Parenting measurement, normativeness, and associations with child outcomes: Comparing evidence from four non-Western cultures.

This study compared parenting across four non-Western cultures to test cross-cultural commonality and specificity principles in three aspects: measurement properties, parenting normativeness, and their associations with child outcomes. Both mothers and fathers (N = 1509 dyads) with preschool-aged children (M = 5.00 years; 48% girls) from urban areas of four countries (Malaysia, N = 372; China, N = 441; Turkey, N = 402; and Japan, N = 294) reported on four parenting constructs (authoritative, authoritarian, group harmony socialization, and intrusive control) and their sub-dimensions using modified culturally relevant measures. Teachers reported on children's internalizing, externalizing, and prosocial behaviors. The commonality principle was supported by two sets of findings: (1) full measurement invariance was established for most parenting constructs and sub-dimensions, except that intrusive control only reached partial scalar invariance, and (2) no variations were found in associations between parenting and any child outcomes across cultures or parent gender at the construct level for all four parenting constructs and at the sub-dimensional level for authoritarian and intrusive control sub-dimensions. The specificity principle was supported by the other two sets of findings: (1) cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, and (2) at the sub-dimensional level, the authoritative parenting and group harmony socialization sub-dimensions were differently associated with child outcomes across cultures and/or parent gender. The findings suggested that examining specific dimensions rather than broad parenting constructs is necessary to reflect cultural specificities and nuances. Our study provided a culturally-invariant instrument and a three-step guide for future parenting research to examine cross-cultural commonalities/specificities. RESEARCH HIGHLIGHTS: This is the first study to use an instrument with measurement invariance across multiple non-Western cultures to examine the commonality and specificity principles in parenting. Measurement invariance was achieved across cultures for authoritative and authoritarian parenting, group harmony socialization, intrusive control, and their sub-dimensions, supporting the commonality principle. Cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, supporting the specificity principle. Both commonalities and specificities were manifested in associations between parenting and child outcomes across cultures.

Trajectories of Chinese paternal emotion-related socialization behaviors during early adolescence: Contributions of father and adolescent factors.

Parental emotion-related socialization behaviors (ERSBs) are developmental and multiply determined. However, longitudinal studies on the development patterns of ERSBs and their antecedents, especially for Chinese fathers, are scarce. This study examined the longitudinal trajectories of Chinese fathers' ERSBs during early adolescence and whether they are influenced by the father (depressive symptoms and emotion dysregulation) and adolescent factors (depressive symptoms and emotional intelligence). We used 4-year, self-reported, survey-based data from Chinese early adolescents (46.70% girls, Mage at Wave 1 = 10.26 years, SD = 0.33) and their fathers (Mage at Wave 1 = 40.36 years, SD = 4.22), and data analyses were conducted using unconditional and conditional latent growth model (N = 1061 at Wave 1). The results revealed an increase in the father's supportive and non-supportive ERSBs over 4 years. Furthermore, father's depression symptoms, emotion dysregulation, and adolescent's depression symptoms can predict paternal supportive ERSBs' trajectories, while only the father's depression symptoms and emotion dysregulation can predict the change in non-supportive ERSBs. The findings give a holistic picture of the developmental trajectories of paternal ERSBs during early adolescence, and highlight the importance of accounting for differences in father and adolescent factors in understanding changes in parental ERSBs during this critical developmental period.

Longitudinal associations between emotion regulation strategies and subjective well-being in migrant and non-migrant adolescents in urban China.

This study examined the long-term reciprocal impact of two key emotion regulation strategies, cognitive reappraisal and expressive suppression, on the subjective well-being of migrant and non-migrant adolescents in urban China. A total of 2397 middle school students from urban China (864 migrant, Mage  = 13.05 years, SD = 0.62, 41.7% girls; 1533 non-migrant, Mage  = 13.01 years, SD = 0.47, 50.1% girls) were followed from 2016 to 2017. Data on the two emotion regulation strategies (measured using the Chinese version of the Emotion Regulation Questionnaire) and subjective well-being (measured using the Subjective Well-Being Inventory) were collected. Although no differences were found in the use of cognitive reappraisal, migrant adolescents reported greater use of expressive suppression than non-migrant adolescents. Furthermore, a two-group cross-lagged panel analysis showed that cognitive reappraisal positively predicted subjective well-being among both migrant and non-migrant adolescents, whereas expressive suppression was positively related to subjective well-being in only migrant adolescents. Migrant adolescents with higher levels of subjective well-being jointly used cognitive reappraisal and expressive suppression, while non-migrant adolescents were prone to only using cognitive reappraisal. These findings indicate that group-level context influences both the utilisation and functionality of emotion regulation strategies among migrant and non-migrant adolescents in urban China.

A study of the MR imaging manifestations with injection of sedative at the buttocks in pediatric patients.

BACKGROUND: During the MRI examination, pediatric patients sleep under the sedation so that the image artifacts caused by the patient motion could be minimized. However, the sedative injection at the buttocks might cause a difficulty in the diagnosis of the buttock diseases using the MRI manifestations. OBJECTIVE: This study aims to explore the imaging characteristics of MR for the pediatric patients with the sedative injected at the buttocks in order to correctly diagnose the diseases. METHODS: MR imaging data of 64 pediatric patients injected with the sedative at the buttocks were retrospectively collected, including 8 cases of buttock disease. The imaging manifestations were analyzed and compared. RESULTS: Out of 64 patients, 8 were diagnosed as the buttock diseases. MR imaging manifestations of the sedatives injected at the buttocks were the locally patchy and streaky long T1 and long T2 signals and were different from what were shown for the normal tissues and diseases. CONCLUSION: The sedative injected at the buttocks has the MRI manifestations different from the normal tissues and diseases. Correctly understanding the MRI manifestations for the pediatric patients with the injection of sedative at the buttocks would reduce the chances of the misdiagnosis on the diseases.

Effect of One-methylcyclopropene (1-MCP) and chlorine dioxide (ClO2) on preservation of green walnut fruit and kernel traits.

The effect of the ethylene receptor competitor 1-methylcyclopropene (1-MCP) and the legally approved disinfectant chlorine dioxide (ClO2) on preservation of the green walnut fruit during storage was investigated. Green Chinese walnut fruit cv. Xilin No.2 was harvested on commercial maturity and stored at 0-1 °C after the fruit was treated by water (control), 80 mg L(-1)ClO2 (ClO2), 0.5 µL L(-1)1-MCP (1-MCP), or combination treatment of 80 mg L(-1) ClO2 with either 0.1 µL L(-1) 1-MCP (0.1 1-MCP+ ClO2) or 0.5 µL L(-1) 1-MCP (0.5 1-MCP+ ClO2). During storage, respiration, ethylene production, phenolics content, antioxidative activity, weight changes, decay of the fruit and kernel traits of acid value, peroxide value,free fatty were measured. All treatments decreased postharvest respiration intensity in different degrees and inhibited ethylene production peak. ClO2 increased the total phenol and flavonoid content of the green fruit compared with other treatments and the control (P < 0.05), but not did the total antioxidant activity for this treatment. After 42-day storage, ClO2 remained higher fresh weight and lower decay index than control, while 1-MCP increased the fruit decay index. Final acid values of kernel from ClO2, control and 0.1 1-MCP+ ClO2 were not different from their initial values, which from 0.5 1-MCP increased. Final peroxide value for kernel from ClO2 showed no change during storage but increased at least 1.0-fold for other treatments. ClO2 preserved 99.9 % of initial free fatty acid, similar to that for the control (99.8 %), whereas 0.5 1-MCP preserved only 95.7 %. ClO2 is of potential in decay retardation and kernel traits maintenance of green walnut fruit, whereas the 1-MCP has a negative effect for decay control on walnut.

Long-Term Results of a Phase 2 Study of Definitive Chemoradiation Therapy Using S-1 for Esophageal Squamous Cell Carcinoma Patients Who Were Elderly or With Serious Comorbidities.

Background: The optimal evidence-based management for the subsets of locally advanced esophageal squamous cell carcinoma (ESCC) patients who rejected or were intolerant to intravenous chemotherapy due to old age or serious comorbidities is currently lacking. This study aimed to assess the safety and local control rate (LCR) of S-1 (tegafur-gimeracil-oteracil potassium) combined with radiotherapy in these subsets of ESCC patients. Methods: Locally advanced ESCC patients who rejected or were intolerant to intravenous chemotherapy due to age >75 years or serious comorbidities were enrolled in a prospective, single-arm, phase 2 trial. The patients were treated with definitive concurrent chemoradiotherapy with S-1, which was administered orally twice daily for 28 days. The radiotherapy dose was 61.2 Gy delivered in 34 fractions. The primary end-point was the 3-year LCR. Results: One hundred five ESCC patients were recruited between March 2013 and October 2015. At the median follow-up of 73.1 months (IQR 65.5-81.4 months), 3-year LCR was 61.1%, and 1, 3, and 5-year overall survival was 77.9, 42.3, and 24.8% respectively. For safety analysis, ≥grade 3 acute adverse events included thrombocytopenia (6.7%), leukopenia (2.9%), anemia (1.0%), anorexia (1.0%), fatigue (10.5%), hiccup (1.0%), pneumonitis (4.8%), and esophagitis (3.8%). Two patients (1.9%) died of late esophageal hemorrhage, and one patient (1.0%) died of late radiation-induced pneumonitis. Conclusion: S-1 is a promising regimen in concurrent chemoradiotherapy with low toxicity and a favorable LCR in ESCC patients who rejected or were intolerant to intravenous chemotherapy due to old age or serious comorbidities. Clinical Trial Registration: ClinicalTrials.gov, NCT01831531.

Risk Factors for Patient-Ventilator Asynchrony and Its Impact on Clinical Outcomes: Analytics Based on Deep Learning Algorithm.

Background and objectives: Patient-ventilator asynchronies (PVAs) are common in mechanically ventilated patients. However, the epidemiology of PVAs and its impact on clinical outcome remains controversial. The current study aims to evaluate the epidemiology and risk factors of PVAs and their impact on clinical outcomes using big data analytics. Methods: The study was conducted in a tertiary care hospital; all patients with mechanical ventilation from June to December 2019 were included for analysis. Negative binomial regression and distributed lag non-linear models (DLNM) were used to explore risk factors for PVAs. PVAs were included as a time-varying covariate into Cox regression models to investigate its influence on the hazard of mortality and ventilator-associated events (VAEs). Results: A total of 146 patients involving 50,124 h and 51,451,138 respiratory cycles were analyzed. The overall mortality rate was 15.6%. Double triggering was less likely to occur during day hours (RR: 0.88; 95% CI: 0.85-0.90; p < 0.001) and occurred most frequently in pressure control ventilation (PCV) mode (median: 3; IQR: 1-9 per hour). Ineffective effort was more likely to occur during day time (RR: 1.09; 95% CI: 1.05-1.13; p < 0.001), and occurred most frequently in PSV mode (median: 8; IQR: 2-29 per hour). The effect of sedatives and analgesics showed temporal patterns in DLNM. PVAs were not associated mortality and VAE in Cox regression models with time-varying covariates. Conclusions: Our study showed that counts of PVAs were significantly influenced by time of the day, ventilation mode, ventilation settings (e.g., tidal volume and plateau pressure), and sedatives and analgesics. However, PVAs were not associated with the hazard of VAE or mortality after adjusting for protective ventilation strategies such as tidal volume, plateau pressure, and positive end expiratory pressure (PEEP).

Combined High-Dose LATTICE Radiation Therapy and Immune Checkpoint Blockade for Advanced Bulky Tumors: The Concept and a Case Report.

Although the combination of immune checkpoint blockades with high dose of radiation has indicated the potential of co-stimulatory effects, consistent clinical outcome has been yet to be demonstrated. Bulky tumors present challenges for radiation treatment to achieve high rate of tumor control due to large tumor sizes and normal tissue toxicities. As an alternative, spatially fractionated radiotherapy (SFRT) technique has been applied, in the forms of GRID or LATTICE radiation therapy (LRT), to safely treat bulky tumors. When used alone in a single or a few fractions, GRID or LRT can be best classified as palliative or tumor de-bulking treatments. Since only a small fraction of the tumor volume receive high dose in a SFRT treatment, even with the anticipated bystander effects, total tumor eradications are rare. Backed by the evidence of immune activation of high dose radiation, it is logical to postulate that the combination of High-Dose LATTICE radiation therapy (HDLRT) with immune checkpoint blockade would be effective and could subsequently lead to improved local tumor control without added toxicities, through augmenting the effects of radiation in-situ vaccine and T-cell priming. We herein present a case of non-small cell lung cancer (NSCLC) with multiple metastases. The patient received various types of palliative radiation treatments with combined chemotherapies and immunotherapies to multiple lesions. One of the metastatic lesions measuring 63.2 cc was treated with HDLRT combined with anti-PD1 immunotherapy. The metastatic mass regressed 77.84% over one month after the treatment, and had a complete local response (CR) five months after the treatment. No treatment-related side effects were observed during the follow-up exams. None of the other lesions receiving palliative treatments achieved CR. The dramatic differential outcome of this case lends support to the aforementioned postulate and prompts for further systemic clinical studies.

Detection of patient-ventilator asynchrony from mechanical ventilation waveforms using a two-layer long short-term memory neural network.

BACKGROUND AND OBJECTIVE: Mismatch between invasive mechanical ventilation and the requirements of patients results in patient-ventilator asynchrony (PVA), which is associated with a series of adverse clinical outcomes. Although the efficiency of the available approaches for automatically detecting various types of PVA from the ventilator waveforms is unsatisfactory, the feasibility of powerful deep learning approaches in addressing this problem has not been investigated. METHODS: We propose a 2-layer long short-term memory (LSTM) network to detect two most frequently encountered types of PVA, namely, double triggering (DT) and ineffective inspiratory effort during expiration (IEE), on two datasets. The performance of the networks is evaluated first using cross-validation on the combined dataset, and then using a cross testing scheme, in which the LSTM networks are established on one dataset and tested on the other. RESULTS: Compared with the reported rule-based algorithms and the machine learning models, the proposed 2-layer LSTM network exhibits the best overall performance, with the F1 scores of 0.983 and 0.979 for DT and IEE detection, respectively, on the combined dataset. Furthermore, it outperforms the other approaches in cross testing. CONCLUSIONS: The findings suggest that LSTM is an excellent technique for accurate recognition of PVA in clinics. Such a technique can help detect and correct PVA for a better patient ventilator interaction.

The Technical and Clinical Implementation of LATTICE Radiation Therapy (LRT).

The concept of spatially fractionated radiation therapy (SFRT) was conceived over 100 years ago, first in the form of GRID, which has been applied to clinical practice since its early inception and continued to the present even with markedly improved instrumentation in radiation therapy. LATTICE radiation therapy (LRT) was introduced in 2010 as a conceptual 3D extension of GRID therapy with several uniquely different features. Since 2014, when the first patient was treated, over 150 patients with bulky tumors worldwide have received LRT. Through a brief review of the basic principles and the analysis of the collective clinical experience, a set of technical recommendations and guidelines are proposed for the clinical implementation of LRT. It is to be recognized that the current clinical practice of SFRT (GRID or LRT) is still largely based on the heuristic principles. With advancements in basic biological research and the anticipated clinical trials to systemically assess the efficacy and risk, progressively robust optimizations of the technical parameters are essential for the broader application of SFRT in clinical practice.