , Mahmoudi Morad
Published: July 2021

Integration of distributed generations that fluctuate widely (such as Photovoltaic panels, Wind power, Electric Vehicles and Energy Storage Systems), poses a chance to the stability of power technology and distribution structures. However, the primary reason is that the electricity ratio between supply and demand may not be balanced. An extra or scarcity inside the production or intake of electricity can disrupt the system and cause critical problems which include a drop/rise in voltage and, under difficult conditions, power outages. The use of Energy Management Systems can effectively increase the balance between supply and demand and decrease peak load throughout unplanned durations. The energy management system is capable of not only sharing or exchanging energy between the different energy resources available, but also of economically supplying loads in a reliable, safe and effective manner under all conditions necessary for the operation of the power grid. This work outlines the structure, goals, benefits and defies of the energy control system via an in-intensity analysis of the distinctive stakeholders and participants engaged on this system. A detailed essential analysis of the functioning of distinct programs which includes Demand Response, Demand Management and Energy Quality Management implemented inside the electricity management gadget is presented in this review. It also summarizes quantifications of the various strategies of uncertainty. It includes as well a comparative and an important assessment of the primary optimization techniques which are used to obtain the extraordinary goals of energy management structures while at the same time meeting a wide range of requirements.
The impact of occlusal support on temporomandibular disorders: a literature review
Authors: Nguyen Minh Son , Saag Mare , Jagomägi Triin , Nguyen Quang Hai , Voog-Oras Ülle
Published: July 2021

Temporomandibular disorders are a multifactorial disease. Occlusal support and the number of teeth in dentition have significant effects on the masticatory system. The current study aims to review the role of occlusal support in association with findings of temporomandibular disorders. Data sources were PubMed, Web of Science and Google Scholar, with 1411 citations published over the period 1992–2019. The selection criteria stipulated that articles must have reported the association between the number of teeth, occlusal unit, occlusal support and temporomandibular disorders. A total of 15 full-text articles was finally accessed for eligibility in the current review. The studies on temporomandibular disorders were collected from various sources, including articles reporting temporomandibular disorder symptoms ( n=1), temporomandibular disorder signs ( n=5), temporomandibular joint osseous changes ( n=1), temporomandibular joint dysfunction using the Helkimo index ( n=2), and temporomandibular disorder classification ( n=6). Of these articles, significant associations were found between: the number of missing teeth and temporomandibular disorders ( n=5); the number of occlusal units and occlusal supports and temporomandibular disorders ( n=3); the position of the lost occlusal units and temporomandibular disorders ( n=1). Loss of the occlusal unit has more impact on temporomandibular disorders than the loss of posterior teeth. The total loss of unilateral occlusal support seems to be an aetiological factor for temporomandibular disorders, and maintenance of balanced posterior occlusal support has a role in the prevention and management of temporomandibular disorders.
Liquorice for pain?
Authors: Bell Rae F. , Moreira Vânia M. , Kalso Eija A. , Yli-Kauhaluoma Jari
Published: July 2021

Liquorice has a long history of use in traditional Chinese, Ayurvedic and herbal medicine. The liquorice plant contains numerous bioactive compounds, including triterpenes, flavonoids and secondary metabolites, with glycyrrhizin being the main active compound. Liquorice constituents have been found to have anti-inflammatory, antioxidant, antiviral, anticancer, hepatoprotective and neuroprotective properties. In addition, they appear to have antidepressant actions and effects on morphine tolerance. Glycyrrhizin, its metabolite glycyrrhetic (glycyrrhetinic) acid and other liquorice-derived compounds such as isoflavonoids and trans-chalcones, exert potent anti-inflammatory effects via a wide range of mechanisms including high mobility group box 1 protein (HMGB1) inhibition, gap junction blockade and α2A-adrenoceptor antagonism. These properties, together with an increasing body of preclinical studies and a long history of use in herbal medicine, suggest that liquorice constituents may be useful for pain management. Glycyrrhizin is used widely in the confectionary, food and tobacco industries, but has documented adverse effects that may limit clinical use. Whether liquorice plant-derived compounds represent a novel class of analgesics is yet to be established. Having a host of bioactive compounds with a broad range of mechanisms of effect, liquorice is a plant that, in the future, may give rise to new therapies for pain.