bluuebunny/crossref_metadata_2025 huggingface dataset:
Electoral corruption unfolded by Operation Car Wash and political rights in Brazil
Authors: Mohallem Michael Freitas
Published: April 2021

Purpose

This article aims to advance the literature on the effects of corruption and its relationship to human rights violations. The article also presents an overview of existing legislative measures as well as those expected to be implemented at the national level to tackle corruption and its impacts on fundamental rights.

Design/methodology/ approach

The study draws on the literature that addresses the relation between corruption and human rights, and analyses a single well-known case in Brazil (Operation Car Wash) in order to discuss both the violation of citizens’ political rights and of those being investigated.

Findings

The article suggests that the Brazilian State has failed to guarantee fundamental rights as well as to effectively control electoral corruption. By exploring the complex structure of illegal campaign financing in Brazil, the article exposes how Operation Car Wash evidenced the violation of both of the right to participate public affairs and to vote in authentic elections in Brazil.

Originality/value

Considering that the literature shows it is difficult to link the breaches of human rights with incidences of corruption, this article debates the macro context in which the Car Wash case is inserted and demonstrates the evidence that link the corrupt acts involved in this operation to the violation of specific fundamental human rights: the political rights.
The symbiotic nitrogen fixation by legumes in a legume‐companion and a legume‐dominant alpine steppe on the central Tibetan Plateau
Authors: Xu‐Ri  , Dai Dongxue , Xu Xingliang
Published: April 2021

Symbiotic N2‐fixing plant species occur in many stressful environments, including the central Tibetan Plateau, where the legume species Oxytropis microphylla, Oxytropis glacialis, Astragalus arnoldii occur in the alpine steppe at elevations as high as 4700 m above sea level, either as companion or as dominant species, accounting for 13.91–60.25% of the total aboveground steppe biomass. However, the degree to which they are nutritionally reliant upon symbiotic N2 fixation is still unclear. We measured the symbiotic nitrogen fixation rate in a legume‐companion (LC) and a legume‐dominant (LD) alpine steppe community using the 15N isotope dilution technique. The N derived from the atmosphere (%Ndfa) in the three legume species ranged from 17% to 61% in aboveground tissues and from 70% to 88% in belowground tissues. The N2 fixation rate was estimated to be 0.25 ± 0.04 and 1.39 ± 0.20 g N  m−2 year−1 for LC and LD based on the aboveground biomass. It was 0.86 ± 0.04 and 2.77 ± 0.22 gNm−2 year−1 for LC and LD, respectively, when both above and belowground tissues were considered. The total biological nitrogen fixation (BNF) of the alpine steppe on the Tibetan Plateau (ca. 0.7 million km2) can then be conservatively estimated at approximately 0.6 T g N year−1 using the BNF estimate from the LC community. Our findings indicate that estimates based solely on aboveground biomass and LC communities might drastically underestimate the N inputs arising from BNF by legumes to the alpine ecosystem N budget.
Low effective population size in the genetically bottlenecked Australian sea lion is insufficient to maintain genetic variation
Authors: Bilgmann K. , Armansin N. , Ferchaud A.L. , Normandeau E. , Bernatchez L. , Harcourt R. , Ahonen H. , Lowther A. , Goldsworthy S.D. , Stow A.
Published: April 2021

Genetic bottlenecks can reduce effective population sizes (Ne), increase the rate at which genetic variation is lost via drift, increase the frequency of deleterious mutations and thereby accentuate inbreeding risk and lower evolutionary potential. Here, we tested for the presence of a genetic bottleneck in the endangered Australian sea lion (Neophoca cinerea), estimated Ne and predicted future losses of genetic variation under a range of scenarios. We used 2238 genome‐wide neutral single‐nucleotide polymorphisms (SNPs) from 72 individuals sampled from colonies off the southern (SA) and western (WA) coastline of Australia. Coalescent analyses using approximate Bayesian computation (ABC) methods indicated that both the SA and WA populations have experienced a historical genetic bottleneck. Using LD‐based methods, we estimated contemporary Ne to be 160 (CI = 146–178) and 424 (CI = 397–458) for the WA and SA populations respectively. Modelled future population declines suggested that disease epidemics prompted the highest increases in inbreeding relative to fishery‐related mortalities and other modelled threats. Small effective sizes and relatively low genetic variation leave this species vulnerable, and these risks may be compounded if current population declines are not reversed.
Patient outcomes in Tropical North Queensland after implementation of a dedicated orthopaedic trauma list
Authors: Knight Matthew , Gouk Conor , Jorgensen Nicholas B. , Puri Arvind , Morrey Christopher
Published: April 2021

Background

To assess patient outcomes after the introduction of a regular orthopaedic‐specific trauma list (OTL).

Methods

A retrospective analysis of 422 trauma cases was performed comparing patient outcomes after the introduction of the OTL. Four common traumatic injuries requiring operative intervention were considered; closed tibial fractures, intra‐capsular neck of femur fractures, displaced paediatric supracondylar humeral fractures and hand tendon injuries. The outcomes assessed included time from patient referral to theatre, time from admission to theatre, operative times, time of day operation commenced, consultant involvement, hospital length of stay (LOS), returns to theatre and mortality.

Results

Tibial fractures had an increased time from admission to theatre (0.46 days pre‐OTL versus 1.21 days post‐OTL, P = 0.01), hand tendons injuries had an increase in time from referral to theatre (1.06 days pre‐OTL versus 2.82 days post‐OTL, P = 0.001). Consultant involvement increased for supracondylar procedures (27% pre‐OTL versus 61% post‐OTL, P < 0.001) and tendinous hand injury repairs (5% pre‐OTL versus 37% post‐OTL, P < 0.001). There was a decrease in cases starting after 17:00 hours; however, no group reached statistical significance. There was a reduction in complications and shorter inpatient LOS, however; these were not statistically significant. There was no difference in overall operative times after OTL implementation; however, individual group differences existed between registrars and consultants.

Conclusion

Implementing regular orthopaedic trauma lists resulted in greater consultant involvement and was associated with decreased after‐hours operating. Delays to theatre increased from both time of referral and admission; however, this was not correlated with increases in significant harm.
Drug synergy of combinatory treatment with remdesivir and the repurposed drugs fluoxetine and itraconazole effectively impairs SARS‐CoV‐2 infection in vitro
Authors: Schloer Sebastian , Brunotte Linda , Mecate‐Zambrano Angeles , Zheng Shuyu , Tang Jing , Ludwig Stephan , Rescher Ursula
Published: April 2021

Background and Purpose

The SARS‐COV‐2 pandemic and the global spread of coronavirus disease 2019 (COVID‐19) urgently call for efficient and safe antiviral treatment strategies. A straightforward approach to speed up drug development at lower costs is drug repurposing. Here, we investigated the therapeutic potential of targeting the interface of SARS CoV‐2 with the host via repurposing of clinically licensed drugs and evaluated their use in combinatory treatments with virus‐ and host‐directed drugs in vitro.

Experimental Approach

We tested the antiviral potential of the antifungal itraconazole and the antidepressant fluoxetine on the production of infectious SARS‐CoV‐2 particles in the polarized Calu‐3 cell culture model and evaluated the added benefit of a combinatory use of these host‐directed drugs with the direct acting antiviral remdesivir, an inhibitor of viral RNA polymerase.

Key Results

Drug treatments were well‐tolerated and potently impaired viral replication. Importantly, both itraconazole–remdesivir and fluoxetine–remdesivir combinations inhibited the production of infectious SARS‐CoV‐2 particles > 90% and displayed synergistic effects, as determined in commonly used reference models for drug interaction.

Conclusion and Implications

Itraconazole–remdesivir and fluoxetine–remdesivir combinations are promising starting points for therapeutic options to control SARS‐CoV‐2 infection and severe progression of COVID‐19.
The effectiveness of technology‐based interventions for smoking cessation: An umbrella review and quality assessment of systematic reviews
Authors: Mersha Amanual Getnet , Bovill Michelle , Eftekhari Parivash , Erku Daniel Asfaw , Gould Gillian S.
Published: April 2021

Issues

With the advancement and rapid increase in the public's interest in utilisation of Internet and mobile phones, technology‐based interventions are being implemented across a range of health conditions to improve patient outcomes. The aim of this review was to summarise findings from systematic reviews that evaluated the effectiveness of technology‐based smoking cessation interventions and to critically appraise their methodological qualities.

Approach

An umbrella review was conducted using studies identified from a comprehensive literature search of six databases and grey literature. All included systematic reviews were checked for eligibility criteria and quality using the Assessment of Multiple Systematic Reviews tool. The level of evidence for each intervention category was assessed, citation matrices were generated and corrected covered area was calculated.

Key Findings

Five systematic reviews with a total of 212 randomised controlled trials and 237 760 participants were included. Fourteen intervention approaches were identified and classified into three categories: stand‐alone web‐based; stand‐alone mobile phone‐based and multicomponent interventions. Incorporating web and/or mobile‐based interventions with face‐to‐face approach improved the rate of smoking cessation. However, there was no consistent evidence regarding the effectiveness of stand‐alone Internet or mobile‐based interventions.

Implications

Policymakers are recommended to develop strategies that enable health professionals to integrate these approaches with face‐to‐face smoking cessation support. Health professionals are recommended to be trained and equipped for online and mobile‐based interventions.

Conclusion

Adding technology‐based intervention to face‐to‐face smoking cessation support improves smoking cessation. Further research is needed to evaluate stand‐alone web‐based and mobile phone‐based interventions.
Endoscopic snare uvulectomy under moderate sedation without endotracheal intubation
Authors: Inoue Takahiro , Kanesaka Takashi , Otozai Shinji
Published: April 2021

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Early intervention for infants at high risk for cerebral palsy: evidently important, but where’s the evidence?
Authors: Basu Anna Purna
Published: April 2021

This commentary is on the systematic review by Damiano and Longo on pages 771–784 of this issue.
Interprofessional education in the Dentistry curriculum: Analysis of a teaching‐service‐community integration experience
Authors: Olsson Thaís Ostroski , Dalmoro Mateus , da Costa Marcelo Viana , Peduzzi Marina , Toassi Ramona Fernanda Ceriotti
Published: April 2021

Introduction

Interprofessional education (IPE) offers relevant theoretical, conceptual and methodological approaches to the development of effective teamwork competencies.

Objective

To analyse an interprofessional experience of teaching‐service‐community integration carried out at a public university in the South of Brazil.

Methods

A case study with a qualitative approach was carried out. The study's participants were thirty‐eight undergraduate dental students who attended the IPE activity between 2012 and 2019. Data collection was developed in two sequential steps that included the application of an online instrument and semi‐structured interviews. The textual material was interpreted by content analysis, considering Kirkpatrick's evaluation levels (reaction, learning and behaviour).

Results

In the reaction level, students highlighted the contents provided by the National Curricular Guidelines regarding public health system and teamwork, as well as the pedagogical teaching proposal by tutoring groups, which stimulated students’ autonomy. It was observed that the learning was geared towards the development of collaborative teamwork competencies and cultural competencies. In the behaviour level, students perceived positive changes in their attitudes and behaviours towards patients, focused on needs related to life conditions, realising that dentists may work within a team. The elective/optional nature of the experience allied with the absence of other IPE activities in the curricular grid showed to be challenging.

Conclusion

IPE in undergraduate education presented positive results related to the reaction, learning and behaviour of dental students. We recommend the inclusion of interprofessional activities of teaching‐service‐community integration in Dentistry curricular structure to complement uniprofessional education.
Ecological and biogeographical predictors of taxonomic discord across the world’s birds
Authors: Neate‐Clegg Montague H. C. , Blount J. David , Şekercioğlu Çağan H.
Published: April 2021

Aim

Species delimitation is fundamental to biology, but disagreement in species concepts and the application of those concepts can lead to substantial variation in species lists, with important implications for conservation. For birds, there are four widely used global checklists that vary in length and application. Here, we investigate the biogeographical and ecological predictors of taxonomic disagreement between the four world bird species lists.

Location

Global.

Time period

Present.

Major taxa studied

Birds.

Methods

We determined taxonomic agreement based on whether each bird species name represented only one species (‘agreement’), that is, no authorities have split the species, or represented multiple species (‘disagreement’) including disputed splits recognised by some authorities. We examined taxonomic agreement for all birds and for each family and biogeographical region. We then modelled taxonomic agreement as a function of six biogeographical and ecological variables: latitude, island endemism, log(mass), forest dependency, primary diet, and migratory status.

Results

Overall taxonomic agreement was 89.5%, and the remaining 10th of taxonomic names represented disputed splits upon which the four authorities disagreed. We found that taxonomic agreement was lowest for species in Southeast Asia/Australasia and the Southern Ocean, understudied regions where islands have driven high levels of cryptic diversification. In contrast, agreement was highest in the temperate Northern Hemisphere where diversity is lower and research is more extensive. Agreement was also higher for large, migratory species living in open habitats.

Main conclusions

Taxonomic agreement was higher for species that are easier to study such as large, temperate species from open habitats. In addition, agreement was lower for lineages that are more likely to undergo cryptic divergence such as island endemics with intermediate forest dependency and mobility. Species with these traits should be the focus of taxonomic research in order to achieve reconciliation of the world's bird lists and to better conserve extant biodiversity.
Seed germination and biochemical responses of two Elytrigia elongata accessions exposed to abiotic stresses
Authors: Tian Xiaoxia , Mao Peichun , Zheng Mingli , Meng Qingyi , Meng Lin
Published: April 2021

Elytrigia elongata, a rhizomatous and sparse‐type perennial herb of the Triticeae tribe, with stronger drought and salt tolerance, is an important wild genetic resource for wheat variety improvement. However, no precise information about seed germination and biochemical responses of this species to drought, salinity and mixed saline–alkaline stresses is available. Hence, this experiment was conducted to investigate the effects of three abiotic stresses on seed germination and physiological characteristics of two E. elongata accessions. The results showed that drought and mixed saline–alkaline stresses impair seed germination and bud seedling growth of E. elongata. However, seed germination and bud seedling growth were promoted by 50 mmol/L, but inhibited by 100–200 mmol/L salinity treatments. The malondialdehyde (MDA) content was increased and the activities of superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) in the bud seedlings were significantly increased (p <.05) with increasing osmotic stress from 0 to −0.4 MPa, and salinity and mixed saline–alkaline from 0 to 150 mmol/L, but reduced at −0.75 MPa osmotic stress and 200 mmol/L salinity and mixed saline–alkaline stresses. Under the same salinity and mixed saline–alkaline treatment, the activities of SOD and CAT of EE030 were higher than those of EE024 except in 200 mmol/L salinity treatment; however, the MDA content of EE030 was lower than that of EE024, except in 150 mmol/L salinity treatment. In conclusion, the results of this study demonstrated that E. elongata seeds are more tolerant to salinity stress than to drought and mixed saline–alkaline stresses, and EE030 seed are more tolerant to three abiotic stresses than are the seeds of EE024.
Mismatch repair deficiency is rare in bone and soft tissue tumors
Authors: Lam Suk Wai , Kostine Marie , de Miranda Noel F C C , Schöffski Patrick , Lee Che‐Jui , Morreau Hans , Bovée Judith V M G
Published: April 2021

Introduction

There has been an increased demand for mismatch repair (MMR) status testing in sarcoma patients after the success of immune checkpoint inhibition (ICI) in MMR deficient tumors. However, data on MMR deficiency in bone and soft tissue tumors is sparse, rendering it unclear if routine screening should be applied. Hence, we aimed to study the frequency of MMR deficiency in bone and soft tissue tumors after we were prompted by two (potential) Lynch syndrome patients developing sarcomas.

Methods

Immunohistochemical expression of MLH1, PMS2, MSH2 and MSH6 was assessed on tissue micro arrays (TMAs), and included 353 bone and 539 soft tissue tumors. Molecular data was either retrieved from reports or microsatellite instability (MSI) analysis was performed. In MLH1 negative cases, additional MLH1 promoter hypermethylation analysis followed. Furthermore, a systematic literature review on MMR deficiency in bone and soft tissue tumors was conducted.

Results

Eight MMR deficient tumors were identified (1%), which included four leiomyosarcoma, two rhabdomyosarcoma, one malignant peripheral nerve sheath tumor and one radiation‐associated sarcoma. Three patients were suspected for Lynch syndrome. Literature review revealed 30 MMR deficient sarcomas, of which 33% were undifferentiated/unclassifiable sarcomas. 57% of the patients were genetically predisposed.

Conclusion

MMR deficiency is rare in bone and soft tissue tumors. Screening focusing on tumors with myogenic differentiation, undifferentiated/unclassifiable sarcomas and in patients with a genetic predisposition / co‐occurrence of other malignancies can be helpful in identifying patients potentially eligible for ICI.
Rhabdomyolysis‐associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis
Authors: Zhu De‐Cai , Li Wen‐Yan , Zhang Jia‐Wen , Tong Jun‐Sheng , Xie Wen‐Yuan , Qin Xiao‐Lan , Zhang Xiao‐Chun
Published: April 2021

Background

Information on rhabdomyolysis‐associated acute kidney injury (AKI) in the emergency department or general ward is limited.

Aim

To assess the risk factors, outcomes and clinical correlates with intensive care unit (ICU) transfer of patients with rhabdomyolysis‐associated AKI.

Methods

Patients with rhabdomyolysis were divided into the rhabdomyolysis‐associated AKI group and the rhabdomyolysis without AKI group. Inhospital outcomes, including ICU transfer, mortality, length of stay, daily cost and renal recovery were analysed. Multivariate regression analysis was performed to identify the association between rhabdomyolysis‐associated AKI and ICU transfer.

Results

Among 149 patients with rhabdomyolysis, 68 (45.6%) developed AKI. Age and urine protein were important risk factors for incidence of rhabdomyolysis‐associated AKI. Patients with rhabdomyolysis‐associated AKI had higher levels of undergoing dialysis (19.1% vs 2.5%; P < 0.01), all‐cause mortality (13.2% vs 1.2%; P < 0.01), cost of hospitalisation (10.8 1000 yuan, IQR (5.5, 3.5) vs 5.9 1000 yuan, IQR 5.9 (3.6, 9.9); P = 0.03), as well as longer length of hospital stay (8.0 days (5.0, 14.0)) versus (6.0 days (4.0, 11.0); P = 0.02). Additionally, the percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% vs 12.3%; P < 0.002) and rhabdomyolysis‐associated AKI was an independent risk factor for ICU transfer (adjusted odds ratio = 2.58; 95% confidence interval, 1.12–6.8, P = 0.03).

Conclusion

Rhabdomyolysis‐associated AKI was common in the emergency department or general ward and led to more severe outcomes. It was also associated with an increased risk of ICU transfer.
Potential cost‐effectiveness of using adjunctive dehydrated human amnion/chorion membrane allograft in the management of non‐healing diabetic foot ulcers in the United Kingdom
Authors: Guest Julian F. , Atkin Leanne , Aitkins Christopher
Published: April 2021

The aim of this study was to estimate the cost‐effectiveness of using dehydrated human amnion/chorion membrane (dHACM) allografts (Epifix) as an adjunct to standard care, compared with standard care alone, to manage non‐healing diabetic foot ulcers (DFUs) in secondary care in the United Kingdom, from the perspective of the National Health Service (NHS). A Markov model was constructed to simulate the management of diabetic lower extremity ulcers over a period of 1 year. The model was used to estimate the cost‐effectiveness of using adjunctive dHACM, compared with standard care alone, to treat non‐healing DFUs in the United Kingdom, in terms of the incremental cost per quality‐adjusted life year (QALY) gained at 2019/2020 prices. The study estimated that at 12 months after the start of treatment, use of adjunctive dHACM instead of standard care alone is expected to lead to a 90% increase in the probability of healing, a 34% reduction in the probability of wound infection, a 57% reduction in the probability of wound recurrence, a 6% increase in the probability of avoiding an amputation, and 8% improvement in the number of QALYs. Additionally, if £4062 is spent on dHACM allografts per ulcer, then adjunctive use of dHACM instead of standard care alone is expected to lead to an incremental cost per QALY gain of £20 000. However, if the amount spent on dHACM allografts was ≤£3250 per ulcer, the 12‐month cost of managing an ulcer treated with adjunctive dHACM would break‐even with that of DFUs treated with standard care, and it would have a 0.95 probability of being cost‐effective at the £20 000 per QALY threshold. In conclusion, within the study's limitations, and within a certain price range, adjunctive dHACM allografts afford the NHS a cost‐effective intervention for the treatment of non‐healing DFUs within secondary care among adult patients with type 1 or 2 diabetes mellitus in the United Kingdom.
Prevalence and predictors of pacing‐induced cardiomyopathy in young adult patients (<60 years) with pacemakers
Authors: Li Dan L. , Yoneda Zachary T. , Issa Tariq Z. , Shoemaker M. Benjamin , Montgomery Jay A.
Published: April 2021

Introduction

Clinical trials and observational studies of pacing‐induced cardiomyopathy (PICM) have largely included elderly patients with mean age >70 years. The prevalence and predictors of PICM in younger patients (age < 60 years) after pacemaker implantation are not known.

Methods

Adults (18–59 years) who received single‐chamber ventricular or dual‐chamber pacemakers at Vanderbilt University Medical Center from 1986 to 2015 were included. Patients without documented ventricular pacing burden and patients with baseline left ventricular ejection fraction (LVEF) <35% were excluded. PICM was defined as LVEF decrease of ≥ 10% and LVEF < 50% during follow‐up with right ventricular pacing ≥20%, and without alternative explanations for cardiomyopathy.

Results

A total of 325 patients were included in the study. During a median follow‐up duration of 11.5 (Interquartile range 7−17) years, 38 patients (11.7%) developed PICM (1.3 per 100 patient‐year). Older age (HR 2.5 for age ≥50 years, p = .013), reduced baseline LVEF (HR 2.4, p = .022), and preimplant AVB (HR 2.7, p = .007) were associated with an increased risk of PICM in the multivariate analysis. Furthermore, baseline AF conferred an increased risk of PICM only in patients without preimplant AVB but not patients with pre‐implant AVB.

Conclusions

The incidence of PICM in young patients was low, but PICM could occur more than a decade after pacemaker implantation. Older age, baseline reduced LVEF, and preimplant AVB were associated with an increased risk of PICM in the young patient cohort.
The Changing Face of Mercosur: Legitimacy and the Politics of Scale in South American Regionalism
Authors: Chodor Tom
Published: April 2021

Mercosur has undergone numerous transformations, from a customs union to an organization promoting development and consulting civil society. Recently, there has been a backlash against such ‘politicization’, and an attempt to return Mercosur to its origins. At each of these phases, Mercosur was plagued by questions about its legitimacy and purpose, and its leaders reached out to different types of actors to legitimize it. This article argues that each phase of Mercosur's evolution represented the ascendancy of a constellation of social forces, which sought to shift the governance of particular issues beyond the national scope, to secure their interests. In this context, the different legitimation processes and changing actors involved in them represent different balances of forces within Mercosur. The article traces the evolution of Mercosur and its legitimation processes, identifying the social struggles behind them, and the different conceptions of legitimacy constructed and contested as part of this process.
The predictive capacity of psychiatric and psychological polygenic risk scores for distinguishing cases in a child and adolescent psychiatric sample from controls
Authors: Jansen Arija G. , Jansen Philip R. , Savage Jeanne E. , Kraft Julia , Skarabis Nora , Polderman Tinca J. C. , Dieleman Gwen C.
Published: April 2021

Background

Psychiatric traits are heritable, highly comorbid and genetically correlated, suggesting that genetic effects that are shared across disorders are at play. The aim of the present study is to quantify the predictive capacity of common genetic variation of a variety of traits, as captured by their PRS, to predict case‐control status in a child and adolescent psychiatric sample including controls to reveal which traits contribute to the shared genetic risk across disorders.

Method

Polygenic risk scores (PRS) of 14 traits were used as predictor phenotypes to predict case‐control status in a clinical sample. Clinical cases (N = 1,402), age 1–21, diagnostic categories: Autism spectrum disorders (N = 492), Attention‐deficit/ hyperactivity disorders (N = 471), Anxiety (N = 293), disruptive behaviors (N = 101), eating disorders (N = 97), OCD (N = 43), Tic disorder (N = 50), Disorder of infancy, childhood or adolescence NOS (N = 65), depression (N = 64), motor, learning and communication disorders (N = 59), Anorexia Nervosa (N = 48), somatoform disorders (N = 47), Trauma/stress (N = 39) and controls (N = 1,448, age 17–84) of European ancestry. First, these 14 PRS were tested in univariate regression analyses. The traits that significantly predicted case‐control status were included in a multivariable regression model to investigate the gain in explained variance when leveraging the genetic effects of multiple traits simultaneously.

Results

In the univariate analyses, we observed significant associations between clinical status and the PRS of educational attainment (EA), smoking initiation (SI), intelligence, neuroticism, alcohol dependence, ADHD, major depression and anti‐social behavior. EA (p‐value: 3.53E‐20, explained variance: 3.99%, OR: 0.66), and SI (p‐value: 4.77E‐10, explained variance: 1.91%, OR: 1.33) were the most predictive traits. In the multivariable analysis with these eight significant traits, EA and SI, remained significant predictors. The explained variance of the PRS in the model with these eight traits combined was 5.9%.

Conclusion

Our study provides more insights into the genetic signal that is shared between childhood and adolescent psychiatric disorders. As such, our findings might guide future studies on psychiatric comorbidity and offer insights into shared etiology between psychiatric disorders. The increase in explained variance when leveraging the genetic signal of different predictor traits supports a multivariable approach to optimize precision accuracy for general psychopathology.
Morbidity and mortality of rheumatic heart disease and acute rheumatic fever in the inpatient setting in Timor‐Leste
Authors: Davis Kimberly , de Oliveira Lidia NL , da Silva Almeida Ines , Noronha Mario , Martins Joao , dos Santos Milena , Monteiro Andre , Brewster David , Horton Ari , Remenyi Bo , Francis Joshua R
Published: April 2021

Aim

To describe the clinical features, treatment and outcomes of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children admitted to the national referral hospital in Dili, Timor‐Leste.

Methods

This prospective study documented cases of ARF and RHD in children aged 14 years and under who were admitted between June 2017 and May 2019. ARF was diagnosed using an adapted version of the 2015 Jones criteria and presumed (rather than proven) exposure to group A Streptococcus. Clinical and echocardiographic findings, comorbidities and discharge outcomes are reported.

Results

A total of 63 patients were admitted with ARF or RHD; 54 were diagnosed with RHD for the first time. Median age was 11 years (range 3–14); 48% were female. Of those with echocardiograms, 56/58 had RHD, 55/56 (98%) had mitral regurgitation (37/55 (67%) severe), 11/56 (20%) had mitral stenosis and 43/56 (77%) had aortic regurgitation. Left ventricular dysfunction (55%), pulmonary hypertension (64%) and cardiac failure (78%) were common. Four (6%) patients died in hospital, and 30/59 (51%) of surviving patients were lost to follow up.

Conclusions

Community echocardiography screening has reported a high prevalence of undetected mild to moderate cases of RHD in Timor‐Leste, whereas this hospital study documents mostly severe disease among hospitalised patients with a high case fatality rate and loss to follow up. RHD is a significant health problem in Timor‐Leste and improved recognition and diagnosis, as well as effective delivery of treatment and follow‐up are imperative.
Variations in IgG antibody subclass responses to oral bacteria: Effects of periodontal disease and modifying factors
Authors: Ebersole Jeffrey L. , Hamzeh Razan , Nguyen Linh , Al‐Sabbagh Mohanad , Dawson Dolph
Published: April 2021

Background and objective

Local and systemic IgG antibodies or oral bacteria have been described with periodontitis. We extended these observations by assessing the impact of a range of intrinsic factors on serum IgG subclass antibodies to both commensal and pathogenic oral bacteria that would contribute to variations in immune protection or disease susceptibility in periodontitis have not been described.

Methods

Subjects (n = 278) were classified as healthy, gingivitis, or periodontitis and categorized as mild, moderate, and severe periodontitis. Demographic stratification included sex, age, race/ethnicity, smoking, and obesity. Whole formalin‐fixed bacteria were used as antigens to detect serum immunoglobulin (Ig)G subclass antibody levels using an ELISA.

Results

The greatest differences in variations in IgG subclasses occurred in periodontitis versus health or gingivitis to bacteria considered oral pathogens (eg, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola) with IgG1, IgG2, and IgG4 increased by three‐ to sevenfold with Pg. Differences in subclass levels and distribution were also observed related to disease severity, particularly related to individual subclass responses to Pg. Examination of the overall population showed that females had elevated antibody, reflected by elevated IgG2 amounts/proportions. The older group of subjects demonstrated elevated antibody to multiple oral bacteria, lacking any particular subclass pattern. IgG2 antibody to Aa and Pg was increased in smokers. Multiple IgG subclass antibody levels to oral pathogens were significantly decreased in the obese subset within this population.

Conclusion

This investigation identified patterns of IgG subclass antibody responses to oral bacteria and demonstrated substantial effects of disease impacting the level and subclass distribution of antibody to an array of oral bacteria. Altered subclass antibody profiles most often in IgG2 levels and for antibody to P. gingivalis were found related to sex, age, disease severity, race/ethnicity, smoking, and obesity to both pathogens and commensal bacteria.
Predictors of appropriate shock after generator replacement in patients with an implantable cardioverter defibrillator
Authors: Arcinas Liane A. , Chew Derek S. , Seifer Colette M. , Baranchuk Adrian , Supel Izabella , Exner Derek V. , Boles Usama , McIntyre William F.
Published: April 2021

Background

Implantable cardioverter defibrillators (ICDs) are indicated for the primary prevention of sudden cardiac death in patients with reduced left ventricular ejection fraction (LVEF). The ongoing risk/benefit profile of an ICD at generator replacement is unknown. This study aimed to identify predictors of appropriate ICD shocks and therapies after first ICD generator replacement, and its procedure‐related complications.

Methods

We conducted a multicenter, retrospective cohort study including patients with primary prevention ICDs who underwent generator replacement between April 2005 and July 2015 at three Canadian centers. The primary and secondary outcomes were appropriate ICD shock and any appropriate ICD therapy, respectively. Procedure‐related complication rates were also reported.

Results

Of the 219 patients in the cohort, 61 (28%) experienced an appropriate shock while 40 (18%) experienced appropriate antitachycardia pacing over a median follow up of 2.2 years. Independent predictors of appropriate ICD shocks included: LVEF at time of replacement (adjusted odds ratio [OR] 0.4 per 10% increase in LVEF, P < .001), a history of appropriate ICD shocks prior to replacement (OR 4.9, P < .001), and a history of inappropriate ICD shocks (OR 4.2, 95%, P < .002). Similar predictors were identified for the secondary outcome of any appropriate ICD therapy. Device‐related complications were reported in 25 (11%) patients, with 1 (0.5%) resulting in death, 14 (6.3%) requiring site re‐operation, and 6 (2.7%) requiring cardiac surgical management.

Conclusion

Not all primary prevention ICD patients undergoing generator replacement will require appropriate device therapies afterwards. Generator replacement is associated with several risks that should be weighed against its anticipated benefit. A comprehensive assessment of the risk‐benefit profile of patients undergoing generator replacement is warranted.
Treading the Thin Line: Pharmacy Workers’ Perspectives on Medication Abortion Provision in Lusaka, Zambia
Authors: Footman Katharine , Chelwa Nachela , Douthwaite Megan , Mdala James , Mulenga Drosin , Brander Caila , Church Kathryn
Published: April 2021

Context: Despite liberal abortion laws, safe abortion access in Zambia is impeded by limited legal awareness, lack of services, and restrictive clinical policies. As in many countries with restricted abortion access, women frequently seek abortions informally from pharmacies.

Methods: We conducted 16 in‐depth interviews in 2019 to understand the experiences and motivations of pharmacy workers who sell medication abortion (MA) drugs in Lusaka.

Results: We found that pharmacy staff reluctantly assume a gatekeeper role for MA due to competing pressures from clients and from regulatory constraints. Pharmacy staff often decide to provide MA, motivated by their duty of care and desire to help clients, as well as financial interests. However, pharmacy workers’ motivation to protect themselves from legal and business risk perpetuates inequalities in abortion access, as pharmacy workers improvise additional eligibility criteria based on personal risk and values such as age, partner approval, reason for abortion, and level of desperation.

Conclusion: These findings highlight how pharmacy staff informally determine women's abortion access when laws and policies prevent comprehensive access to safe abortion. Reform of clinical guidelines, public education, strengthened public sector availability, task sharing, and improved access to prescription services are needed to ensure women can legally access safe abortion.
A global phylogenetic analysis of trap‐jaw ants, Anochetus Mayr and Odontomachus Latreille (Hymenoptera: Formicidae: Ponerinae)
Authors: Fernandes Itanna O. , Larabee Fredrick J. , Oliveira Marcio L. , Delabie Jacques H. C. , Schultz Ted R.
Published: April 2021

We present a phylogeny of the trap‐jaw ant genera Anochetus and Odontomachus with dense taxon sampling representing all biogeographical regions and all species groups for both genera. Four nuclear protein‐coding genes (Long‐wavelength rhodopsin, Topoisomerase I, Wingless and Rudimentary) and one mitochondrial gene (cytochrome oxidase I) were sequenced for 221 individuals of Anochetus (44 species) and Odontomachus (38 species). Analyses using Bayesian and maximum‐likelihood criteria recovered essentially the same phylogenetic relationships, including strongly supported reciprocal monophyly of both genera. The analyses recovered nine of the 12 species groups previously proposed for Odontomachus and nine of the 22 species groups previously proposed for Anochetus. Based on these results, species groups are redefined. Anochetus contained an additional new, previously unrecognized group defined here as the hohenbergiae group. Divergence‐time analyses estimated the clade composed of Odontomachus + Anochetus arose during the early Paleocene, with Odontomachus and Anochetus diverging during the Eocene. Biogeographic analyses suggest that the most recent common ancestor (MRCA) of Odontomachus and Anochetus occupied either the Neotropical or Afrotropical region during the late Cretaceous and that the two genera radiated during the early Paleocene. The ancestor of Odontomachus originated in the Neotropical or Afrotropical regions, giving rise to lineages that radiated during the late Eocene, and the ancestor of Anochetus originated in the Neotropical region, giving rise to lineages that radiated during the early Eocene.
A Method of Numerical Analysis of Plastic Flow in Plane Strain and Its Application to the Compression of a Ductile Material Between Rough Plates
Authors: Hill R. , Lee E. H. , Tupper S. J.
Published: April 2021

Problems of plastic flow which arise in practice, with complicated boundary conditions, are seldom amenable to exact analysis, and it becomes necessary to devise some numerical method of solution. This paper describes a rapid numerical procedure for the determination of the stress and velocity distributions in plane plastic flow where the plastic strains are large. The method is applied to the problem of the squeezing of a plastic material between rough plates. This example has been chosen as it illustrates the treatment of most types of boundary condition likely to be encountered and supplies for contrast several incomplete solutions attempted by previous authors. The solution shows the fallacy of the apparent static determinancy of the plane plastic problem, indicating the need to consider the velocity field in obtaining the true distribution of stress. A further advantage of this example is the possibility of checking the numerical procedure, which is found to be extremely accurate.
The Solution of Elastic Plate Problems by Electrical Analogies
Authors: MacNeal R. H.
Published: April 2021

A dynamic-analogy method for the solution of elastic plate problems is described in this paper. The electrical circuits developed here can be set up and studied on an electric-analog computer. Problems involving deflections under constant load, transient vibrations, or normal modes can be solved in this way. The method of applying boundary conditions to plates with irregular edges is given, together with a detailed description of the representation of the boundary conditions for a rectangular variable-thickness plate. Solutions that have been obtained on the Cal Tech electric-analog computer are presented for the static deflections and normal modes of a rectangular cantilever plate.
Some Thin-Plate Problems by the Sine Transform
Authors: Deverall L. I. , Thorne C. J.
Published: April 2021

General expressions for the deflection of thin rectangular plates are obtained for cases in which two opposite edges have arbitrary but given deflections and moments. The sine transform is used as a part of the method of solution, since solutions can be found for an arbitrary load for each set of edge conditions at the other two edges. Even for the classical cases, the use of the sine transform makes the process of solving the problem much easier. The six general solutions given are those which arise from all possible combinations of physically important edge conditions at the other two edges. Solutions for a specific load function can be found by integration or by the use of a table of sine transforms. Tables useful in application of the method to specific problems are included.
Bending of Thin Ring-Sector Plates
Authors: Deverall L. I. , Thorne C. J.
Published: April 2021

General expressions for the deflection of plates whose planform is a sector of a circular ring are given for cases in which the straight edges have arbitrary but given deflection and bending moment. The solutions are given for all combinations of physically important edge conditions on the two circular edges. Sectors of circular plates are included as special cases. Solutions are given for a general load which is a continuous function of r, and a sectionally continuous function of θ, where r and θ are the usual polar co-ordinates with the pole at the center of the ring. Several specific examples are given.
Plastic-Wave Propagation Effects in High-Speed Testing
Authors: Lee E. H. , Wolf H.
Published: April 2021

A material test carried out at high speed may be markedly influenced by plastic-wave propagation effects. In such a case, a variation of strain occurs along the test specimen, and the stress-strain relation cannot be determined from measurements made on the specimen as a whole. If average values are taken, it is shown that a spurious strain-rate influence will be deduced when propagation effects first begin to appear as the testing speed is increased. The effect is due not to a true material strain-rate dependence, but to the appearance of strain variations along the specimen, and its magnitude depends upon the dynamics of the whole test arrangement. The theoretical plastic-wave analysis of a particular test arrangement is also given. The range of speed is determined which permits satisfactory interpretation without the need for detailed analysis of plastic-wave propagation. Application to other test arrangements is discussed, and it is pointed out that a theoretical analysis can, in general, be made to predict the permissible speed range in planning a high-speed testing program.
Bending of a Cylindrically Aeolotropic Circular Plate With Eccentric Load
Authors: Sen Gupta A. M.
Published: April 2021

The problem of small-deflection theory applicable to plates of cylindrically aeolotropic material has been developed, and expressions for moments and deflections produced have been found by Carrier in some symmetrical cases under uniform lateral loadings and with different boundary conditions. The author has also found the moments and deflection in the case of an unsymmetrical bending of a plate loaded by a distribution of pressure of the form p = p0r cos θ, with clamped edge. The object of the present paper is to investigate the problem of the bending of a cylindrically aeolotropic circular plate of uniform thickness under a concentrated load P applied at a point A at a distance b from the center, the edge being clamped.
Supersonic Flow With Variable Specific Heat
Authors: Durham F. P.
Published: April 2021

Formulas are developed for stagnation conditions and one-dimensional flow through shock waves, including Rankine-Hugoniot values, taking into account the variation of the specific heat of air with temperature by means of the concept of mean specific heats. These formulas are reduced to correction factors that may be applied to the widely used constant specific-heat formulas up to a Mach number of 7. The corrections involved are appreciable in the case of the density change through a shock wave and for the total pressure ratio across a shock wave, as well as for stagnation pressures and temperatures. The limitations imposed by the deviation of a gas at high pressure from the ideal equation of state, relaxation time, and dissociation are discussed.
A Contribution to the Theory of the Development and Stability of Detonation in Gases
Authors: Oppenheim A. K.
Published: April 2021

The development of detonation of an explosive gas mixture contained in a constant-cross-section duct is analyzed on the basis of a unidimensional, gasdynamic treatment of a double-discontinuity combustion system. A steady and an unsteady system are considered, and it is shown that the latter yields an adequate explanation of the effect of coalition of the two discontinuities on the establishment and subsequent stability of the detonation wave. The locus of states behind the detonating combustion zone during the development of the process is determined and analyzed.
Measurement of Recovery Factors and Friction Coefficients for Supersonic Flow of Air in a Tube: 2—Results Based on a Two-Dimensional Flow Model for Entrance Region
Authors: Kaye J. , Toong T. Y. , Shoulberg R. H.
Published: April 2021

The first part of a program to obtain reliable data on the rate of heat transfer to air moving at supersonic speeds in a tube has been devoted to measurements made on adiabatic supersonic flow of air in a tube. The details of these measurements have been described in a previous paper. The calculated quantities such as the local apparent friction coefficient, recovery factor, Mach number, and so forth, were obtained from the simple one-dimensional flow model for which the properties of the stream are uniform at any section, and boundary-layer effects are ignored. The analysis of some of the same data given in the previous paper is undertaken here with the aid of a simplified two-dimensional flow model. The supersonic flow in the tube is divided into a supersonic core of variable mass with the fluid remaining in the core undergoing a reversible adiabatic change of state, and a laminar boundary layer of variable mass. The compressible laminar boundary layer increases in thickness in the direction of flow, and then undergoes a transition to a turbulent boundary layer. The two-dimensional flow model is limited here to the region where a laminar boundary layer appears to be present in the entrance region of the tube. The results of the analysis based on the two-dimensional flow model indicate that where the flow in the tube boundary layer appears to be laminar, the measured pressures and temperatures in the tube for adiabatic supersonic flow of air could have been predicted, with sufficient accuracy for engineering problems, from measured data for supersonic flow of air over a flat plate with a laminar boundary layer, and with zero pressure gradient.