bluuebunny/crossref_metadata_2025 huggingface dataset:
Paul’s Ministry and the Miraculous
Authors: Twelftree Graham H.
Published: April 2021

Observations such as the importance of the miraculous for Jews among Paul’s peers, Paul considering the eschaton had come at least in part, that he saw himself in the tradition of the scriptural prophets, that the miraculous was important in the Christianity Paul initially encountered, and that his own experience included the miraculous, lead to a predisposition to finding the miraculous important in Paul’s ministry. In turn, passages that have been at the centre of discussions about Paul’s ministry and the miraculous show that his gospel was a combination of his speaking and the miraculous. However, instead of claiming to perform miracles, Paul most often described himself as ‘gospelling’ rather than preaching, assigning God the credit for the miraculous. The miraculous was, then, part of Paul’s ministry not because he was a person of spiritual power, but because the power of God worked through his weakness.
Whether Jews, Whether Greeks: Was 1 Cor. 15:29 Addressed to Jewish Disciples of Jesus?
Authors: Keshet Hanoch Ben
Published: April 2021

A satisfying solution for 1 Corinthians 15:29 remains to be achieved, and this certainly justifies new directions of investigation. This article, then, focuses on two main issues: a) an indirect middle reading of baptizomenoi and baptizontai instead of permissive middle or passive, and b) Jewish burial practices performed in hope of the resurrection. Jews purified their deceased prior to burial in the Second Temple. Jewish belief in bodily resurrection was wide-spread, though not universal. Paul’s argument in 1 Cor. 15:29, then, may engage certain Jewish disciples of Jesus who believed he is the Messiah, and was resurrected, but who, like the Sadducees, denied a last-day resurrection. Paul may have enlisted Jewish burial practices and an unusual Greek construction to support the concept of resurrection.
The Person of Jesus Christ as the Normative Basis for the Doctrine of Creation: Re-Envisioning T. F. Torrance’s Christocentric Doctrine of Creation
Authors: Irving Alexander J. D.
Published: April 2021

T. F. Torrance’s Christocentric doctrine of Creation prioritises the Father-Son relation as the objective basis of the knowledge of creation. However, Torrance’s approach to the doctrine of creation has not satisfactorily applied core insights from his broader theological method. Specifically, Torrance’s conviction that the union of God and humanity in the person of Jesus Christ articulated in the conceptual structure of the hypostatic union is normative over all other doctrines that have to do with the relationship of God and creation makes no impact on his doctrine of creation. This essay re-envisions Torrance’s Christocentric doctrine of creation by extending the focus from the Father-Son relation to the person of the Son and establishes how the conceptual structure of the hypostatic union articulated through the couplet of anhypostasia and enhypostasia may be employed as a Christological structure within which to conceive of the relationship of God and creation.
Theological Turns Toward Theopoetic Sensibilities: Embodiment, Humility, and Hospitality
Authors: Michener Ronald T.
Published: April 2021

A ‘theopoetic’ issues a clarion call for an embodied, multi-dimensional theology as an affirmative response to the excesses of reason and cognition often characteristic of modernity and evangelical theological expressions. When reason becomes detached from the imagination, it robs the Church of the breadth of God’s incarnational communicative action through both the mind and heart: theo-logic and theo-poiesis. This article will highlight several recent ‘theopoetic’ trajectories as exemplars towards an overall theological sensibility that includes human thinking, affections, and imaginations manifested through embodiment, humility and hospitality. It intends to stimulate further research and dialogue for evangelical theopoetic initiatives, integrating both the cognitive and affective in theological discourse.
Maps, Improvisation, and Games: Retaining Biblical Authority in Local Theology
Authors: Ott Craig
Published: April 2021

One of the primary tasks of local theology is to address questions and challenges that are context-specific but not explicitly addressed in the Bible. How can biblical authority be retained while attempting to answer questions, whereby the theologian is compelled to go beyond explicit biblical teaching? Ways of resolving the seeming tension between local theologizing and the normative authority of Scripture are addressed by examining three somewhat novel approaches to conceptualizing the theological process. The first is Paul G. Hiebert’s idea of critical realism and the analogy of maps. The second is Kevin J. Vanhoozer’s idea of theodrama and improvisation. The third is my own concept of game logic and strategy. Each of these three conceptualizations will be briefly described with particular attention to the task of local theologizing and biblical authority.
Idem Fecit: Irenical Animadversions on the Boundaries of the Classical Doctrine of Penal Substitutionary Atonement
Authors: Williams Garry J.
Published: April 2021

Garry Williams responds to Michael Lynch’s critique of his chapters in From Heaven He Came and Sought Her. The response focuses on Lynch’s claim that Williams unduly narrows the definition of classical penal substitutionary atonement to bounds set by John Owen. It shows that Williams did not include in his definition Owen’s account of Christ bearing the same (idem) as sinners deserved, and thus did not exclude major Reformed authors. Rather, Williams argued that the classical doctrine identifies Christ’s sufferings with the actual sins of real persons, a criterion fulfilled by the authors. The idem question is seen to be more subtle than Lynch allows. The idea of a non-quantifiable specificity in the sufferings of Christ is restated. Significant findings emerge for the importance of imputation and transfer to penal substitutionary atonement, and for articulating the different senses in which Christ bore (or did not) the idem as sinners deserved.
Mark 10:38–39: Was Jesus’s Challenge ‘Drinking the Cup and Becoming Drunk’? Extended Senses of Baptizō in the NT
Authors: Keshet Hanoch Ben
Published: April 2021

Use of baptizō and baptisma in Mark 10:38–39 to signify ‘destined suffering’ has puzzled many exegetes. It appears, however, that baptizō bore a contemporary extended sense of intoxicate that provides a reasonable solution. Jesus’s original Semitic saying behind Mark 10:38–39 may have challenged James and John with drinking the cup and being drunken, employing two Semitic metaphors to signify a horrific ordeal. This article reviews evidence that supports use of baptizō for intoxication. The article also reviews Eckhard Schnabel’s proposed lexical entry for defining extended senses of baptizō, including drunkenness, and his call to translate baptizō in the NT and not merely to transliterate it as ‘baptize’.
A More Virtuous Understanding of Sex
Authors: Graham Wyatt
Published: April 2021

To strengthen a Christian understanding of sex, this article uses the framework of virtue ethics to show how males and females can flourish in distinguishable ways. It shows a positive rather than a negative vision for sexual complementarity since humans tend to gravitate toward beauty. In so doing, it contributes to the complementarian-egalitarian debate which has come to a standstill. Some have tried to bypass the debate by proposing new avenues of conceiving of the divide, yet such proposals fail to convince those entrenched within their exegetical, theological, and social positions. A virtue-centered approach to the debate may breach the impasse and will provide a more accurate account of sex. Specifically, this article argues that motherhood and fatherhood form the essential difference between the sexes and points to humanity’s telos.
Having ‘Ears to Hear’: Jesus, Gethsemane, and Epistemology
Authors: Moser Paul K.
Published: April 2021

The New Testament synoptic Gospels suggest an epistemology exemplified by Jesus in Gethsemane and in his use of parables. This article explains the epistemology in terms of reconciliatory evidence and knowledge of God as sought by Jesus. The synoptic Gospels use Jesus’s kind of obedience in Gethsemane to characterize a receptive human mode for God to self-manifest and thus to anchor reconciliatory knowledge. This mode includes Gethsemane-style acquaintance with and conviction by God’s perfect will in conscience. The article proposes that a non-cooperative human response can prompt divine hiding for good redemptive reasons. In illuminating what it is to have ‘ears to hear’ God’s word, the article reveals a unity between knowledge of the earthly Jesus and knowledge of the risen Jesus. The article draws from the apostle Paul for some helpful elucidation.
Characteristics and Causes of Extreme Snowmelt over the Conterminous United States
Authors: Welty Josh , Zeng Xubin
Published: April 2021

Snowmelt is an essential process for the health and sustenance of numerous communities and ecosystems across the globe, though it also presents potential hazards when ablation processes are exceedingly rapid. Using 4-km daily snow water equivalent, temperature, and precipitation data for three decades (1988–2017), here we provide a broad characterization of extreme snowmelt episodes over the conterminous United States in terms of magnitude, timing, and coincident synoptic weather patterns. Larger-magnitude extreme snowmelt events usually coincide with minimal precipitation and elevated temperatures. However, certain regions, particularly mountainous regions and the northeastern United States, exhibit greater likelihood of extreme snowmelt events during pronounced rain-on-snow events. During snowmelt extremes, snowmelt rate often exceeds precipitation in many regions. Meteorological patterns and associated water vapor transport most directly connected to extreme events over different regions are classified via a machine-learning technique. Over the 30-yr study period, there is a weakly increasing trend in the frequency of extremes, though this does not necessarily signify an increase in snowmelt magnitudes.
Automated Radiographic Evaluation of Adenoid Hypertrophy Based on VGG-Lite
Authors: Liu J.L. , Li S.H. , Cai Y.M. , Lan D.P. , Lu Y.F. , Liao W. , Ying S.C. , Zhao Z.H.
Published: April 2021

Adenoid hypertrophy is a pathological hyperplasia of the adenoids, which may cause snoring and apnea, as well as impede breathing during sleep. The lateral cephalogram is commonly used by dentists to screen for adenoid hypertrophy, but it is tedious and time-consuming to measure the ratio of adenoid width to nasopharyngeal width for adenoid assessment. The purpose of this study was to develop a screening tool to automatically evaluate adenoid hypertrophy from lateral cephalograms using deep learning. We proposed the deep learning model VGG-Lite, using the largest data set (1,023 X-ray images) yet described to support the automatic detection of adenoid hypertrophy. We demonstrated that our model was able to automatically evaluate adenoid hypertrophy with a sensitivity of 0.898, a specificity of 0.882, positive predictive value of 0.880, negative predictive value of 0.900, and F1 score of 0.889. The comparison of model-only and expert-only detection performance showed that the fully automatic method (0.07 min) was about 522 times faster than the human expert (36.6 min). Comparison of human experts with or without deep learning assistance showed that model-assisted human experts spent an average of 23.3 min to evaluate adenoid hypertrophy using 100 radiographs, compared to an average of 36.6 min using an entirely manual procedure. We therefore concluded that deep learning could improve the accuracy, speed, and efficiency of evaluating adenoid hypertrophy from lateral cephalograms.
How We Fail to Know: Group-Based Ignorance and Collective Epistemic Obligations
Authors: Schwenkenbecher Anne
Published: April 2021

Humans are prone to producing morally suboptimal and even disastrous outcomes out of ignorance. Ignorance is generally thought to excuse agents from wrongdoing, but little attention has been paid to group-based ignorance as the reason for some of our collective failings. I distinguish between different types of first-order and higher order group-based ignorance and examine how these can variously lead to problematic inaction. I will make two suggestions regarding our epistemic obligations vis-a-vis collective (in)action problems: (1) that our epistemic obligations concern not just our own knowledge and beliefs but those of others, too and (2) that our epistemic obligations can be held collectively where the epistemic tasks cannot be performed by individuals acting in isolation, for example, when we are required to produce joint epistemic goods.
Civil Society in Hybrid Regimes: Trade Union Activism in Post-2003 Iraq
Authors: Isakhan Benjamin
Published: April 2021

This article explores the relationship between hybrid regimes and civil society. It examines the extant debate between ‘neo-Tocquevilleans’ and their opponents over whether or not a robust civil society portends democratic transition and consolidation. It demonstrates the limits of these two models by arguing that civil society in hybrid regimes can in fact agitate against the state, advocate for democratic freedoms and achieve significant political reforms even when these do not lead to broader democratization. To demonstrate, this article documents the case of the Iraqi Federation of Oil Unions through 15 years of complex Iraqi politics, from the 2003 US-led intervention and during the incumbency of Prime Minister’s Maliki (2006–2014) and Abadi (2014–2018). By analysing primary materials produced by and about the Iraqi Federation of Oil Unions, it finds that this case holds important lessons for those seeking to understand the complex interface between civil society and the state in hybrid regimes.
Adaptive fuzzy PID cross coupled control for multi-axis motion system based on sliding mode disturbance observation
Authors: Wang Sanxiu , Chen Yue , Zhang Guoan
Published: April 2021

Multi-axis motion system is widely applied in commercial industrial machines such as precision CNC machine tools, Robot manipulator and laser cutting machines, etc. Contour accuracy plays a major role for the multi-axis servo motion system. The contour machining accuracy is related to the synthesis of single-axis position accuracy and multi-axis linkage accuracy. Only improving the single-axis tracking performance cannot effectively guarantee the machining accuracy of multi-axis system. The primary objective of this study was to design a contour control method to improve single-axis tracking accuracy and multi-axis contour accuracy. A control strategy that combines a sliding mode tracking controller, a disturbance observer and an adaptive fuzzy PID cross coupled controller is proposed. Sliding mode control is simple and has strong robustness to parameter changes and disturbance, which is especially suitable for control of such as non-linear multi-axis motion system. Besides, disturbance is inevitable in practical application, which degrades the motion accuracy. In order to eliminate the influence of external disturbance and uncertainty, disturbance observer is adopted to accurately estimate external disturbance and reduce the chattering phenomenon of sliding mode control, then improve the single-axis tracking accuracy. In order to further consider the coordination between different motion axes and improve the contour accuracy, the PID cross coupled control is used. Owing to conventional PID control cannot satisfy the multi-axis servo motion system with nonlinearity and uncertainty, an adaptive fuzzy method with on-line real-time PID parameters adjustment is proposed. The three-axis motion platform driven by PMLSM is used as the control object, to analysis the influence of disturbance observer on sliding mode control signal and analysis adaptive fuzzy PID cross coupled control performance respectively. The disturbance observer is used to observe the disturbance signal and estimate the disturbance well. The chattering of the sliding mode control signal is obviously improved. Next, compared with the conventional PID-CCC control, adaptive fuzzy PID- CCC control can significantly reduce the tracking error, the contour accuracy is also obviously improved. The disturbance observer can effectively eliminate the influence of external disturbance, reduce the chattering of sliding mode control, and ensure the single-axis accurate tracking. The self-adaptive fuzzy PID cross coupled controller can eliminate the influence of the dynamic characteristics mismatching and parameter difference of each axis, and improve contour accuracy. The simulation results clearly demonstrate the effectiveness of the proposed control method.
Managing exactness and vagueness in computer science work: Programming and self-repair in meetings
Authors: Pütz Ole
Published: April 2021

The formulation of computer algorithms requires the elimination of vagueness. This elimination of vagueness requires exactness in programming, and this exactness can be traced to meeting talk, where it intersects with the indexicality of expressions. This article is concerned with sequences in which a team of computer scientists discuss the functionality of prototypes that are already implemented or possibly to be implemented. The analysis focuses on self-repair because this is a practice where participants can be seen to orient to meanings of different expressions as alternatives. By using self-repair, the computer scientists show a concern with exact descriptions when they talk about existing functionality of their prototypes but not when they talk about potential future functionality. Instead, when participants talk about potential future functionality and attend to meanings during self-repair, they use vague expressions to indicate possibilities. Furthermore, when the computer scientists talk to external stakeholders, they indicate through hedges whenever their descriptions approximate already implemented technical functionality but do not describe it exactly. The article considers whether the code of working prototypes can be said to fix meanings of expressions and how we may account for human agency and non-human resistances during development.
Photophobia and allodynia in persistent post-traumatic headache are associated with higher disease burden
Authors: Cortez Melissa M , Millsap Leah , Rea Natalie A , Sciarretta Christopher , Brennan KC
Published: April 2021

Objective

To assess photophobia and allodynia in subjects with post-traumatic headache and examine how these sensory hypersensitivities associate with clinical measures of disease burden.

Background

Post-traumatic headache is the most frequent and disabling long-term consequence of mild traumatic brain injury. There is evidence of sensory dysfunction in acute post-traumatic headache, and it is known from other headache conditions that sensory amplifications correlate with more severe disease. However, systematic studies in post-traumatic headache are surprisingly scarce.

Methods

We tested light and tactile sensitivity, along with measures of disease burden, in 30 persistent post-traumatic headache subjects and 35 controls.

Results

In all, 79% of post-traumatic headache subjects exhibited sensory hypersensitivity based on psychophysical assessment. Of those exhibiting hypersensitivity, 54% exhibited both light and tactile sensitivity. Finally, sensory thresholds were correlated across modalities, as well as with headache attack frequency.

Conclusions

In this study, post-traumatic headache subjects with both light and tactile sensitivity had significantly higher headache frequencies and lower sensitivity thresholds to both modalities, compared to those with single or no sensory hypersensitivity. This pattern suggests that hypersensitivity across multiple modalities may be functionally synergistic, reflect a higher disease burden, and may serve as candidate markers of disease.
The Human Factor of Cybercrime
Authors: Dupont Benoît , Holt Thomas
Published: April 2021

This volume highlights the central role of the human factor in cybercrime and the need to develop a more interdisciplinary research agenda to understand better the constant evolution of online harms and craft more effective responses. The term “human factor” is understood very broadly and encompasses individual, institutional, and societal dimensions. It covers individual human behaviors and the social structures that enable collective action by groups and communities of various sizes, as well as the different types of institutional assemblages that shape societal responses. This volume is organized around three general themes whose complementary perspectives allow us to map the complex interplay between offenders, machines, and victims, moving beyond static typologies to offer a more dynamic analysis of the cybercrime ecology and its underlying behaviors. The contributions use quantitative and qualitative methodologies and bring together researchers from the United States, the United Kingdom, the Netherlands, Denmark, Australia, and Canada.
Creation of a pioneering interdisciplinary genital dermatology unit for Hispanic men: First 269 patients
Authors: Navarrete Jorge , Hernández Juan Manuel , Cristi Joaquín , Eltit Ignacio , Kutscher Patricia , Guillones Astrid , Oberti Virginia , Arrillaga Annie , Della Santa Rodrigo , Echenagusía Pilar , Sosa Tamara , Fernández Cecilia , Martínez Levín , De Cunto Andrea , Bunker Christopher , Vola Magdalena , Agorio Caroline
Published: April 2021

The role of circumcision in partially protecting against sexually transmitted infections (STIs) and other dermatoses has been documented. Neonatal circumcision is not routinely practiced in South America. Although it is logical to assume that male genital dermatoses are more prevalent in Hispanic men, they are underrepresented in the existing literature. Objective: To describe the epidemiological characteristics from our male genital dermatology unit in Montevideo (Uruguay), the diagnoses, and correlate them with circumcision status and comorbidities. Methods: A retrospective observational cohort study was conducted. A dermatologist and urologist evaluated all patients using standard questionnaires. In 3 years and 8 months, 269 patients were seen. Median age was 41, prevalence of neonatal circumcision was 0.7%, HIV was 4.2%, STIs were 24.9%, non-STIs were 63.9%, and both (STI + non-STI) were 11.2%. Most frequent entities: eczema/balanoposthitis (27.1%), condyloma (24.9%), and lichen sclerosus (15.6%). Data correlating circumcision and other diagnoses did not reach statistical significance. HIV was positively associated with other STIs ( p < 0.05), and an association with balanoposthitis was seen; however, it did not reach statistical significance ( p < 0.1). Main limitation was small sample size. This is the first study of its kind based on Hispanic patients. Collaboration between specialties proved to be fundamental. Further studies are needed in this demographic to find an association between circumcision, comorbidities, and genital dermatoses.
Design of a slender turning cutting tool via a vibration absorber equipped with piezoelectric ceramic
Authors: Yang Yiqing , Gao Haoyang , Liu Qiang
Published: April 2021

Turning cutting tool with large length–diameter ratio has been essential when machining structural part with deep cavity and in-depth hole features. However, chatter vibration is apt to occur with the increase of tool overhang. A slender turning cutting tool with a length–diameter ratio of 7 is developed by using a vibration absorber equipped with piezoelectric ceramic. The vibration absorber has dual functions of vibration transfer to the absorber mass and vibration conversion to the electrical energy via the piezoelectric effect. Equations of motion are established considering the dual damping from the piezoelectric ceramic and rubber gasket. The equivalent damping of piezoelectric ceramic is derived, and the geometries are optimized to achieve optimal vibration suppression. The modal analysis demonstrates that the cutting tool with the vibration absorber can reach 80.1% magnitude reduction. Machining tests are carried out in the end. The machining acceleration and machined surface roughness validate the vibration suppression of the VA, and the output voltage by the piezoelectric ceramic demonstrates the ability of vibration sensing.
The Additive Effects of Implementing Advanced Tiers of SWPBIS With Fidelity on Disciplinary Exclusions
Authors: Grasley-Boy Nicolette M. , Gage Nicholas A. , Lombardo Michael , Anderson Lucas
Published: April 2021

Schools continue to rely on disciplinary exclusions as a consequence for behavioral rule violations, despite evidence that removing students from instruction for discipline purposes is associated with poor behavioral, academic, and social outcomes. School-wide positive behavior interventions and supports (SWPBIS) is one multitiered support framework used to prevent behavior problems while developing effective and efficient systems for intervening with students who require more support. Prior research suggests implementing Tier 1 of SWPBIS with fidelity is associated with reductions in disciplinary exclusions. In this study, we evaluated the additive effects of implementing Tier 1 and advanced tiers (i.e., Tiers 2 and 3) with fidelity compared with Tier 1 alone for 558 schools in California. Results indicate schools implementing all three tiers with fidelity had significantly lower rates of students receiving one out-of-school suspension, out-of-school suspension incidents, and referrals to law enforcement. We also discuss implications and recommendations for future research.
Investigating Vietnamese undergraduate students’ willingness to pay for higher education under the cost-sharing context
Authors: Le Trung T , Nguyen Thuy L , Trinh Minh T , Le Van T , Pham Hiep-Hung
Published: April 2021

Currently, Vietnam is adopting a cost-sharing policy for public higher education. A dual mechanism of tuition fees has been introduced: (i) the tuition fee covers part of the instruction cost; and (ii) the tuition fee covers the full instruction cost. Despite this, Vietnamese public universities still face a shortage of income for maintaining good quality higher education. There has been ongoing debate about measures to resolve this problem: while some suggest the current tuition fee cap predetermined by the government should be raised, in conjunction with high levels of aid, others are opposed to this idea. However, this debate lacks students' perspectives. In this paper, we examine student’s willingness to pay for tuition in association with its predictors. A survey of 237 students shows that there is a high willingness to pay for higher education, evidenced by their willingness to pay for extra classes in addition to tuition fees for universities. The study also revealed that the following factors affect students’ views on total payments for higher education (including tuition fees and fees for extra classes): the academic year of the student, their major, whether they are fully self-paid vs. state-subsidized, their family’s economic situation and academic-related factors. Meanwhile, their willingness to pay was not influenced by gender and economic-related factors. These findings provide implications for policymakers and university administrators for the adjustment of financing policies.
Respiratory-tract infections among geriatrics: prevalence and factors associated with the treatment outcomes
Authors: Akhtar Ali , Hassali Mohamed Azmi Ahmad , Zainal Hadzliana , Ali Irfhan , Iqbal Muhammad Shahid , Khan Amer Hayat
Published: April 2021

Background:

Geriatric individuals are more susceptible to different infections, especially respiratory-tract infections (RTIs) due to their compromised immune system. Hence, the objectives of the present study were to evaluate the prevalence, medication regimen complexity and factors associated with the treatment outcomes of different RTIs among geriatrics.

Methods:

A retrospective cross-sectional study (5 years) was conducted at the respiratory department, Hospital Pulau Pinang. Patients aged ⩾65 years with confirmed diagnosis of RTI were included in the study.

Results:

A total of 474 patients were included, and the most prevalent RTIs were community-acquired pneumonia (65.6%) followed by chronic obstructive pulmonary disease (20.7%), bronchitis (8.2%) and hospital-acquired pneumonia (5.5%). Amoxicillin/clavulanate (69.8%), ampicillin/sulbactam (9.1%) and cefuroxime (6.5%) are the most common antibiotics prescribed to treat RTIs among geriatrics. Smoking, alcohol consumption, polypharmacy and presence of other co-morbidities are statistically significant factors associated with treatment outcomes of RTIs among geriatrics.

Conclusion:

Prevalence of community-acquired pneumonia (65.6%) among older patients aged 65 years and older higher than other RTIs. Smoking, alcohol use, presence of polypharmacy and other co-morbidities are important factors associated with the treatment outcomes of RTIs. The reviews of this paper are available via the supplemental material section.
The prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms
Authors: Kawai Mio , Miyai Nobuyuki , Arita Mikio
Published: April 2021

Objectives:

We aimed to examine the prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms.

Methods:

This follow-up study included 48 newly graduated female nurses (aged 22 ± 3 years) employed in acute care hospitals. The orthostatic dysregulation symptoms were evaluated using a screening checklist. A sit-to-stand test was conducted to assess the autonomic nervous function. Subjective stress and depressive symptoms were determined using a self-administered questionnaire. The data were collected at baseline on the first month and on the seventh month of employment. Statistical differences within groups were analyzed using paired t-test and McNemar’s test. The independent associations of orthostatic dysregulation status with stress and depressive symptoms were analyzed using a multivariate logistic regression model.

Results:

The percentage of individuals who were diagnosed with orthostatic dysregulation increased from 25.0% at baseline to 35.4% at follow-up. Logistic regression analyses revealed that stress and depressive symptoms were closely associated with orthostatic dysregulation status at follow-up, despite a weak association reported at baseline. The participants were categorized according to their orthostatic dysregulation status: among individuals without orthostatic dysregulation at baseline but with orthostatic dysregulation at follow-up, the increase in autonomic nervous activity, as assessed by the coefficient of variation of the R-R intervals, in response to the postural changes was significantly attenuated at follow-up. Furthermore, this group exhibited a significant increase in stress and depressive symptoms.

Conclusions:

At 7 months after employment, newly graduated nurses showed a higher prevalence of orthostatic dysregulation in combination with autonomic nervous system modulation, which was accompanied by an increase in stress and depressive symptoms. These observations suggest that the orthostatic dysregulation is associated with poor mental and physical health among newly graduated nurses in the early phase of employment.
Admissions to Medical School during the COVID-19 Era without the MCAT
Authors: Corridon Peter R.
Published: April 2021

As medical schools cope with the consequences of the COVID-19 pandemic, a new cohort of students will be admitted in the fall. Administrators are again challenged to make unprecedented enrollment decisions without standardized exams. This challenge provides unique opportunities to re-evaluate admission processes that has been employed since 1928 and support holistic admissions. This article highlights key factors that are being considered during current medical school admission cycles, including limited opportunities to take standardized exams, heightened student anxiety, and potential exam alternatives. These factors are framed and discussed within the context of the medical college admission test (MCAT) exam.
Gait speed and adverse outcomes following hospitalised exacerbation of COPD
Authors: Walsh Jessica A. , Barker Ruth E. , Kon Samantha S.C. , Jones Sarah E. , Banya Winston , Nolan Claire M. , Patel Suhani , Polgar Oliver , Haselden Brigitte M. , Polkey Michael I. , Cullinan Paul , Man William D-C.
Published: April 2021

Background

The 4-m gait speed (4MGS) test is a simple physical performance measure and surrogate marker of frailty that is associated with adverse outcomes in older adults. We aimed to assess the ability of 4MGS to predict prognosis in patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods

213 participants hospitalised with AECOPD (52% male, mean age 72 years and mean forced expiratory volume in 1 s (FEV1) 35% predicted) were enrolled. 4MGS and baseline demographics were recorded at hospital discharge. All-cause readmission and mortality were collected for 1 year after discharge and multivariable Cox proportional hazards regressions were performed. Kaplan–Meier and competing risks analyses were conducted comparing time to all-cause readmission and mortality between 4MGS quartiles.

Results

111 participants (52%) were readmitted and 35 (16%) died during the follow-up period. 4MGS was associated with all-cause readmission, with an adjusted subdistribution hazard ratio of 0.868 (95% CI 0.797–0.945; p=0.001) per 0.1 m·s−1increase in gait speed, and with all-cause mortality, with an adjusted subdistribution hazard ratio of 0.747 (95% CI 0.622–0.898; p=0.002) per 0.1 m·s−1increase in gait speed. Readmission and mortality models incorporating 4MGS had higher discrimination than age or FEV1% pred alone, with areas under the receiver operator characteristic curves of 0.73 and 0.80, respectively. Kaplan–Meier and competing risks curves demonstrated that those in slower gait speed quartiles had reduced time to readmission and mortality (log-rank, both p<0.001).

Conclusions

4MGS provides a simple means of identifying at-risk patients with COPD at hospital discharge. This provides valuable information to plan post-discharge care and support.
Incidence and predictors of asthma exacerbations in middle-aged and older adults: the Rotterdam Study
Authors: de Roos Emmely W. , Lahousse Lies , Verhamme Katia M.C. , Braunstahl Gert-Jan , in ‘t Veen Johannes C.C.M. , Stricker Bruno H. , Brusselle Guy G.O.
Published: April 2021

Aim

The aim of this study was to investigate occurrence and determinants of asthma exacerbations in an ageing general population.

Methods

Subjects aged 45 years or above with physician-diagnosed asthma in the Rotterdam Study, a population-based prospective cohort from January 1991 to May 2018, were assessed for asthma exacerbations. Exacerbations were defined as acute episodes of worsening asthma treated with oral corticosteroids. Cox proportional hazards analysis was used to investigate risk factors for a future exacerbation.

Results

Out of 763 participants with asthma (mean age 61.3 years, 69.2% female), 427 (56.0%) experienced at least one exacerbation, in a mean follow-up time of 13.9 years. The mean annual exacerbation rate was 0.22. Most exacerbations occurred during winter months. Risk factors for exacerbations were a history of previous exacerbations (HR 4.25; 95% CI 3.07–5.90, p<0.001)), respiratory complaints (HR 2.18; 95% CI 1.48–3.21, p<0.001), airflow obstruction (HR 1.52; 95% CI 1.07–2.15, p=0.019), obesity (HR 1.38; 95% CI 1.01–1.87, p=0.040) and depressive symptoms (HR 1.55; 95% CI 1.05–2.29, p=0.027). Compared to those not using respiratory medication, we observed higher hazard ratios for those on short-acting β2-agonists (SABA,i.e.rescue medication) only (HR 3.08, 95% CI 1.61–5.90, p=0.001) than those on controller medication (HR 2.50, 95% CI 1.59–3.92, p<0.001).

Conclusion

Many older adults with asthma suffer from at least one severe exacerbation. Previous exacerbations, use of SABA without concomitant controller medication, respiratory complaints, obesity, airway obstruction and depression are independent risk factors for exacerbations.
Descriptive analysis of long COVID sequelae identified in a multidisciplinary clinic serving hospitalised and non-hospitalised patients
Authors: Johnsen Stine , Sattler Stefan M. , Miskowiak Kamilla Woznica , Kunalan Keerthana , Victor Alan , Pedersen Lars , Andreassen Helle Frost , Jørgensen Barbara Jolanta , Heebøll Hanne , Andersen Michael Brun , Marner Lisbeth , Hædersdal Carsten , Hansen Henrik , Ditlev Sisse Bolm , Porsbjerg Celeste , Lapperre Thérèse S.
Published: April 2021

Background

There are emerging data of long-term effects of coronavirus disease 2019 (COVID-19) comprising a diversity of symptoms. The aim of this study was to systematically describe and measure pulmonary and extra-pulmonary post-COVID-19 complications in relation to acute COVID-19 severity.

Methods

Patients attending a standard of care 3 months post-hospitalisation follow-up visit and those referred by their general practitioner because of persistent post-COVID-19 symptoms were included. Patients underwent symptomatic, quality of life, pulmonary (lung function and high-resolution computed tomography (HRCT)), cardiac (high-resolution ECG), physical (1-min sit and stand test (1-MSTST), handgrip strength, cardiopulmonary exercise testing (CPET)) and cognitive evaluations.

Results

All 34 hospitalised and 22 out of 23 non-hospitalised patients had ≥1 complaint or abnormal finding at follow-up. Overall, 67% of patients were symptomatic (Medical Research Council (MRC) ≥2 or COPD assessment test (CAT) ≥10), with no difference between hospitalisedversusnon-hospitalised patients. Pulmonary function (forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO)) <80% of predicted) was impaired in 68% of patients.DLCOwas significantly lower in those hospitalised compared to non-hospitalised (70.1±18.0versus80.2±11.2% predicted, p=0.02). Overall, 53% had an abnormal HRCT (predominantly ground-glass opacities) with higher composite computed tomography (CT) scores in hospitalisedversusnon-hospitalised patients (2.3 (0.1–4.8) and 0.0 (0.0–0.3), p<0.001). 1-MSTST was below the 25th percentile in almost half of patients, but no signs of cardiac dysfunction were found. Cognitive impairments were present in 59–66% of hospitalised and 31–44% of non-hospitalised patients (p=0.08).

Conclusion

Three months after COVID-19 infection, patients were still symptomatic and demonstrated objective respiratory, functional, radiological and cognitive abnormalities, which were more prominent in hospitalised patients. Our study underlines the importance of multidimensional management strategies in these patients.
Health-related quality of life and disease progression in pulmonary arterial hypertension patients: a 3-year study
Authors: Halimi Laurence , Suehs Carey M. , Marin Gregory , Boissin Clement , Gamez Anne-Sophie , Vachier Isabelle , Molinari Nicolas , Bourdin Arnaud
Published: April 2021

Objectives

The role of health-related quality of life (HRQoL) and psychological variables in pulmonary arterial hypertension (PAH) progression remains poorly quantified. We aimed to investigate the relationship between disease progression in PAH patients and HRQoL and psychological characteristics.

Methods

A 3-year longitudinal cohort was initiated. Patients with stable PAH (groups I–IV ineligible for angioplasty/endarterectomy) were included (n=55). Standard clinical variables, including invasive haemodynamic parameters, were prospectively recorded. A battery of questionnaires was used to characterise the psychological status of patients upon study initiation, and HRQoL was quantified using the SF-36 Questionnaire every 3 months for 24 months, and then again at 36 months. Guideline-defined disease progression and progression-free survival were recorded for 36 months.

Measurements and main results

Psychological distress was highly prevalent at baseline. The Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the HRQoL were poor (PCS=37.13±8.18; MCS=42.42±10.88) but stable over 3 years of follow-up. Among PCS subscales, Physical Functioning (PF) (p=0.012) was identified as being independently associated with disease progression (Cox survival model), along with mean pulmonary arterial pressure (p=0.003) and cardiac output (p=0.005). Depression was the unique independent psychological characteristic associated with PF (p=0.0001).

Conclusions

PAH patients have poor HRQoL. In addition to already known criteria related to disease severity, the HRQoL PF subscale is independently associated with disease progression in PAH. This may be explained by depression.
Low-Intensity Focused Ultrasound-Augmented Multifunctional Nanoparticles for Integrating Ultrasound Imaging and Synergistic Therapy of Metastatic Breast Cancer
Authors: Zhang Qian , Wang Wen , Shen Hongyuan , Tao Hongyu , Wu Yating , Ma Liyuan , Yang Guangfei , Chang Ruijiao , Wang Jiaxing , Zhang Hanfei , Wang Chenyu , Zhang Furong , Qi Jiaojiao , Mi Chengrong
Published: April 2021

The metastasis of breast cancer is believed to have a negative effect on its prognosis. Benefiting from the remarkable deep-penetrating and noninvasive characteristics, sonodynamic therapy (SDT) demonstrates a whole series of potential leading to cancer treatment. To relieve the limitation of monotherapy, a multifunctional nanoplatform has been explored to realize the synergistic treatment efficiency. Herein, we establish a novel multifunctional nano-system which encapsulates chlorin e6 (Ce6, for SDT), perfluoropentane (PFP, for ultrasound imaging), and docetaxel (DTX, for chemotherapy) in a well-designed PLGA core–shell structure. The synergistic Ce6/PFP/DTX/PLGA nanoparticles (CPDP NPs) featured with excellent biocompatibility and stability primarily enable its further application. Upon low-intensity focused ultrasound (LIFU) irradiation, the enhanced ultrasound imaging could be revealed both in vitro and in vivo. More importantly, combined with LIFU, the nanoparticles exhibit intriguing antitumor capability through Ce6-induced cytotoxic reactive oxygen species as well as DTX releasing to generate a concerted therapeutic efficiency. Furthermore, this treating strategy actives a strong anti-metastasis capability by which lung metastatic nodules have been significantly reduced. The results indicate that the SDT-oriented nanoplatform combined with chemotherapy could be provided as a promising approach in elevating effective synergistic therapy and suppressing lung metastasis of breast cancer.
The apheresis platelet donation was increased after a nationwide ban on family/replacement donation in China
Authors: Chen Jinyan , Zhou Guoli , Fu Xuemei , Li Shijie , Li Ying , Kang Jianxun , Chen Huiyou , Zhou Liqiao , Fu Yongshui
Published: April 2021

Background

A nationwide ban on family/replacement donation (FRD) went into effect on April 1, 2018 in China. To date, no reports relevant to the trend of plateletpheresis donations before and after a nationwide ban on FRD were found.

Methods

We used two independent full samples, consisting of 135,851 and 82,129 plateletpheresis donors from Guangzhou and Chengdu between October 2012 and September 2019, respectively. A pseudo-panel data approach was applied by grouping three time-invariant covariates – gender, blood donation history, and birth year across 14 cross-sections (a 6-month interval each) to form a total of 24 cohort groups (14 × 24 = 336 cohorts, i.e., cells) with each having common covariates. The outcome was average apheresis platelet units per donor in each cell. We performed a two-piecewise linear mixed model with the cross-section (i.e., time) just right before the ban as a time breakpoint (i.e., 11th cross-section) to examine the trend of outcome with the adjustment of three time-invariant covariates. We removed the FRDs in each of the first 11 cross-sections to detect its possible influence on the trend.

Results

The final model for the samples from Guangzhou presented a two-piecewise linear trend of the outcome over time with a horizontal line to the left of the breakpoint (βtimeBefore11 = 0.0111,p = 0.0976) and a significantly positive linear trend to the right (βtimeAfter11 = 0.0404,p < 0.0001). The male donors and the donors with plateletpheresis donation history had an increased baseline outcome and a significant outcome change over time after the ban. Such a two-piecewise linear trend pattern can be replicated using the samples from Chengdu with some minor variations. Removing the FRD before the ban can change the pattern.

Conclusion

The significant increase of the average apheresis platelet units per donor over time after the FRD ban may be related to the implement of the FRD ban and the improved donation behavior of male donors and/or donors with platelet donation history after the ban. Our findings may potentially motivate the policymakers in other countries where the FRD for plateletpheresis donation is still legitimate to phase out their FRD strategy and ultimately achieve 100% voluntary plateletpheresis donation.
Key factors associated with oral health-related quality of life in Sri Lankan adolescents: a cross sectional study
Authors: Amilani Uttara , Jayasekara Prasanna , Carter Hannah E. , Senanayake Sameera , Kularatna Sanjeewa
Published: April 2021

Background

Oral Health Related Quality of Life (OHRQoL) measures have emerged as an important oral health outcome that is able to reveal the subjective burden of illness due to oral diseases. The association between sociodemographic and socioeconomic factors, clinical dental conditions and OHRQoL indicators has been investigated in adolescent populations across the world. The purpose of this study was to investigate key factors associated with oral health-related quality of life of Sri Lankan adolescents.

Methods

A cross sectional study was conducted in a sample of 15–19 year-old secondary school students in the Gampaha district of Sri Lanka. The data was collected using two self-administered questionnaires. A modified Sinhalese version of the Oral Impact on Daily Performance (OIDP) questionnaire that has been validated for Sri Lankan adolescents was administered. A second questionnaire collected information on socioeconomic characteristics, oral health care seeking and oral health behaviours. A clinical oral examination was performed on each participant. Oral health related quality of life was measured using OIDP domains and total OIDP scores. Poisson regression was used to investigate the key factors associated with the OIDP additive score.

Results

A total of 1332 adolescents participated in the study. Negative quality of life impacts were more prevalent in the social and psychological domains of OIDP as compared with the functional domain. Total OIDP scores ranged from 0 to 36 with a mean of 3.16 (SD = 4.71). The multivariable analysis revealed that increasing age, low income, brushing teeth only once per day, and increased number of decayed teeth were found to be associated with poor overall OHRQoL, while male gender, frequent oral healthcare seeking patterns and absent dento-facial anomalies were associated with good OHRQoL.

Conclusion

This study identified modifiable behavioural and oral health related factors which are associated with OHRQoL in Sri Lankan adolescents. Oral health interventions should target these modifiable factors to improve the OHRQoL in these populations.