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Due to the recent COVID-19 pandemic, people tend to wear masks indoors and outdoors. Therefore, systems with face recognition, such as FaceID, showed a tendency of decline in accuracy. Consequently, many studies and research were held to improve the accuracy of the recognition system between masked faces. Most of them targeted to enhance dataset and restrained the models to get reasonable accuracies. However, not much research was held to explain the reasons for the enhancement of the accuracy. Therefore, we focused on finding an explainable reason for the improvement of the model's accuracy. First, we could see that the accuracy has actually increased after training with a masked dataset by 12.86%. Then we applied Explainable AI (XAI) to see whether the model has really focused on the regions of interest. Our approach showed through the generated heatmaps that difference in the data of the training models make difference in range of focus. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The energy-efficient plate heat exchanger (PHE) and refrigerant R1234yf, which has a low global warming potential (GWP), can be used to realize an energy efficient heat pump (HP) system for electric vehicles (EV), extending their driving range. Therefore, the characteristics of R1234yf in an offset-fin strip (OSF) flowstructured PHE are critical for heat-exchanger design. This study investigates the condensation heat transfer coefficient (C-HTC) and two-phase frictional pressure drop (2P-FPD) of R1234yf during condensation in an OSF flow-structured PHE under various operating conditions. First, a modified Wilson plot method was used to determine the multiplier (C) and Reynolds number exponential (n) for the coolant side as -0.426 and 0.494, respectively. When the heat flux (q), average vapor quality (xa), and mass flux (G) increased, the C-HTC increased, whereas it decreased with saturation temperature (Tsat). Despite the force-convective condensation flow regime, the C-HTC increment was minimal with G at lower xa owing to the lesser significance of the shear effect. Additionally, the 2P-FPD was unaffected by q but increased considerably with an increase in xa and G and a decrease in Tsat. Based on the current experimental database, empirical correlations for forecasting friction factor and Nusselt number were developed with a 91% predictability.
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In this study, the components of microwave-assisted extracts obtained from Thuja orientalis leaves were analyzed, and the cytotoxicity, antibacterial and antiviral activities were evaluated. The predominant components from microwave-assisted extraction were catechin, leucopelargonidin, arecatannin, quinolone, and kaempferol derivatives, which are classified in the fla-vonoid and tannin groups. We observed that the 0.11 mg/mL of extract concentration did not show cytotoxicity in HaCaT cells. The antibacterial activities were tested according to the guidelines of methods for determining the bactericidal activity of antimicrobial agents. The extracts showed 99.9% antibacterial efficiency against gram-positive S. aureus, while the anti-bacterial effect on gram-negative E. coli was insignificant. When the extract concentration and contact time with bacteria were increased, 99.9% antibacterial efficiency was observed for E. coli as well as S. aureus. Following the standard to assess the activity of microbicides against viruses in suspension (ASTM-E1052-20), the antiviral efficiency was more than 99.99% for influenza A (H1N1) and SARS-CoV-2. These results suggest its potential use in antiviral disinfectants, surface coatings, personal protective equipment, and textiles. © 2023 The Korean Society of Industrial and Engineering Chemistry. All rights reserved.
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Background: Breast cancer survivors often report their high needs for help during the transition to cancer survivorship. During the COVID-19 pandemic, technology-based programs are increasingly popular because of their high flexibility and accessibility in delivering information and coaching/support to address the current needs for help among cancer survivors. Yet, little is known about how socio-behavioral factors influence the effects of a technology-based intervention on the needs for help of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. Purpose(s): The purpose of this secondary analysis was to examine the multiple socio-behavioral factors (including attitudes, self-efficacy, perceived barriers, and social influences related to breast cancer survivorship) mediated the effects of a technology-based intervention on the needs for help among Asian American breast cancer survivors. Method(s): This analysis was conducted with the data from 199 Asian American breast cancer survivor women who were recruited from January 2017 to June 2020 through online and offline communities/groups. The needs for help were measured using the Support Care Needs Survey-34 Short Form (SCNS) with five domains on psychological, information, physical, support, and communication needs. Mediation analysis was conducted using the PROCESS macro within SPSS. The analysis determined the mediating effects of four socio-behavioral mediators on the needs for help at pre-test [T0 ], post 1-month [T1 ], and post 3-months [T2 ] of a technology-based intervention. Result(s): Overall, all the mediators had statistically significant mediation effects on all types of needs for help (p < .05) at different points. Attitudes and social influence presented statistically significant mediation effects on the total needs for help score over 3 months (T0 , T1 , and T2 ). Perceived Barriers had mediation effects on all types of needs for help over 1 month (T0 , T1 ). Self-efficacy mediated the effects on all types of needs for help only at post 1 month (T1 ). Conclusion(s): The findings supported that all the socio-behavioral factors (attitudes, self-efficacy, perceived barriers, and social influences) mediated the effects of a technology-based intervention on the needs for help of Asian American breast cancer survivors. Future research and practice should consider socio-behavioral factors to reduce their needs for help during their survivorship process.
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PURPOSE: Colorectal cancer (CRC) is preventable with screening, yet remains the second leading cause of cancer deaths in the U.S. Nationally, CRC screening substantially declined during the COVID-19 pandemic and is underutilized by ethnic minorities and in safety-net systems. Therefore, City of Hope partnered with Federally Qualified Health Centers (FQHCs) and community and faithbased organizations to improve CRC screening among medically underserved communities. METHOD(S): Between October 2020 and October 2022, we implemented a multi-component intervention that included community outreach and education (a multi-ethnic multimedia campaign and community training adapted from the NCI Screen2Save (S2S) program) and clinic-based interventions (provider/staff training and patient education). Intervention reach and training participant surveys were assessed. Within our four FQHC sites, we also compared clinic-level CRC screening rates among age-eligible patients before (June 2021) and after implementation of the clinic-based intervention (June 2022). RESULT(S): Our reach assessment showed that our multi-ethnic multimedia campaign reached 35.4 million impressions, our S2S education training reached 300 diverse community members, and our provider/staff training reached 150 medical providers. Among the 100 providers surveyed, >80% felt confident they could get their patients to complete their CRC screening test and follow-up care. For the clinic-based intervention component, our baseline sample included 11,259 age-eligible patients across the four FQHC sites. Overall CRC screening rates increased from 45% to 52% before vs. after the intervention implementation period. The site with the highest CRC screening rate (>62%) maintained steady rates over the observation period, whereas three sites with lower baseline rates showed greater pre-post improvements (average 15 percentage-point increase). CONCLUSION(S): An overall increase in CRC screening rates was achieved across FQHCs, despite clinic staffing challenges during the COVID-19 pandemic. Intervention implementation is ongoing with attempts to document individual, clinic improvements by race/ethnicity.
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Purpose - study aims to investigate the relationships between global value chain (GVC)-and transportation-related determinants and economic performance. Also, moderating effects of COVID-19 on the relationships are theoretically and empirically discussed. A limitation of previous studies includes their over-reliance on the opportunities of GVC participation and larger transportation. This study represents the challenges associated with them. Also, it shows how GVC and logistics can be difficult in case of a market fluctuation such as COVID-19.Design/methodology - The sample for this study includes 828 observations from 138 countries. A semi-panel data set has been used. Six observations for each country are used to empirically test the hypotheses and a Two-way cluster model is conducted.Findings - It is confirmed that GVC forward participation contributes more than the backward participation to enhance performance. Transportation infrastructure is critical, but large scales of marine and air transportations are not positive in terms of economic performance. Stricter government response to COVID-19 negatively moderates economic performance by GVC backward participation and transportation infrastructure.Originality/value - The spread of COVID-19 is causing a severe collapse of GVC and transportation. This study empirically verifies the moderating effects of the government stringency on GVC and transportation. Previous studies usually discuss a positive impact of GVC and transportation size on economic performance. However, this study aims to show various challenges behind GVC participation and large scale transportation.
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The COVID-19 pandemic has significantly impacted society, having led to a lack of social skills in children who became used to interacting with others while wearing masks. To analyze this issue, we investigated the effects of masks on face identification and facial expression recognition, using deep learning models for these operations. The results showed that when using the upper or lower facial regions for face identification, the upper facial region allowed for an accuracy of 81.36%, and the lower facial region allowed for an accuracy of 55.52%. Regarding facial expression recognition, the upper facial region allowed for an accuracy of 39% compared to 49% for the lower facial region. Furthermore, our analysis was conducted for a number of facial expressions, and specific emotions such as happiness and contempt were difficult to distinguish using only the upper facial region. Because this study used a model trained on data generated from human labeling, it is assumed that the effects on humans would be similar. Therefore, this study is significant because it provides engineering evidence of a decline in facial expression recognition;however, wearing masks does not cause difficulties in identification.
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Objective: We examined the degrees of change in familial discussions about racial issues (i.e., race, ethnicity, racism, and discrimination) due to the surge of anti-Asian discrimination during the COVID-19 pandemic.Background: Asian American family racial-ethnic socialization that teaches the values, information, and perspectives about racial-ethnic group membership and race relations carry great implications for youth development. However, little is known about how anti-Asian sentiments may have contributed to the degrees of change in racial issues.Method: The participants included 143 second-generation East Asian American youth (e.g., Chinese, Korean, Japanese, and Taiwanese) ages 11-18 years (M = 14.96, SD = 1.98). Youth were attending middle (38%) or high (62%) schools in the United States.Results: Latent profile analysis identified four profiles of degrees of change in familial discussions: (a) moderate change in racial discussions about other ethnicities, (b) much change in racial discussions, (c) moderate change in racial discussions about own ethnicities, and (d) little change in racial discussions.Conclusion: Our findings provide a snapshot of the ways East Asian American families' racial discussions are changing, which in turn shape youth's experiences in navigating their social contexts.Implications: The findings provide valuable directions for research and interventions to promote important racial discussion among East Asian American families.
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The unprecedented COVID-19 pandemic posed major challenges to local, regional, and global economies and health systems, and fast clinical diagnostic workflows were urgently needed to contain the spread of SARS-CoV-2. Here, we describe the platform and workflow established at the Cornell COVID-19 Testing Laboratory (CCTL) for high-throughput testing of clinical samples from the university and the surrounding community. This workflow enabled efficient and rapid detection, and successful control of SARS-CoV-2 infection on campus and its surrounding communities. Our cost-effective and fully automated workflow enabled testing of over 8,000 pooled samples per day and provided results for over 2 million samples. Automation of time- and effort-intensive sample processing steps such as accessioning and pooling increased laboratory efficiency. Customized software applications were developed to track and store samples, deconvolute positive pools, track and report results and for workflow integration from sample receipt to result reporting. Additionally, quality control dashboards and turn-around time tracking applications were built to monitor assay and laboratory performance. As infectious disease outbreaks pose a constant threat to both human and animal health, the highly effective workflow implemented at CCTL could be modeled to establish regional high-capacity testing hubs for infectious disease preparedness and emergency response.
Subject(s)
COVID-19 , Communicable DiseasesABSTRACT
Research has examined the detrimental effects of the coronavirus disease (COVID-19) pandemic on health and physical fitness in adolescents;however, studies comparing these parameters before and after the COVID-19 outbreak have been scarce. Therefore, this study investigated differences in perceived health status, perceived physical fitness, and participation in physical activity among adolescents in the Republic of Korea before and after the COVID-19 outbreak. We chose a sample of data from 2102 adolescents aged 14-19, collected as part of a national survey by the Republic of Korea Ministry of Culture, Sports, and Tourism from 2019 to 2021. We focused on five items from the survey related to health awareness and physical activity. Although perceived health status was lower in 2021 than in 2019 or 2020, there were no differences in perceived physical fitness during the three years of the study. Regular participation in physical activity was less common in 2020 than in 2019 or 2021. The proportion of adolescents reporting sufficient rest and sleep was lower in 2021 than in 2020. In addition, fewer adolescents reported eating regular meals and engaging in nutritional supplementation in 2021 than in 2019 and 2020. Rates of abstinence from alcohol and smoking cessation were higher in 2021 than in 2019 or 2020. For all three years, adolescents reported the following as the primary reasons for engaging in regular physical activity (in order): "maintenance of mental health", "maintenance of physical health", "help in daily life", and "reduction of medical expenses". In preparation for the post-COVID-19 era, these results highlight the need to prepare measures and countermeasures to promote health and physical activity among adolescents in the Republic of Korea.Copyright ©2023 The Author(s). Published by MRE Press.
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In this study, the components of microwave-assisted extracts obtained from Thuja orientalis leaves were analyzed, and the cytotoxicity, antibacterial and antiviral activities were evaluated. The predominant components from microwave-assisted extraction were catechin, leucopelargonidin, arecatannin, quinolone, and kaempferol derivatives, which are classified in the fla-vonoid and tannin groups. We observed that the 0.11 mg/mL of extract concentration did not show cytotoxicity in HaCaT cells. The antibacterial activities were tested according to the guidelines of methods for determining the bactericidal activity of antimicrobial agents. The extracts showed 99.9% antibacterial efficiency against gram-positive S. aureus, while the anti-bacterial effect on gram-negative E. coli was insignificant. When the extract concentration and contact time with bacteria were increased, 99.9% antibacterial efficiency was observed for E. coli as well as S. aureus. Following the standard to assess the activity of microbicides against viruses in suspension (ASTM-E1052-20), the antiviral efficiency was more than 99.99% for influenza A (H1N1) and SARS-CoV-2. These results suggest its potential use in antiviral disinfectants, surface coatings, personal protective equipment, and textiles. © 2023 The Korean Society of Industrial and Engineering Chemistry. All rights reserved.
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Background/Aims With widespread implementation of COVID-19 vaccine, there has been concern that it would trigger an immune activation due to its immunogenic properties. There is low-level evidence that patients with rheumatological diagnosis often have a disease flare following COVID-19 vaccination which not only has personal health implications but also wider socioeconomic implications. Inflammatory arthritis patients are classified as vulnerable patients requiring booster vaccinations. Therefore, there is a need to ascertain whether there is a risk of disease flare in this group of patients so as to counsel them appropriately in order to ensure flares are managed in timely manner. This study aims to determine the proportion of patients with inflammatory arthritis who have a flare of their rheumatological disease within 30 days of receiving a COVID-19 vaccine using CRP as a surrogate marker. Methods A retrospective notes review was conducted of patients with inflammatory arthritis within 30 days of their COVID-19 vaccine. An electronic database (DAWN) was used to identify all patients that were currently on a disease-modifying anti-rheumatic drug (DMARD) or biologic therapy. This was then correlated with vaccine data from the National Immunisation and Vaccination system (NIVS) and C-reactive protein (CRP) within 30 days of their vaccination. Results 1620 adults were identified from DAWN databases (mean age 61 years, 64% female). Three types of vaccination were used: AstraZeneca (AZ), BioNTech-Pfizer or Moderna. Vaccine uptake was 1542/1620 (95.2% 1st dose), 1550/1620 (95.7% 2nd dose) and 1437/ 1620 (88.7% 3rd dose). 192/1542 patients (12.5%) had a CRP rise of greater than 10mg/L within 30 days of their vaccine, which was higher than baseline flare rate of 8.6% (p=0.0004). Conclusion Patients with inflammatory arthritis and on DMARDS have high uptake of COVID-19 vaccine (95%) which is greater than the national average. A CRP rise greater than 10mg/L within 30 days of vaccination was observed in roughly 1 in 10 patients in our study population on all three doses which is consistent with other studies in the literature. Our results show statistically significant increase in the rate of disease flare (12.5% compared with baseline rate of 8.6%). However, SARS-CoV-2 infection has been shown many times to be an independent risk factor for rheumatic disease flare ranging from 20-40%. Therefore, patients with inflammatory arthritis should still be encouraged to receive COVID-19 vaccination. To maintain high levels of vaccine uptake, it is important to ensure that patients are aware of the risks of vaccinations and sufficiently safety netted so flares are managed early. As on-going booster vaccinations are planned for rheumatology patients, we recommend further research to better inform and counsel our patients. Furthermore, this study calls for diligence in monitoring patients with inflammatory arthritis for disease flare and for swift intervention to prevent losing disease control.
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Background: The coronavirus disease pandemic has caused significant disruption in the field of education, resulting in the need for more online classes and a blended offline and online teaching model. Therefore, understanding what makes this model effective is important. Accordingly, this study explored the structural relationships among academic pressure, independent learning ability, and academic self-efficacy in a blended teaching environment during the pandemic and independent learning ability's mediating effect on the relationship between academic pressure and academic self-efficacy. Methods: Adopting a random sampling method, this study surveyed 761 Chinese college, Shaanxi Province, China in 2022 and university students. Factor analysis, correlation analysis, structural equation modeling, and path analysis were used to analyze the data. Results: The results show that the academic pressure faced by Chinese English majors had a significant negative impact on academic self-efficacy (P<0.001). However, academic pressure had no statistical effect on stu-dents' independent learning ability (P=0.317). Moreover, independent learning ability had a significant positive effect on academic self-efficacy (P<0.001) and a mediating effect on the relationship between academic pressure and academic self-efficacy (P=0.032). Conclusion: Independent learning ability can directly and indirectly affect academic self-efficacy. Thus, in an online and offline blended teaching model, teachers should guide students regarding self-exploration, com-munication, and cooperation based on existing knowledge and experience. They should also enable students to improve their learning process and independent learning ability. Various language learning situations should be established for learning English so that by experiencing success and failure, students can ultimately improve their academic self-efficacy. © 2023 Zhao et al.
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The hard lesson learnt from the COVID-19 pandemic is lack of understanding the risk and preparedness for response which resulted in millions of losses of lives and unprecedented cascading effects. This chapter analyzes how frontier technologies are supporting the key stakeholders to manage the COVID-19 crises—protect lives, livelihoods, and enhance the quality of risk governance in Asia and the Pacific. This chapter addresses five key lessons emerging from the COVID-19 response: (1) making risk assessment more dynamics, (2) empowering at risk communities, (3) managing a global risk with local action, (4) managing uncertainties, and (5) bridging the gaps in knowledge and understanding in systemic risks. This chapter also outlines three key enablers—frontier technologies, data science, and national innovation systems that help to prepare for the future crises. The nature and scale of risk has changed. In our increasingly complex inter-connected world, managing risk forms the key to preparing for the future. Smart preparedness is the way forward. Artificial Intelligence (AI), Big Data, Machine Learning, 5G technologies, drones, automated vehicles, robotics, etc., were used to track, monitor, warn, and support logistics as well as its rapid diagnostic and telemedicine. A wide-range of risk analytics such as impact forecasting and risk informed early warning, indexing and creating risk matrix to target at risk communities which have been developed and put to use in response to the COVID-19 pandemic and its intersection with extreme climate events. Digital solutions can help enhanced preparedness to protect at risk communities but also strengthen their resilience. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.
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Introduction: Lorlatinib is a third-generation tyrosine kinase inhibitor that inhibits anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1). Although 2-10% of patients with non-small cell lung cancer developed hyperglycemia in phase 2 and 3 studies of lorlatinib, only one case has subsequently reported hyperglycemia >500 mg/dL, and no cases of diabetic ketoacidosis (DKA) have been previously reported. Phase 1 trials in neuroblastoma are ongoing. Case Description: A 34-year-old woman with ALK-mutated paraspinal neuroblastoma presented with DKA 14 months after initiation of lorlatinib. Prior to starting lorlatinib, her hemoglobin A1c had been 5.0% (n: < 5.7%). After 12 months of therapy, her A1c increased to 7.8%, prompting the initiation of metformin 500 mg daily. However, two months later she was admitted for DKA with a blood glucose of 591 mg/dL (n: 65-99 mg/dL), CO2 17 mmol/L (n: 20-30 mmol/L), anion gap 18 (n: 8-12), moderate serum ketones, and 3+ ketonuria. Her A1c was 14.8%, C-peptide was 1.2 ng/mL (n: 1.1-4.3 ng/mL), and her glutamic acid decarboxylase-65 and islet antigen-2 autoantibodies were negative. She was also found to be incidentally positive for COVID-19 but was asymptomatic without any oxygen requirement. The patient's DKA was successfully treated with IV insulin infusion, and she was discharged after 3 days with insulin glargine 27 units twice daily and insulin aspart 16 units with meals. One month later, her hemoglobin A1c had improved to 9.4%, and the patient's oncologist discontinued lorlatinib due to sustained remission of her neuroblastoma and her complication of DKA. After stopping lorlatinib, her blood glucose rapidly improved, and she self-discontinued all her insulin in the following 3 weeks. One month later, she was seen in endocrine clinic only taking metformin 500 mg twice daily with fasting and post-prandial blood glucose ranging 86-107 mg/dL. Discussion(s): This is the first reported case of DKA associated with lorlatinib. This case highlights the importance of close glucose monitoring and the risk of severe hyperglycemia and DKA while on lorlatinib therapy. Discontinuation of lorlatinib results in rapid improvement of glycemic control, and glucose-lowering treatments should be promptly deescalated to avoid hypoglycemia.Copyright © 2023
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Background: Immunocompromised patients with COVID-19 tend to shed viable virus for a prolonged period. Therefore, for moderately or severely immunocompromised patients with COVID-19, CDC recommends an isolation period of at least 20 days and ending isolation in conjunction with serial testing and consultation with an infectious disease specialist. However, data on viral kinetics and risk factors for prolonged viral shedding in these patients are limited. Method(s): From February 1, 2022 to April 1, 2022, we collected weekly saliva samples from immunocompromised patients with COVID-19 admitted to a tertiary hospital in Seoul, South Korea. Genomic and subgenomic RNAs were measured, and virus culture was performed. Result(s): A total of 41 patients were enrolled;29 (70%) were receiving chemotherapy against hematologic malignancies and the remaining 12 (30%) had undergone solid organ transplantation. Of the 41 patients, 14 (34%) had received 3 doses or more of COVID-19 vaccines. Real-time RT-PCR revealed that 7 (17%) were infected with Omicron BA.1, and 33 (80%) with Omicron BA.2. The median duration of viable virus shedding was 4 weeks (IQR 3-6). Patients undergoing B-cell depleting therapy shed viable virus for longer than the comparator (p=0.01). Multivariable analysis showed that 3-dose or more vaccination (HR 0.33, 95% CI 0.12 - 0.93, p = 0.04) and B-cell depleting therapy (HR 12.50, 95% CI 2.44 - 100.00, p = 0.003) independently affected viable virus shedding of SARS-CoV-2. Conclusion(s): Immunocompromised patients with COVID-19 shed viable virus for median 4 weeks. B-cell depleting therapy increases the risk of prolonged viable viral shedding, while completion of a primary vaccine series reduces this risk. Overall distribution of samples according to genomic viral copy number and culture positivity. Red dot indicates positive culture results, whereas blue dot indicated negative culture results. (Figure Presented).
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Dragon fruit is widely grown in Southeast Asia and other tropical or subtropical regions. As a high-value cash crop ideal for exportation, dragon fruit cultivation has boomed during the past decade in southern Vietnam. Light supplementing during the winter months using artificial lighting sources is a widely adopted cultivation technique to boost productivity in the major dragon fruit planting regions of Vietnam. The application of electric lighting at night leads to a significant increase of nighttime light (NTL) observable by satellite sensors. The strong seasonality signal of NTL in dragon fruit cultivation enables identifying dragon fruit plantations using NTL images. We employed Visible Infrared Imaging Radiometer Suite (VIIRS) Day/Night Band (DNB) monthly nighttime imagery from 2012 to 2019 to extract the growing area of dragon fruit in Bình Thuan Province, the largest dragon fruit growing region of Vietnam. The Breakpoint for Additive Seasonal Trend (B-FAST) analysis was applied to calculate the seasonality of NTL inside the dragon fruit plantations and distinguish them from the background. The results indicated that the dragon fruit cultivation strongly increased after 2014 and reached a plateau after 2017. In recent years, dragon fruit cultivation has experienced a slight decrease due to market fluctuations. We applied a buffer analysis over the largest dragon fruit cultivation area in Bình Thuan to analyze the spatial trend of the expansion of dragon fruit planting. Our results suggest that the dragon fruit cultivation of Bình Thuan has expanded to cover most inter-hill plains, reaching a spatial extent capacity due to the topographical constraints, and thus has begun to encroach into the low-elevation foothill area. In the case of emergency lock-down orders in February 2020 during the COVID-19 pandemic, NTL used for dragon fruit cultivation changed heterogeneously in space and time, driven by market price and shipping limitations far away from the local restrictions. Under the dual rural-urban hot spot situation with strong and contemporary developments of both dragon fruit agriculture and the urban tourism industry, building structures were detected densely in the city and gradually dispersed well into the rural landscape in Bình Thuan. The outcomes of this study will be valuable for local policymakers to better understand of the available area for dragon fruit cultivation and achieve better-coordinated cultivation planning against future fluctuations of the global market while providing insights and new understanding into the dual hot-spot developments valuable for planning rural-urban change strategies. © Springer Nature Switzerland AG 2022. All rights reserved.
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OBJECTIVE: To assess the effectiveness of oral spironolactone for acne vulgaris in adult women. DESIGN: Pragmatic, multicentre, phase 3, double blind, randomised controlled trial. SETTING: Primary and secondary healthcare, and advertising in the community and on social media in England and Wales. PARTICIPANTS: Women (≥18 years) with facial acne for at least six months, judged to warrant oral antibiotics. INTERVENTIONS: Participants were randomly assigned (1:1) to either 50 mg/day spironolactone or matched placebo until week six, increasing to 100 mg/day spironolactone or placebo until week 24. Participants could continue using topical treatment. MAIN OUTCOME MEASURES: Primary outcome was Acne-Specific Quality of Life (Acne-QoL) symptom subscale score at week 12 (range 0-30, where higher scores reflect improved QoL). Secondary outcomes were Acne-QoL at week 24, participant self-assessed improvement; investigator's global assessment (IGA) for treatment success; and adverse reactions. RESULTS: From 5 June 2019 to 31 August 2021, 1267 women were assessed for eligibility, 410 were randomly assigned to the intervention (n=201) or control group (n=209) and 342 were included in the primary analysis (n=176 in the intervention group and n=166 in the control group). Baseline mean age was 29.2 years (standard deviation 7.2), 28 (7%) of 389 were from ethnicities other than white, with 46% mild, 40% moderate, and 13% severe acne. Mean Acne-QoL symptom scores at baseline were 13.2 (standard deviation 4.9) and at week 12 were 19.2 (6.1) for spironolactone and 12.9 (4.5) and 17.8 (5.6) for placebo (difference favouring spironolactone 1.27 (95% confidence interval 0.07 to 2.46), adjusted for baseline variables). Scores at week 24 were 21.2 (5.9) for spironolactone and 17.4 (5.8) for placebo (difference 3.45 (95% confidence interval 2.16 to 4.75), adjusted). More participants in the spironolactone group reported acne improvement than in the placebo group: no significant difference was reported at week 12 (72% v 68%, odds ratio 1.16 (95% confidence interval 0.70 to 1.91)) but significant difference was noted at week 24 (82% v 63%, 2.72 (1.50 to 4.93)). Treatment success (IGA classified) at week 12 was 31 (19%) of 168 given spironolactone and nine (6%) of 160 given placebo (5.18 (2.18 to 12.28)). Adverse reactions were slightly more common in the spironolactone group with more headaches reported (20% v 12%; p=0.02). No serious adverse reactions were reported. CONCLUSIONS: Spironolactone improved outcomes compared with placebo, with greater differences at week 24 than week 12. Spironolactone is a useful alternative to oral antibiotics for women with acne. TRIAL REGISTRATION: ISRCTN12892056.
Subject(s)
Acne Vulgaris , Spironolactone , Adult , Humans , Female , Spironolactone/adverse effects , Quality of Life , Wales , Acne Vulgaris/drug therapy , Acne Vulgaris/complications , Anti-Bacterial Agents/therapeutic use , Double-Blind Method , Immunoglobulin A , Treatment OutcomeABSTRACT
Purpose: The purpose of this study was to investigate the factors affecting the quality of life of cancer patients by examining the de-gree of the COVID-19 pandemic-related depression, anxiety, stress, and treatment-crisis. Methods: Data were collected from 132 cancer patients undergoing surgery, chemotherapy, radiotherapy, and hormone therapy at K University Hospital in D City using a structured questionnaire. The period of data collection was from May 6 to May 28, 2022. The collected data were analyzed using de-scriptive statistics, t-test, ANOVA, Pearson's correlation, and stepwise multiple regression. Results: The mean scores of quality of life, depression, anxiety, stress, and treatment-crisis during the COVID-19 pandemic were 84.64 +/- 29.09, 15.14 +/- 6.49, 4.66 +/- 5.27, 75.83 +/- 17.70, and 78.52 +/- 19.95, respectively. In terms of factors affecting the quality of life related to the COVID-19 pandemic, CO-VID-19 pandemic-related stress (beta=.41,p<.001) appeared to have the greatest impact, followed by COVID-19 pandemic-related treatment-crisis (beta=.28,p=.002), anxiety (beta=.21, p=.002), and gender (beta=.14, p=.009), with a total explanatory power of 67.6%. Con-clusion: To improve the quality of life during the COVID-19 pandemic, COVID-19 pandemic-related stress, treatment-crisis, and anxiety should be periodically monitored and nursing interventions such as education on infection prevention, management, and emotional support programs should be provided to decrease the COVID-19 pandemic-related stress, treatment-crisis, and anxiety.