bluuebunny/crossref_metadata_2025 huggingface dataset:
Do bark beetle outbreaks amplify or dampen future bark beetle disturbances in Central Europe?
Authors: Sommerfeld Andreas , Rammer Werner , Heurich Marco , Hilmers Torben , Müller Jörg , Seidl Rupert
Published: September 2020

Bark beetle outbreaks have intensified in many forests around the globe in recent years. Yet, the legacy of these disturbances for future forest development remains unclear. Bark beetle disturbances are expected to increase further because of climate change. Consequently, feedbacks within the disturbance regime are of growing interest, for example, whether bark beetle outbreaks are amplifying future bark beetle activity (through the initiation of an even‐aged cohort of trees) or dampening it (through increased structural and compositional diversity).

We studied bark beetle–vegetation–climate interactions in the Bavarian Forest National Park (Germany), an area characterised by unprecedented bark beetle activity in the recent past. We simulated the effect of future bark beetle outbreaks on forest structure and composition and analysed how disturbance‐mediated forest dynamics influence future bark beetle activity under different scenarios of climate change. We used process‐based simulation modelling in combination with machine learning to disentangle the long‐term interactions between vegetation, climate and bark beetles at the landscape scale.

Disturbances by the European spruce bark beetle were strongly amplified by climate change, increasing between 59% and 221% compared to reference climate. Bark beetle outbreaks reduced the dominance of Norway spruce (Picea abies (L.) Karst.) on the landscape, increasing compositional diversity. Disturbances decreased structural diversity within stands (α diversity) and increased structural diversity between stands (β diversity). Overall, disturbance‐mediated changes in forest structure and composition dampened future disturbance activity (a reduction of up to −67%), but were not able to fully compensate for the amplifying effect of climate change.

Synthesis. Our findings indicate that the recent disturbance episode at the Bavarian Forest National Park was caused by a convergence of highly susceptible forest structures with climatic conditions favourable for bark beetle outbreaks. While future climate is increasingly conducive to massive outbreaks, the emerging landscape structure is less and less likely to support them. This study improves our understanding of the long‐term legacies of ongoing bark beetle disturbances in Central Europe. It indicates that increased diversity provides an important dampening feedback, and suggests that preventing disturbances or homogenizing post‐disturbance forests could elevate the future susceptibility to large‐scale bark beetle outbreaks.
Characterisation of a rat model of mechanical low back pain at an advanced stage using immunohistochemical methods
Authors: Park Thomas S. W. , Khan Nemat , Kuo Andy , Nicholson Janet R. , Corradini Laura , Smith Maree T.
Published: September 2020

Chronic low back pain (LBP) has high prevalence in the adult population which is associated with enormous disability. Hence, our aim was to further characterise our LBP rat model by using immunohistological and immunohistochemical methods at an advanced stage (day 49) of the model. Male Sprague‐Dawley rats were anaesthetised and their lumbar L4/L5 and L5/L6 intervertebral discs (IVDs) were punctured (0.5 mm outer diameter, 2 mm‐deep) 10 times per disc. Sham‐rats underwent similar surgery, but no discs were punctured. For LBP‐ but not sham‐rats, noxious pressure hyperalgesia was fully developed in the lumbar axial deep tissues on day 21 post‐surgery, which was maintained until at least day 49. In the lumbar (L4–L6) dorsal root ganglia (DRGs), somatostatin (SRIF) and the somatostatin receptor type 4 (SST4 receptor) were co‐localised with substance P and IB4, markers of small diameter unmyelinated peptidergic and non‐peptidergic C‐fibres respectively as well as with NF200, a marker of medium to large diameter neurons. On day 49, there was increased expression of SRIF but not the somatostatin receptor type 4 (SST4 receptor) in the lumbar DRGs and the spinal dorsal horns. There were increased DRG expression levels of the putative pro‐nociceptive mediators: phosphorylated p38 (pp38) mitogen‐activated protein kinase (MAPK) and phosphorylated p44/p42 MAPK (pp44/pp42 MAPK) as well as pp38 MAPK expression levels in the lumbar spinal cord. Taken together, the increased expression of SRIF in the lumbar DRGs and spinal cord and its co‐localisation with nociceptive fibres in DRG sections suggest a potential role of SRIF in modulating chronic mechanical LBP.
Economic growth dynamics between resource‐rich and resource‐poor countries in sub‐Saharan Africa: The role of politics and institutions
Authors: Adika Gameli
Published: September 2020

This paper employs the system generalized method of moments to examine the diversity of economic growth in 33 resource‐rich and resource‐poor countries in sub‐Saharan Africa (SSA) over the period 1996–2017. The last decade has witnessed resource‐poor countries such as Rwanda and Ethiopia sustain impressive economic growth while resource‐rich countries such as Nigeria and the Democratic Republic of the Congo continue to struggle. On the other hand, non‐oil resource‐rich countries such as Botswana and Namibia record steady economic growth rates. Are resource‐rich countries better off? Or is there sufficient evidence in support of the resource curse phenomenon in SSA? We examine the resource curse hypothesis and the effects of political and institutional variables in explaining economic growth in SSA. We find that resource‐rich countries grow at an annual average of 1.3% more than resource‐poor countries. Furthermore, we find strong complementarity between institutional quality and economic growth in resource‐rich countries; a stable democracy, political stability, and periodic rotation of political power are critical prerequisites in sustaining economic growth in resource‐rich countries in SSA. Overall, the findings suggest weak evidence in support of the resource curse phenomenon in SSA.
Capital flight and diamond exports in the Central African Republic: The role of political governance crisis
Authors: Yapatake Kossele Thales Pacific , Njong Mom Aloysius
Published: September 2020

The purpose of this paper is to examine the relationship between capital flight, diamond exports and political governance crisis in the Central African Republic. To achieve this, use is made of multiple correspondence analysis to construct a political governance crisis index, and the Autoregressive Distributed Lag Model and Bound test for co‐integration are employed to establish short‐run and long‐run relationships. The short‐run results show political governance crisis and diamond exports have a significant and negative effect on capital flight. The interaction term between diamonds exports and political governance crisis is found to be positively related to capital flight in the short run. The long‐run equilibrium shows a significant and negative relationship between political governance crisis, diamond exports, and gross domestic product growth even though the interaction between political governance crisis and diamond exports show a positive and significant relationship. The total natural resource rent is found to be positively related to capital flight but not statistically significant. It is then recommended that a combination of stable political governance associated with reducing corruption in public affairs and promoting transparency in the management of the diamond sector be strengthened to effectively reduce the flight of capital.
Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29 864 twin pregnancies
Authors: Marleen S , Dias C , Nandasena R , MacGregor R , Allotey J , Aquilina J , Khalil A , Thangaratinam S
Published: September 2020

Background

The perinatal mortality and morbidity among twins vary by chorionicity. Although it is considered that monochorionicity is associated with an increased risk of preterm birth in twin pregnancies, no systematic review exists evaluating this association.

Objectives

This systematic review was undertaken to assess the association between preterm birth and chorionicity in twin pregnancies.

Search strategy

We searched the electronic databases from January 1990 to July 2019 without language restrictions.

Selection criteria

All studies on twin pregnancies where chorionicity and preterm birth were evaluated were included.

Data collection and analysis

Findings are reported as odds ratios with 95% confidence intervals. The estimates are pooled using random‐effects meta‐analysis.

Main results

From 13 156 citations, we included 39 studies (29 864 pregnancies). Monochorionicity was significantly associated with increased risk of preterm birth at ≤28, ≤32, ≤34 and <37 weeks in women asymptomatic and symptomatic for preterm labour (odds ratio [OR] 2.14, 95% CI 1.52–3.02, I2 = 46%, OR 1.55, 95% CI 1.27–1.89 I2 = 68%, OR 1.47, 95% CI 1.27–1.69, I2 = 60%, OR 1.66, 95% CI 1.43–1.93, I2 = 65%, respectively). Among those asymptomatic for preterm labour, significantly increased odds of preterm birth were seen for monochorionicity at gestations ≤34 weeks (OR 1.85, 95% CI 1.42–2.40, I2 = 25%) and <37 weeks (OR 1.75, 95% CI 1.22–2.53, I2 = 61%). Sensitivity analysis showed significantly increased odds of spontaneous preterm birth at ≤34 and <37 weeks for monochorionicity (OR 1.25, 95% CI 1.01–1.55, I2 = 0% and OR 1.41, 95% CI 1.13–1.78, I2 = 0%).

Conclusions

Monochorionicity is significantly associated with preterm birth at all gestations.

Tweetable abstract

In twin pregnancies, monochorionicity is associated with an increased risk of preterm birth at all gestations.
Impact of changes to national UK Guidance on testing for gestational diabetes screening during a pandemic: a single‐centre observational study
Authors: van‐de‐l’Isle Y , Steer PJ , Watt Coote I , Cauldwell M
Published: September 2020

Objective

To examine the differences in detection rate for gestational diabetes (GDM) comparing the methodology recommended by the National Institute for Health and Clinical Excellence (NICE) compared with testing described as appropriate during the Covid‐19 pandemic by the Royal College of Obstetricians and Gynaecologists (RCOG).

Design

Cohort study of women delivering between 1 January 2016 and 1 July 2020.

Setting

London Teaching Hospital.

Population

All women delivering between 1 January 2016 and 13 May 2020 and follow up of women screening negative between 1 April 2020 and 13 May 2020.

Methods

Retrospective study of prospectively collected data.

Main outcome measures

Detection rate of gestational diabetes.

Results

Using the RCOG guidance, the overall rate of women identified as having gestational diabetes fell from 7.7% (1853/24168) to 4.2% (35/831)(P = 0.0003). Of 230 women who tested negative according to the RCOG criteria from 1 April to 13 May but who subsequently had an oral glucose tolerance test, 47 (20.4%) were diagnosed as having gestational diabetes according to the NICE criteria.

Conclusions

In our setting, the RCOG Covid‐19 gestational diabetes screening regime failed to detect 47 of 82 (57%) women subsequently identified as gestational diabetics, and therefore cannot be recommended for general use.

Tweetable abstract

Screening for GDM using RCOG Covid criteria reduced detection rates.
Spatial Spillovers on Input‐specific Inefficiency of Dutch Arable Farms
Authors: Schneider Kevin , Skevas Ioannis , Oude Lansink Alfons
Published: September 2020

Traditional benchmarking implicitly assumes that decision making units operate in isolation from their peers. For arable production systems in particular, this assumption is unlikely to hold in reality. This paper quantifies spatial spillovers on input‐specific inefficiency using data envelopment analysis and a second‐stage bootstrap truncated regression model. The bootstrap algorithm is extended to allow for the estimation of the parameter of the spatial weight matrix, which captures the proximity between producers. The empirical application concerns Dutch arable farms for which latitudes and longitudes are available. The average inefficiency across years was 3.87% for productive inputs and 2.98% for damage abatement inputs under variable returns to scale. For productive inputs technical inefficiency, statistically significant spillover effects from neighbours’ age and their degree of specialisation depended on the type of the spatial weight matrix used (inverse distance or k‐nearest neighbours). Statistically significant spillover effects of subsidy payments were adverse while statistically significant spillover effects from insurance payments were beneficial. For damage abatement inputs technical inefficiency, statistically significant adverse effects were found for neighbours’ age and subsidy payments and beneficial effects from neighbours’ insurance payments and their degree of specialisation.
Emulsion structure design for improving the oxidative stability of polyunsaturated fatty acids
Authors: Wang Chenxi , Sun Cuixia , Lu Wei , Gul Khalid , Mata Analucia , Fang Yapeng
Published: September 2020

Polyunsaturated fatty acids (PUFAs) play an important role in promoting brain development, decreasing the incidence of cardiovascular diseases, and reducing inflammation. However, PUFAs are inherently unstable and susceptible to oxidative deterioration due to two or more double bonds in their structure. Delivery systems have been developed to provide effective encapsulation and protection for PUFAs, and finally fulfill their health benefits. Emulsion‐based encapsulation is one of the most promising techniques for the delivery of PUFAs. The emulsion composition and structure, as well as the storage conditions are regarded as key factors to influence the stability of emulsions. To maximize the resistance of PUFAs in emulsions against oxidation, emulsion structure design has been particularly highlighted, and different methods for tailoring emulsion structure have been developed. The current work is focused on the careful design of emulsion structure to improve the oxidative stability of PUFAs. Different types of emulsions, including conventional emulsions, multilayer emulsions, gelled emulsions, and Pickering emulsions are introduced, and their protective effect for PUFAs are discussed. The major role of interfacial structure in emulsions is emphasized. The effects of emulsifiers and involved modification methods on the interfacial structure are presented to further improve the stability of PUFAs during storage.
Regulatory mechanisms of microbial homeostasis in insect gut
Authors: Bai Shuai , Yao Zhichao , Raza Muhammad Fahim , Cai Zhaohui , Zhang Hongyu
Published: September 2020

Insects live in incredibly complex environments. The intestinal epithelium of insects is in constant contact with microorganisms, some of which are beneficial and some harmful to the host. Insect gut health and function are maintained through multidimensional mechanisms that can proficiently remove foreign pathogenic microorganisms while effectively maintaining local symbiotic microbial homeostasis. The basic immune mechanisms of the insect gut, such as the dual oxidase–reactive oxygen species (Duox‐ROS) system and the immune deficiency (Imd)‐signaling pathway, are involved in the maintenance of microbial homeostasis. This paper reviews the role of physical defenses, the Duox‐ROS and Imd signaling pathways, the Janus kinase/signal transducers and activators of transcription signaling pathway, and intestinal symbiotic flora in the homeostatic maintenance of the insect gut microbiome.
Influence of different extraction techniques on recovery, purity, antioxidant activities, and microstructure of flaxseed gum
Authors: Safdar Bushra , Zhihua Pang , Xinqi Liu , Jatoi Mushtaque Ahmad , Rashid Muhammad Tayyab
Published: September 2020

Four extraction techniques (that is, hot water extraction [HWE], alkaline–acidic extraction [AAE], ultrasound assisted extraction [UAE], and microwave assisted extraction [MAE]) were compared for flaxseed gum extraction and their influence on the yield, purity, structural characterization (monosaccharide composition, molecular weight distribution, and microstructure by transmission electron microscope), and antioxidant activity (in terms of scavenging ability of 2,2‐diphenyl‐1‐picrylhydrazyl [DPPH], 2,2'‐azino‐bis(3‐ethylbenzothiazoline‐6‐sulphonic acid [ABTS], and reducing power) was investigated. The HWE achieved higher yield (8.96%) than UAE (7.84%) followed by MAE (7.01%) and AAE (6.44%). Moreover, the four flaxseed gum (FSG) samples exhibited the identical monosaccharide composition, but slight difference was observed in the content, whereas the molecular weight ratios exhibited significant difference. All samples displayed concentration‐dependent manner for all antioxidant assays. UAE‐FSG showed significant higher scavenging ability on DPPH free radical, ABTS free radical, reducing power, and β‐carotene bleaching assay followed by HWE‐FSG, MAE‐FSG, and AAE‐FSG. Overall results showed that UAE was favorable to the purity of FSG, whereas HWE was more advantageous to improve the extraction yield and facile as it requires no special equipment.

Practical Application

Extraction methods directly affect the recovery and purity of the extracted compound. Thus, this study could help in selection of appropriate extraction method for FSG. The results suggested that FSG possesses potential healthcare application in food industry because of their nutrition composition and antioxidant activities, and thus, it can be used for formulation of functional food as a natural antioxidant agent.
Feasibility of rapid piperine quantification in whole and black pepper using near infrared spectroscopy and chemometrics
Authors: Park Jong‐Rak , Kang Hyun‐Hee , Cho Jong‐Ku , Moon Kwang‐Deog , Kim Young‐Jun
Published: September 2020

Piperine is a bioactive alkaloid that possesses various health benefits and is responsible for the pungent aroma of pepper. Piperine content in whole and ground black pepper (n= 132) was analyzed by near‐infrared spectroscopy (NIRS) in the 950 to 1650 nm wavelength window. Chemometric modeling using partial least square regression was performed, and outliers were checked and removed during the preparation of the calibration curve by considering sample residual variance and sample leverage. Model accuracy was evaluated with a low root‐mean‐square error of cross‐validation (RMSECV) and a high ratio performance to deviation (RPD). The optimal model had a coefficient of determination (R2) of 0.726, RMSECV of 0.289 g/100 g, and RPD of 1.744 for the whole black pepper. The results ofR2, RMSECV, and RPD for the ground black pepper were 0.850, 0.231 g/100 g, and 2.424, respectively. Therefore, based on the perspective of onsite process, the proposed NIRS method can be employed for selecting abnormal samples during the inspection of black pepper raw material and for quantifying piperine contents of final black pepper product.

Practical Application

Generally, the quality indicators of black pepper are graded solely based on their external appearance, quality, and size. This study discloses the development of a near‐infrared spectroscopy‐based fast and accurate nondestructive analytical method for the detection of piperine, a bioactive constituent of pepper, as a tool for the quality control of whole and ground black pepper.
Spray drying encapsulation of stevia extract with maltodextrin and evaluation of the physicochemical and functional properties of produced powders
Authors: Zorzenon Maria Rosa T. , Formigoni Maysa , da Silva Sandra B. , Hodas Fabiane , Piovan Silvano , Ciotta Simone R. , Jansen Cler A. , Dacome Antonio S. , Pilau Eduardo J. , Mareze‐Costa Cecília E. , Milani Paula G. , Costa Silvio C.
Published: September 2020

This work aimed to formulate and perform physicochemical and functional characterization of maltodextrin microcapsules containing ethanolic extract of stevia, rich in antioxidant compounds, encapsulated by a spray‐drying process with two maltodextrins (DE10 and DE19). The powders were named M10 and M19, respectively. We analyzed the physicochemical parameters, antidiabetic activity, cytotoxicity, bioaccessibility of the compounds by in vitro digestion, as well as the structure of the microcapsules by scanning electron microscopy. Microcapsules showed higher solubility (∼35%), lower moisture content (∼29%), and the maltodextrin DE10 had higher efficiency as an encapsulating agent (87%) when compared to DE19 (76%) and showed well‐defined spherical structures. The microencapsulation preserved the content of phenolic compounds and antioxidant activity present in the extract (7.2% and 87.5%, respectively). The bioaccessibility of these microencapsulated compounds and antioxidant activity were higher under different conditions of in vitro digestion (mouth, gastric, and intestinal conditions) and showed no cytotoxic effects. We identified 41 compounds (by UHPLC‐MS/MS‐Qtof) related to the nutritional benefits offered by stevia and the microencapsulation technique can be recommended to preserve bioactive compounds.

Practical Application

Ethanol extract from stevia leaves contains antioxidant phytochemicals related to the nutritional benefits of stevia. However, this extract presents low solubility and consequently low bioaccessibility under in vitro digestion. The microencapsulation process protects the bioactive compounds of the different pH from digestion and improves the physical‐chemical parameters of the extract, increasing its applicability as a possible food additive.
The quest for absolute abundance: The use of internal standards for DNA‐based community ecology
Authors: Harrison Joshua G. , John Calder W. , Shuman Bryan , Alex Buerkle C.
Published: September 2020

To characterize microbiomes and other ecological assemblages, ecologists routinely sequence and compare loci that differ among focal taxa. Counts of these sequences convey information regarding the occurrence and relative abundances of taxa, but provide no direct measure of their absolute abundances, due to the technical limitations of the sequencing process. The relative abundances in compositional data are inherently constrained and difficult to interpret. The incorporation of internal standards (ISDs; colloquially referred to as ‘spike‐ins’) into DNA pools can ameliorate the problems posed by relative abundance data and allow absolute abundances to be approximated. Unfortunately, many laboratory and sampling biases cause ISDs to underperform or fail. Here, we discuss how careful deployment of ISDs can avoid these complications and be an integral component of well‐designed studies seeking to characterize ecological assemblages via sequencing of DNA.
The 90% effective dose of intranasal dexmedetomidine for procedural sedation in children with congenital heart disease before and after surgery: A biased‐coin design up‐and‐down sequential allocation trial
Authors: Zhang Jing , Chen YuJiao , Li ShangYingYing , Liu Hui , Tu ShengFen
Published: September 2020

Background

Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, there are few reports investigating the effective dose of intranasal dexmedetomidine for sedation in children with congenital heart disease (CHD) before and after surgery.

Methods

Children aged 13‐36 months with acyanotic CHD requiring trans‐thoracic echocardiography before cardiac surgery were recruited for this study. One month after the cardiac surgery, the same children were studied again. The 90% effective dose was established using a biased‐coin design up‐and‐down sequential method. Onset time, examination time, wake‐up time and adverse effects were measured. Safety was evaluated in terms of changes in vital signs.

Results

A total of fifty‐eight subjects were recruited for this study. The 90% effective dose of intranasal dexmedetomidine for sedation was 2.13 μg/kg (95% CI, 1.73‐2.34 μg/kg) in children with CHD before cardiac surgery and 3.51 μg/kg (95% CI, 2.99‐3.63 μg/kg) after cardiac surgery (P < .01). There were no differences between the groups in terms of demographic variables, onset time, examination time, wake‐up time or adverse effects.

Conclusions

The 90% effective dose of intranasal dexmedetomidine for sedation in children with CHD was 2.13 μg/kg before cardiac surgery and 3.51 μg/kg after cardiac surgery.
Prevalence and impact of chronic dysglycemia in intensive care unit patients—A retrospective cohort study
Authors: Balintescu Anca , Palmgren Ida , Lipcsey Miklós , Oldner Anders , Larsson Anders , Cronhjort Maria , Lind Marcus , Wernerman Jan , Mårtensson Johan
Published: September 2020

Background

The prevalence of chronic dysglycemia (diabetes and prediabetes) in patients admitted to Swedish intensive care units (ICUs) is unknown. We aimed to determine the prevalence of such chronic dysglycemia and asses its impact on blood glucose control and patient‐centered outcomes in critically ill patients.

Methods

In this retrospective observational cohort study, we obtained glycated hemoglobin A1c (HbA1c) in patients admitted to four tertiary ICUs in Sweden between March and August 2016. Based on previous diabetes history and HbA1c we determined the prevalence of chronic dysglycemia. We used multivariable regression analyses to study the association of chronic dysglycemia with the time‐weighted average blood glucose concentration, glycemic lability index (GLI), and development of hypoglycemia (co‐primary outcomes), and with ICU length of stay, mechanical ventilation duration, renal replacement therapy (RRT) use, vasopressor use, ICU‐acquired infections, and mortality (exploratory clinical outcomes).

Results

Of 943 patients, 312 (33%) had chronic dysglycemia. Of these 312 patients, 84 (27%) had prediabetes, 43 (14%) had undiagnosed diabetes and 185 (59%) had known diabetes. Chronic dysglycemia was independently associated with higher time‐weighted average blood glucose concentration (P < .001), higher GLI (P < .001), and hypoglycemia (P < .001). Chronic dysglycemia was independently associated with RRT use (adjusted odds ratio 1.97, 95% CI 1.24‐3.13, P = .004) but not with other exploratory clinical outcomes.

Conclusions

In four tertiary Swedish ICUs, measurement of HbA1c showed that one‐third of patients had chronic dysglycemia. Chronic dysglycemia was associated with marked derangements in glycemic control, and a greater need for renal replacement therapy.
Anesthesiologists’ airway management expertise: Identifying subjective and objective knowledge gaps
Authors: Bessmann Ebbe L. , Rasmussen Lars S. , Konge Lars , Kristensen Michael S. , Rewers Mikael , Kotinis Alexandros , Rosenstock Charlotte V. , Graeser Karin , Pfeiffer Peter , Lauritsen Torsten , Østergaard Doris ,   Adaptive E‐learning Airway Study Group
Published: September 2020

Background

Failure in airway management continues to cause preventable patient harm, and the recommended continuing education is challenged by anesthesiologists’ unknown knowledge gaps. This study aimed to identify anesthesiologists’ subjective and objective knowledge gaps as well as areas where anesthesiologists are incorrect and unaware.

Methods

An adaptive E‐learning program with 103 questions on adult airway management was used for subjective and objective assessment of anesthesiologists’ knowledge. All anesthesiologists in the Capital Region of Denmark were invited to participate.

Results

The response rate was 67% (191/285). For preoperative planning, participants stated low confidence (subjective assessment) regarding predictors of difficult airway management in particular (69.1%‐79.1%). Test scores (objective assessment) were lowest for obstructive sleep apnea as a predictor of difficult airway management (28.8% correct), with participants being incorrect and unaware in 33.5% of the answers. For optimization of basic techniques, the lowest confidence ratings related to patient positioning and prediction of difficulties (57.4%‐83.2%), which agreed with the lowest test scores. Concerning advanced techniques, videolaryngoscopy prompted the lowest confidence (72.4%‐85.9%), while emergency cricothyrotomy resulted in the lowest test scores (47.4%‐67.8%). Subjective and objective assessments correlated and lower confidence was associated with lower test scores: preoperative planning [r = −.58, P < .001], optimization of basic techniques [r = −.58, P = .002], and advanced techniques [r = −.71, P < .001].

Conclusion

We identified knowledge gaps in important areas of adult airway management with differing findings from the subjective and objective assessments. This underlines the importance of objective assessment to guide continuing education.
Continuous intravenous infusion of enoxaparin controls thrombin formation more than standard subcutaneous administration in critically ill patients. A sub‐study of the ENOKSI thromboprophylaxis RCT
Authors: Vahtera Annukka , Szanto Timea , Lassila Riitta , Valkonen Miia , Sivula Mirka , Huhtala Heini , Pettilä Ville , Kuitunen Anne
Published: September 2020

Introduction

Standard subcutaneous low‐molecular‐weight heparin (LMWH) thromboprophylaxis yields low anti‐factor Xa activity in patients in the intensive care unit (ICU). The aim of the study was to assess coagulation status in ICU patients randomized to receive enoxaparin thromboprophylaxis either as a standard subcutaneous bolus (SCB) or continuous intravenous infusion (CII) for 3 consecutive days after the initiation of LMWH thromboprophylaxis.

Materials and Methods

Thirty‐eight patients were studied by conventional coagulation variables: prothrombin fragment F 1+2 (F 1+2) representing FXa inhibition and antithrombin (AT). Additionally, 18 patients were analyzed by the thrombin generation assay‐calibrated automated thrombogram (TGA‐CAT). Blood samples were collected before the initiation of the LMWH thromboprophylaxis (ie, baseline), at 51 h, and at 72 h.

Results

At beginning, no differences in coagulation biomarkers were observed. The levels of F 1+2 were significantly lower at 51 and 72 h in the CII group than in the SCB group. AT levels increased during the follow‐up in the CII group, unlike in the SCB group.

TGA‐CAT was poor in some patients overall. In a subset of patients at 51 h lag time (4.3 vs 7.5 min, respectively, P < 0.05) and time to peak (7.7 vs 14.3 min, respectively, P < 0.05) were prolonged in the SCB group. At 72 h, however, peak thrombin was lower in the CII than in the SCB group: 271 vs 356 nM, respectively (P < 0.05).

Conclusions

Enoxaparin thromboprophylaxis administered by CII inhibited more prominently FXa and preserved better the AT level, compared with standard subcutaneous care.
Identifying Maltreatment in Infants and Young Children Presenting With Fractures: Does Age Matter?
Authors: Mitchell Ian C. , Norat Bradley J. , Auerbach Marc , Bressler Colleen J. , Como John J , Escobar Mauricio A. , Flynn‐O’Brien Katherine T. , Lindberg Daniel M. , Nickoles Todd , Rosado Norell , Weeks Kerri , Maguire Sabine
Published: September 2020

Objectives

Child abuse is a significant cause of morbidity and mortality in preverbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We sought to determine which children presenting with rib or long‐bone fractures should undergo a routine abuse evaluation based on age.

Methods

A systematic review searching Ovid, PubMed/Medline, Scopus, and CINAHL from 1980 to 2020 was performed. An evidence‐based framework was generated by a consensus panel and applied to the results of the systematic review to form recommendations. Fifteen articles were suitable for final analysis.

Results

Studies with comparable age ranges of subjects and sufficient evidence to meet the determination of abuse standard for pediatric patients with rib, humeral, and femoral fractures were identified. Seventy‐seven percent of children presenting with rib fractures aged less than 3 years were abused; when those involved in motor vehicle collisions were excluded, 96% were abused. Abuse was identified in 48% of children less than 18 months with humeral fractures. Among those with femoral fractures, abuse was diagnosed in 34% and 25% of children aged less than 12 and 18 months, respectively.

Conclusion

Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: 1) children aged less than 3 years old presenting with rib fractures and 2) children aged less than 18 months presenting with humeral or femoral fractures (Level of Evidence: III Review).
Randomized Double‐blind Trial of Intramuscular Droperidol, Ziprasidone, and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department
Authors: Martel Marc L. , Driver Brian E. , Miner James R. , Biros Michelle H. , Cole Jon B.
Published: September 2020

Background

The optimal agent to treat acute agitation in the emergency department (ED) has not been determined. The objective of this study was to compare the effectiveness and safety of intramuscular droperidol, ziprasidone, and lorazepam for acute agitation in the ED.

Methods

This was a randomized, double‐blind trial of ED patients with acute agitation requiring parenteral sedation. The study was conducted under exception from informed consent (21 CFR 50.24) from July 2004 to March 2005. Patients were randomized to receive 5 mg of droperidol, 10 mg of ziprasidone, 20 mg of ziprasidone, or 2 mg of lorazepam intramuscularly. We recorded Altered Mental Status Scale (AMSS) scores, nasal end‐tidal carbon dioxide (ETCO2), and pulse oximetry (SpO2) at 0, 15, 30, 45, 60, 90, and 120 minutes as well as QTc durations and dysrhythmias. Respiratory depression was defined as a change in ETCO2 consistent with respiratory depression or SpO2 < 90%. The primary outcome was the proportion of patients adequately sedated (AMSS ≤ 0) at 15 minutes.

Results

We enrolled 115 patients. Baseline AMSS scores were similar between groups. For the primary outcome, adequate sedation at 15 minutes, droperidol administration was effective in 16 of 25 (64%) patients, compared to seven of 28 (25%) for 10 mg of ziprasidone, 11 of 31 (35%) for 20 mg of ziprasidone, and nine of 31 (29%) for lorazepam. Pairwise comparisons revealed that droperidol was more effective that the other medications, with 39% (95% confidence interval [CI] = 3% to 54%) more compared to 20 mg of ziprasidone and 33% (95% CI = 8% to 58%) more compared to lorazepam. There was no significant difference between groups in need of additional rescue sedation. Numerically, respiratory depression was lower with droperidol (3/25 [12%]) compared to 10 mg of ziprasidone (10/28 [36%]), 20 mg of ziprasidone (12/31 [39%]), or lorazepam (15/31 [48%]). One patient receiving 20 mg of ziprasidone required intubation to manage an acute subdural hematoma. No patients had ventricular dysrhythmias. QTc durations were similar in all groups.

Conclusions

Droperidol was more effective than lorazepam or either dose of ziprasidone for the treatment of acute agitation in the ED and caused fewer episodes of respiratory depression.
Does Drinking Initiation of Young Thai Drinkers Vary Over Time and Generation? Results of the National Surveys on Tobacco and Alcohol Consumption of the Thai Populations 2007 to 2017
Authors: Assanangkornchai Sawitri , Vichitkunakorn Polathep
Published: September 2020

Background

Early age at drinking initiation may be one factor responsible for underage drinking in Thailand and this may be affected by cultural and generational changes over certain periods of time. This study aimed to explore the effects of time period and generation on drinking onset of young Thai drinkers in the past decade.

Methods

We analyzed data from a total of 60,018 Thais aged 15 to 24 years from 4 national surveys conducted in 2007, 2011, 2014, and 2017. We used multilevel and event history analysis to examine the effects of period (survey year) and cohort (birth year of participants), adjusted for sex, age, area of residence, and region on drinking onset.

Results

The overall prevalence of past‐year drinking was 23.6 % (95% confidence interval [CI]: 23.2, 23.9) among participants of all surveys. Cox proportional hazards model revealed significantly different probabilities to have initiated drinking between participants of different surveys and birth years, indicating significant period and cohort effects. After adjusting for sex, age, cohort, living region, and area of residence, participants in the 2014 survey had the highest likelihood to have started drinking (hazard ratio [HR]: 1.25 CI: 1.15 to 1.36), compared to the participants of the same age in the 2007 survey while those in the 2011 (HR: 0.89, CI: 0.85, 0.93) and 2017 (HR: 0.63, CI: 0.58, 0.68) surveys had less likelihood. Participants born in 1993 to 2002 (later cohort) had higher probability to have started drinking than those born in 1983 to 1992 (HR: 1.80, CI: 1.69, 1.92).

Conclusion

Thai youths of the recent generations living in recent years tend to have a higher probability of initiating drinking than those in the past. Interventions to prevent underage drinking should begin earlier for the young generation.
Influence of Comorbid Psychiatric Disorders on the Risk of Development of Alcohol Dependence by Genetic Variations of ALDH2 and ADH1B
Authors: Itoh Mitsuru , Yonemoto Tomoko , Ueno Fumihiko , Iwahara Chie , Yumoto Yosuke , Nakayama Hideki , Maesato Hitoshi , Kimura Mitsuru , Matsushita Sachio
Published: September 2020

Background

Inactive aldehyde dehydrogenase‐2 (ALDH2) is a well‐known deterrent to the development of alcohol use disorder (AUD), and however, some individuals with inactive ALDH2 do go on to develop AUD. These alcoholics are likely to have strong risk factors for the development of this disorder. Using a model of alcoholics with inactive ALDH2 (the AIA model), we investigated the unique characteristics of alcoholics with inactive ALDH2 in an attempt to identify the risk factors for AUD. In this study, we focused on comorbid psychiatric and personality disorders as potential risk factors for AUD.

Methods

The subjects were 103 male alcoholics with inactive ALDH2 (AIAs), 87 age‐ and ADH1B genotype‐matched alcoholics with active ALDH2 (AAAs) and 200 age‐matched healthy men. The alcoholics were divided into 4 subgroups according to their ALDH2 and ADH1B genotypes (inactive ALDH2 vs. active ALDH2, usual ADH1B vs. superactive ADH1B). To assess the participants’ comorbid psychiatric disorders, we conducted semi‐structured interviews using the Japanese translation of SSAGA version 2. We compared the prevalence of comorbid psychiatric and personality disorders among groups with different combinations of the ALDH2 and ADH1B genotypes.

Results

The prevalence of attention‐deficit/hyperactivity disorder (ADHD) was significantly higher in the AIAs with usual ADH1B than in the other 3 subgroups of alcoholics. In contrast, the prevalence rates of agoraphobia and panic disorder were significantly lower in the AIAs with superactive ADH1B than in the other 3 subgroups of alcoholics.

Conclusions

This study suggested that (i) ADHD is a risk factor for AUD, consistent with previous reports; (ii) agoraphobia and panic disorder may have deterrent effects against the development of AUD in individuals with inactive ALDH2, probably attributable to the similarity between the symptoms of agoraphobia and panic disorder and the adverse reactions to consumption of alcohol in subjects with inactive ALDH2.
Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer?
Authors: Brandt Laura , Chao Thomas , Comer Sandra D. , Levin Frances R.
Published: September 2020

Background

Cocaine use contines to be a significant public health problem world‐wide. However, despite substantial research efforts, no pharmacotherapies are approved for the treatment of cocaine use disorder (CUD).

Argument

Studies have identified positive signals for a range of medications for treating CUD. These include long‐acting amphetamine formulations, modafinil, topiramate, doxazosin and combined topiramate and mixed amphetamine salts extended‐release (MAS‐ER). However, valid conclusions about a medication's clinical efficacy require nuanced approaches that take into account behavioural phenotypes of the target population (frequency of use, co‐abuse of cocaine and other substances, genetic subgroups, psychiatric comorbidity), variables related to the medication (dose, short‐/long‐acting formulations, titration speed, medication adherence) and other factors that may affect treatment outcomes. Meta‐analyses frequently do not account for these co‐varying factors, which contributes to a somewhat nihilistic view on pharmacotherapeutic options for CUD. In addition, the predominant focus on abstinence, which is difficult for most patients to achieve, may overshadow more nuanced therapeutic signals.

Conclusion

While there is an emphasis on finding new medications with novel mechanisms of action for treating CUD, currently available medications deserve further investigation based on the existing literature. Evaluating refined metrics of treatment success in well‐defined subgroups of patients, and further exploring combination therapies and their synergy with behavioural/psychosocial interventions, are promising avenues to establishing effective therapies for CUD.
Applying a ‘harm to others’ research framework to illicit drugs: political discourses and ambiguous policy implications
Authors: Wilkinson Claire , Ritter Alison
Published: September 2020

During the past decade, ‘alcohol's harm to others’ (AHTO) has emerged as an international approach to studying alcohol problems and informing policy. The AHTO approach seeks to increase political will for alcohol policy by mapping, measuring and often costing harms beyond the person who drinks (e.g. family members, co‐workers). In this paper we consider the implications of a ‘harm to others’ approach for illicit drugs. We ask whether it could and should be used as a policy tool, given the high risks of further stigmatizing people who use drugs. We consider the ways in which the concept and measurement of ‘harm to others’ may be either productive or potentially harmful, depending on the extent to which the AHTO is replicated for illicit drugs. Shifting the language may assist: the term ‘harm from others’ appears to carry less risk of stigma. In addition, all harms inclusive of drug supply and drug consumption need to be included if a full picture of harms that accrue to other people from illicit drugs is to be achieved.
Gateway or common liability? A systematic review and meta‐analysis of studies of adolescent e‐cigarette use and future smoking initiation
Authors: Chan Gary C. K. , Stjepanović Daniel , Lim Carmen , Sun Tianze , Shanmuga Anandan Aathavan , Connor Jason P. , Gartner Coral , Hall Wayne D. , Leung Janni
Published: September 2020

Background and Aims

Studies have consistently found a longitudinal association between e‐cigarette use (vaping) and cigarette smoking. Many have interpreted such association as causal. This systematic review and meta‐analysis evaluated the plausibility of a causal interpretation by (1) estimating the effect of adolescent vaping on smoking initiation, adjusted for study quality characteristics, (2) evaluating the sufficiency of adjustment for confounding based on the social development model (SDM) and the social ecological model (SEM) and E‐value analyses and (3) investigating sample attrition and publication bias.

Methods

Systematic review and meta‐analysis of longitudinal studies that examined the association between e‐cigarette use at baseline and smoking at follow‐up. Participants were non‐smokers aged < 18 at baseline.

Results

Meta‐analysis of 11 studies showed a significant longitudinal association between vaping and smoking [adjusted odds ratio (aOR) = 2.93, 95% confidence interval (CI) = 2.22, 3.87]. Studies with sample sizes < 1000 had a significantly higher odds ratio (OR = 6.68, 95% CI = 3.63, 12.31) than studies with sample sizes > 1000 (OR = 2.49, 95% CI = 1.97, 3.15). Overall, the attrition rate was very high (median = 30%). All but one study reported results from complete sample analysis, despite those dropping out having higher risk profiles. Only two studies comprehensively adjusted for confounding. The median E‐value was 2.90, indicating that the estimates were not robust against unmeasured confounding.

Conclusions

There is a longitudinal association between adolescent vaping and smoking initiation; however, the evidence is limited by publication bias, high sample attrition and inadequate adjustment for potential confounders.
Does intentional asphyxiation by strangulation have addictive properties?
Authors: Chater Angel Marie
Published: September 2020

Background and aims

Intentional asphyxiation leads to cerebral hypoxia, starving the brain of oxygen and inducing hypoxic euphoria, but carries a serious risk of accidental death, especially if practised alone. This article raises the question as to whether it could usefully be regarded as having addictive properties.

Methods and results

A review of the literature, together with eight case study vignettes, are presented. Intentional asphyxiation can occur with or without sexual activity. Initiation often occurs in adolescence, with development in some cases of an entrenched behaviour pattern, driven by a strong euphoriant effect, without adequate safeguarding from serious harm, and being undertaken by people with comorbidities. There does not appear to be strong evidence of seeking support for cessation of the practice.

Conclusions

Intentional asphyxiation behaviours may have addictive properties, and understanding this aspect of the problem may be fruitful in guiding research and interventions aimed at addressing it.