Airway Reactance Predicts Static Lung Hyperinflation in Severe Asthma

BACKGROUND AND OBJECTIVES

Background: Static lung hyperinflation (SLH) measured using body plethysmography in patients with asthma is associated with poor outcomes. The severity of SLH may be associated with small airway dysfunction (SAD), which can be measured using impulse oscillometry (IOS). Objective: This study aims to determine the correlation between SLH and SAD in patients with severe asthma and assess the improvement in SLH and SAD with treatment.

METHODS

We analyzed data from patients who were enrolled in the Taiwan Severe Asthma Registry, which comprises a prospective observational cohort. Plethysmography and IOS were performed regularly. The relationship between spirometry and IOS parameters was determined. Changes in the clinical outcomes in response to treatment were analyzed.

RESULTS

Of 107 patients with severe asthma, 83 (77.6%) had SLH based on an increased residual volume to total lung capacity ratio (RV/ TLC). Most patients were older women with worse pulmonary function and SAD than those without SLH. SAD, defined as increased airway resistance/reactance, was significantly correlated with SLH. Airway reactance at 5 Hz (X5) ≤-0.21 kPa/(L/s) detected SLH with an area under the receiver operating characteristic curve of 0.84 (P<.0001; sensitivity, 85.2%; and specificity, 83.3%). After 12 months, patients who received add-on biologics (vs those who did not) had significantly reduced exacerbations, fractional exhaled nitric oxide level, and blood eosinophil counts, as well as improved forced expiratory volume in the first second, X5, and a trend toward reduced RV/TLC ratio.

CONCLUSIONS

In severe asthma, airway reactance (X5) could be a novel parameter for assessing SLH.

The Influence of Anticipated HIV Stigma on Health-related Behaviors, Self-rated Health, and Treatment Preferences Among People Living with HIV in East Asia

Long-acting injectable regimens for HIV treatment have been developed which are less frequent, more discreet, and more desirable for some people living with HIV (PLHIV) and may help reduce stigma-related barriers to HIV treatment. However, there is little information on the relationship between reported stigma and preference for these newer treatments. We characterized anticipated, experienced, and internalized HIV stigma and examined the associations with treatment preferences among an international sample of PLHIV. Data came from the international, web-based, cross-sectional study called "Positive Perspectives" conducted among PLHIV aged ≥ 18 years in 25 geographic locations during 2019 (n = 2389). Descriptive analyses were stratified among East Asian (n = 230) vs. non-Asian (n = 2159) participants. Results showed that prevalence of anticipated stigma was significantly higher among East Asian than non-Asian participants (72.2%[166/230] vs. 63.8%[1377/2159], p = 0.011). A significantly higher percentage of East Asian (68.7%[158/230]) than non-Asian participants (43.3%[935/2159] indicated that someone finding their HIV pills would cause them much "stress or anxiety" (p < 0.001). Actions taken by some PLHIV to prevent unwanted disclosure included restricting who they shared their HIV status with, hiding their HIV pills, or even skipping a dose altogether because of privacy concerns. Overall, 50.0%[115/230] East Asian participants believed HIV would reduce their lifespan and 43.0%[99/230] no longer planned for their old age because of HIV. Anticipated stigma was strongly associated with receptivity to non-daily regimens. Concerted efforts to reduce stigma and deliver flexible treatment options that address the unmet treatment needs of PLHIV, including confidentiality concerns, may improve their health-related quality of life.

Changes in Interferon-Gamma Release Assay Readout after COVID-19 Vaccination: A Prospective Cohort Study

OBJECTIVES

Interferon-gamma release assays (IGRAs) are widely used in public health practice to diagnose latent tuberculosis. During the coronavirus disease (COVID-19) pandemic and rollout of COVID-19 vaccination, it has remained unclear whether COVID-19 vaccines interfere with IGRA readouts.

METHODS

We prospectively recruited healthcare workers during their annual occupational health examinations in 2021. Baseline IGRA readouts were compared with follow-up data after the participants had received two doses of COVID-19 vaccination.

RESULTS

A total of 134 baseline IGRA-negative cases (92 with ChAdOx1 vaccine, 27 with mRNA-1273 vaccine, and 15 with heterologous vaccination) and seven baseline IGRA-positive cases were analysed. Among the baseline IGRA-negative cases, there were decreased interferon-γ concentrations over the Nil (p = 0.005) and increased Mitogen-Nil (p < 0.001) values post-vaccination. For TB2-Nil value, there was a similar trend (p = 0.057) of increase observed. Compared with the 0.35 IU/mL threshold, the baseline and follow-up readout differences were less than |±0.10| IU/mL over the TB1-Nil and TB2-Nil values in >90% baseline IGRA-negative cases. No significant readout difference was observed among baseline IGRA-positive cases.

CONCLUSIONS

COVID-19 vaccination did not change IGRA interpretation in most cases. Cases showing conversion/borderline IGRA readouts should be given special consideration.

Prevalence of drug resistance mutations in HIV-infected individuals with low-level viraemia under combination antiretroviral therapy: an observational study in a tertiary hospital in Northern Taiwan, 2017-19

BACKGROUND

Effective ART is crucial for combating the HIV pandemic. Clinically, plasma viral load monitoring to achieve virological suppression is the guide for an optimal ART. The presence of low-level viraemia (LLV) below the definition level of virological failure is a risk factor for ART failure. However, there is no treatment consensus over LLV yet, mainly due to the limitation of standard HIV-RNA genotyping and the resultant insufficient understanding of LLV characteristics.

OBJECTIVES

To better profile drug resistance mutations (DRMs) and the associated factors in cases experiencing LLV.

METHODS

A prospective observational study was conducted from 2017 to 2019. HIV-DNA was used as an alternative to HIV-RNA for HIV genotyping coupled with deep sequencing for ART-naive and ART-failure cases, as well as those with LLV.

RESULTS

Eighty-one ART-naive, 18 ART-failure and 16 LLV cases received HIV genotyping in the study. Three-quarters (12/16) of cases experiencing LLV harboured DRMs. Cases with LLV had higher prevalence of DRMs to NNRTIs than the ART-naive group (69% versus 20%, P < 0.001), but lower DRM prevalence to NRTIs than the ART-failure group (25% versus 61%, P < 0.001). Approximately half of the LLV cases had issues of suboptimal ART compliance/ART interruption, and 68.8% (11/16) did not display drug resistance to their ART at the time of LLV.

CONCLUSIONS

HIV DRM profiles in LLV cases were significantly different to those in ART-naive and ART-failure cases. Approaches to consolidate ART compliance and early exploration of potential ART resistance may be needed for cases experiencing LLV episodes.

Preparation and Thermomechanical Properties of Ketone Mesogenic Liquid Crystalline Epoxy Resin Composites with Functionalized Boron Nitride

In order to enhance the thermomechanical behaviors of epoxy molding compounds, the hexagonal boron nitride (h-BN) fillers were incorporated in a ketone mesogenic liquid crystalline epoxy (K–LCE) matrix to prepare a high-performance epoxy composites. The h-BN was modified by surface coupling agent 3-aminopropyltriethoxysilane (APTES). The grafting of silane molecules onto the surface of BN fillers improved the compatibility and homogeneous dispersion state of BN fillers in the K–LCE matrix with a strong interface interaction. The surface-modified BN fillers were characterized using Fourier transform infrared spectroscopy. The thermomechanical properties and morphologies of K–LCE/BN composites loading with different contents of modified BN fillers, ranging from 0.50 to 5.00 wt%, were investigated. These results show that modified BN fillers uniformly dispersed in K–LCE matrix, contributing to the enhancement in storage modulus, glass transition temperatures, impact strength and reduction in the coefficient of thermal expansion (CTE). The thermal stability and char yield of the K–LCE/BN composites were increased by increasing the amount of modified BN fillers and the thermal decomposition temperatures of composites were over 370 °C. The thermal conductivity of the K–LCE/BN composites was up to 0.6 W/m·K, for LC epoxy filled with 5.00-wt%-modified BN fillers. Furthermore, the K–LCE/BN composites have excellent thermal and mechanical properties compared to those of the DGEBA/BN composites.

Facilitating Green Supply Chain in Dental Care through Kansei Healthscape of Positive Emotions

Dentistry is highly energy- and resource-intensive with a significant environmental impact. To consolidate green dentistry supply chains, delivering the care of highest quality that meets client value should not be neglected. This study emphasized the importance of client-centered healthscape design for facilitating a green dentistry supply chain. A client-centered healthscape design, which promotes clients' positive emotions and increases willingness to revisit the dentist, plays a critical role in realizing green dentistry supply chains in the long run. For this purpose, the relationship among dental healthscape design elements, client emotions, and revisit intentions was investigated using a Kansei engineering-based approach. The effects of dental healthscape elements on clients' positive emotions and the effects of positive emotions on clients' revisit intentions were holistically examined on the basis of the stimulus-organism-response model. Through this approach, 17 elements of design, ambience, and social interaction factors that comprise the dental healthscape and 20 Kansei words used to express clients' positive emotions regarding dental service were identified. A questionnaire survey was used to assess Kansei and revisit intention in healthscape scenarios, composed of varied design elements. Primary data were collected from 600 individuals from 2017 to 2018 throughout Taiwan. Partial least squares was applied to holistically analyze the effects of dental healthscape elements on clients' positive emotions and the effects of positive emotions on clients' revisit intention to generate a Kansei model for the dental healthscape. All 20 Kansei words had significant positive effects on the dental revisit intention of clients. The five positive emotions most associated with increased revisit intention were thoughtful, hopeful, tender, comfortable, and cozy. The Kansei model of the dental healthscape provides references for healthscape design that maintains positive client emotions during the dental service and results in high revisit intention. This approach can realize an emotion-centered design for dental healthscapes that promotes preventive dental care, early treatment, and effective use of medical resources, and consequently contributes to green dentistry supply chains.

Demographic differences in people living with HIV according to recruitment sources: comparison between health-care systems and social media networks

With the improvement of internet technology in health applications, the utilization of internet and social media as new survey methodologies and recruitment source for research participants have been encouraged, yet evidence of the feasibility in people living with HIV (PLHIV) study is still lacking. We conducted a cross-sectional survey to determine whether there are differences among PLHIV recruited from social media networks and health-care systems using an HIV stigma and discrimination questionnaire. The result revealed that PLHIV recruited from social media networks were younger, more sexually active, and had higher educational status and awareness of the country's HIV rights protection laws than those recruited from hospitals. By contrast, participants recruited from hospitals were more diverse regarding key population compositions, had lived with HIV for a longer duration, had a higher prevalence of concomitant physical disabilities than those recruited from social media networks, and fit Taiwan PLHIV characteristics described by 2016 census from Taiwan Centres for Disease Control. We conclude that sampling bias exists when utilizing social media networks for PLHIV studies.

Applying big data analytics to support Kansei engineering for hotel service development

Purpose

Leisure and tourism activities have proliferated and become important parts of modern life, and the hotel industry plays a necessary role in the supply for and demand from consumers. The purpose of this paper is to develop guidelines for hotel service development by applying a service development approach integrating Kansei engineering and text mining.

Design/methodology/approach

The online reviews represent the voice of customers regarding the products and services. Consumers’ online comments might become a key factor for consumers choosing hotels when planning their tourism itinerary. With the framework of Kansei engineering, this paper adopts text mining to extract the sets of Kansei words and hotel service characteristics from the online contents as well as the relationships among Kansei words, service characteristics and these two sets. The relationships are generated by using link analysis, and then the guidelines for hotel service development are proposed based on the obtained relationships.

Findings

The results of the present research can provide the hotel industry a comprehensive understanding of hotels’ customers opinions, and can offer specific advice on how to differentiate one’s products and services from competitors’ in order to improve customer satisfaction and increase hotels’ performance in the end. Finally, this study finds out the service development guidelines to meet customers’ requirements which can provide suggestions for hotel managers. The implications both for academic and industry are also drawn based on the obtained results.

Originality/value

Now, in the internet era, consumers can comment on their hotel living experience directly through the internet. The large amount of user-generated content (UGC) provided by consumers also provides chances for the hospitality industry to understand consumers’ opinions through online review mining. The UGC with consumers’ opinions to hotel services can be continuously collected and analyzed by hoteliers. Therefore, this paper demonstrates how to apply the hybrid approach integrating Kansei engineering and online review mining to hotel service development.

Duplicated FoxA genes in the leech Helobdella: Insights into the evolution of direct development in clitellate annelids

BACKGROUND

As an adaptation to the land, the clitellate annelid had reorganized its embryogenesis to develop "directly" without the ancestral planktonic larval stage. To study the evolution of gut development in the directly developing clitellates, we characterized the expression pattern of the conserved gut gene, FoxA, in the embryonic development of the leech.

RESULTS

The leech has three FoxA paralogs. Hau-FoxA1 is first expressed in a subset of endoderm cells and then in the foregut and the midgut. Hau-FoxA2 is expressed in the stomodeum, which is secondarily derived from the anterior ectoderm in the clitellates rather than the tissue around the blastopore, the ancestral site of mouth formation in Phylum Annelida. Hau-FoxA3 is expressed during the morphogenesis of segmental ganglia from the ectodermal teloblast lineages, a clitellate-specific trait. Hau-FoxA1 and Hau-FoxA2 are also expressed during the morphogenesis of the leech-specific front sucker.

CONCLUSIONS

The expression patterns suggested that Hau-FoxA1 carries out most of the conserved function in the endoderm and gut development, while the other two duplicates appear to have evolved unique novel functions in the directly developing clitellate embryos. Therefore, neofunctionalization and co-option of FoxA might have made a significant contribution to the evolution of direct development in Clitellata. Developmental Dynamics 247:763-778, 2018. © 2018 Wiley Periodicals, Inc.

Multiclass MTS for saxophone timbre quality inspection using waveform-shape-based features

Under the highly developed automation today, the manufacture of saxophone is still a nonautomatic process and much relies on highly skilled technicians. In order to insure the timbre quality, the sound of finished saxophone must be tested in the final inspection stage. The evaluation of timbre quality mainly depends on the professional musicians' hearing judgment; however, the sensitivity of human perception can be influenced by many factors. To improve the reliability of saxophone timbre quality inspection, an automatic multiclass timbre classification system (AMTCS) is developed and used to assist in the inspection work. The AMTCS is composed of our proposed waveform-shape-based feature extraction method in parameterization phase and multiclass Mahalanobis-Taguchi system in classification phase. The numerical experiments show that the musical instrument classification accuracy obtained by our proposed AMTCS is satisfactory. Through employing the AMTCS, strong assistance was provided to the inspection of saxophone timbre quality, and a perfect identification rate on the saxophones with different timbre quality levels is achieved. Moreover, the significant tones having impact on saxophone timbre quality can also be easily identified by AMTCS.

Molecular signatures of metaplastic carcinoma of the breast by large-scale transcriptional profiling: identification of genes potentially related to epithelial-mesenchymal transition

Metaplastic carcinoma of the breast (MCB) is a poorly understood subtype of breast cancer. It is generally characterized by the coexistence of ductal carcinomatous and transdifferentiated sarcomatous components, but the underlying molecular alterations, possibly related to epithelial-mesenchymal transition (EMT), remain elusive. We performed transcriptional profiling using half-a-genome oligonucleotide microarrays to elucidate genetic profiles of MCBs and their differences to those of ductal carcinoma of breasts (DCBs) using discarded specimens of four MCBs and 34 DCBs. Unsupervised clustering disclosed distinctive expression profiles between MCBs and DCBs. Supervised analysis identified gene signatures discriminating MCBs from DCBs and between MCB subclasses. Notably, many of the discriminator genes were associated with downregulation of epithelial phenotypes and with synthesis, remodeling and adhesion of extracellular matrix, with some of them have known or inferred roles related to EMT. Importantly, several of the discriminator genes were upregulated in a mutant Snail-transfected MCF7 cell known to exhibit features of EMT, thereby indicating a crucial role for EMT in the pathogenesis of MCBs. Finally, the identification of SPARC and vimentin as poor prognostic factors reinforced the role of EMT in cancer progression. These data advance our understanding of MCB and offer clues to the molecular alterations underlying EMT.

Secondary personality change in psychiatric in-patients

Secondary personality change (SPC) can be caused by various medical conditions and is rarely reported. We retrospectively investigated the prevalence, characteristics, clinical features and treatment response in psychiatric in-patients with a primary diagnosis of SPC. Ten cases of SPC were diagnosed in a series of 5774 patients. Head trauma was the leading cause of SPC. Impulsivity, affective lability and aggression were commonly found in these SPC patients. After medication treatment, all SPC patients had mild to moderate improvement. Secondary personality change is rarely diagnosed in psychiatric in-patients and responds poorly to medication treatment.