bluuebunny/crossref_metadata_2025 huggingface dataset:
Wellness tourism and the components of its offer system: a holistic perspective
Authors: Dini Mauro , Pencarelli Tonino
Published: July 2021

Purpose

The purpose of this paper is to conceptually examine the phenomenon of wellness tourism under a holistic and systemic lens, focusing on the offer system and the main components necessary for the staging of wellness experiences. This approach to holistic wellbeing within the tourism sector has led to a broadening of the type of services and experiences that make up the value propositions that can positively contribute to people’s wellbeing.

Design/methodology/approach

This study identifies and defines the components of wellness tourism (including sectors not traditionally associated with it) through a review and analysis of the extant literature on “wellness tourism” and “wellbeing tourism” of the past two decades; the components were classified through an open coding process.

Findings

Wellness tourism, as a broad multidimensional concept, is composed by ten different components of the offer system: hot springs, spas, medical tourism, care of the body and mind, enogastronomy, sports, nature and environment, culture, spirituality and events. Each of these categories may represent a single touristic offer targeted to specific market segments, but they may also be one of several components within an integrated mix of tourism products proposed.

Originality/value

A holistic view of wellness tourism has implications for strategic marketing processes. Destination Management Organizations and company managers should segment their demand according to more innovative criteria than what has traditionally been adopted for wellness in terms of health care and medical procedures. Value propositions for tourists should be wellness-driven to satisfy the growing demand for wellness/well-being and should involve the participation of all the various actors and producers within the wellness tourism offer system at wellness destinations.
Control of inverters in standalone and grid-connected microgrid using different control strategies
Authors: Gurugubelli Vikash , Ghosh Arnab
Published: July 2021

Purpose

The share of renewable energy sources (RESs) in the power system is increasing day by day. The RESs are intermittent, therefore maintaining the grid stability and power balance is very difficult. The purpose of this paper is to control the inverters in microgrid using different control strategies to maintain the system stability and power balance.

Design/methodology/approach

In this paper, different control strategies are implemented to the voltage source converter (VSC) to get the desired performance. The DQ control is a basic control strategy that is inherently present in the droop and virtual synchronous machine (VSM) control strategies. The droop and VSM control strategies are inspired by the conventional synchronous machine (SM). The main objective of this work is to design and implement the three aforementioned control strategies in microgrid.

Findings

The significant contributions of this work are: the detailed implementation of DQ control, droop control and VSM control strategies for VSC in both grid-connected mode and standalone mode is presented; the MATLAB/Simulink simulation results and comparative studies of the three aforementioned controllers are introduced first time in the proposed work; and the opal-RT digital real-time simulation results of the proposed VSM control show the superiority in transient response compared to the droop control strategy.

Research limitations/implications

In the power system, the power electronic-based power allowed by VSM is dominated by the conventional power which is generated from the traditional SM, and then the issues related to stability still need advance study. There are some differences between the SM and VSM characteristics, so the integration of VSM with the existing system still needs further study. Economical operation of VSM with hybrid storage is also one of the future scopes of this work.

Originality/value

The significant contributions of this work are: the detailed implementation of DQ control, droop control and VSM control strategies for VSC in both grid-connected mode and standalone mode is presented; the MATLAB/Simulink simulation results and comparative studies of the three aforementioned controllers are introduced first time in the proposed work; and the opal-RT digital real-time simulation results of the proposed VSM control show the superiority in transient response compared to the droop control strategy.
Online learning in COVID-19 pandemic: an empirical study of Indian and Turkish higher education institutions
Authors: Churi Prathamesh , Mistry Kamal , Asad Muhammad Mujtaba , Dhiman Gaurav , Soni Mukesh , Kose Utku
Published: July 2021

Purpose

Online learning is essential in today’s world. The COVID-19 has resulted in shutting down all the universities across the globe. Countries like India and Turkey (lower-income countries) are suffering a lot in giving the best classroom practice to their students through online mode. The entire way of teaching-learning has changed drastically, and it is a need of an hour. Research suggests that online learning has been shown to increase retention of information, and take less time, meaning the changes coronavirus have caused might be here to stay. It is therefore important to understand from student’s perspectives about learning online. The paper systematically surveys the perception of learning online for Indian and Turkan students.

Design/methodology/approach

To achieve this goal, 594 samples of students (from India and Turkey country) have been taken into considerations, and through statistical measures, the results were analyzed. The set of four research questions comprising of effect of study on COVID-19 pandemic, perception of learning online in COVID-19 pandemic, perception of different genders in learning online and perception of Indians over Turkan students in learning online were analyzed through statistical measures such as mean, standard deviation and so on.

Findings

The descriptive statistics of various responses across various dimensions (gender, country) reveals that there is no effect in learning online as compared to classroom-based teaching. On the other hand, there is no significant difference in gender and country in learning online.

Originality/value

Online learning has become crucial in higher education as far as pandemic situation is concerned. Many higher education institutions across different countries are suffering various problems from student point of view. Middle-income countries who are with limited assets and less advancements in higher education need to adhere to certain guidelines in online learning. This empirical study will help to understand the perception of students in online learning across India and Turkey.
Predicting the competitive interactions and trophic niche consequences of a globally invasive fish with threatened native species
Authors: Dominguez Almela Victoria , South Josie , Britton J. Robert
Published: July 2021

Novel trophic interactions between invasive and native species potentially increase levels of interspecific competition in the receiving environment. However, theory on the trophic impacts of invasive fauna on native competitors is ambiguous, as while increased interspecific competition can result in the species having constricted and diverged trophic niches, the species might instead increase their niche sizes, especially in omnivorous species.

The competitive interactions between an omnivorous invasive fish, common carpCyprinus carpio, and a tropically analogous native and threatened fish, crucian carpCarassius carassius, were tested using comparative functional responses (CFRs). A natural pond experiment then presented the species in allopatry and sympatry, determining the changes in their trophic (isotopic) niche sizes and positions over 4 years. These predictive approaches were complemented by assessing their trophic relationships in wild populations.

Comparative functional responses revealed that compared to crucian carp, carp had a significantly higher maximum consumption rate. Coupled with a previous cohabitation growth study, these results predicted that competition between the species is asymmetric, with carp the superior competitor.

The pond experiment used stable isotope metrics to quantify shifts in the trophic (isotopic) niche sizes of the fishes. In allopatry, the isotopic niches of the two species were similar sized and diverged. Conversely, in sympatry, carp isotopic niches were always considerably larger than those of crucian carp and were strongly partitioned. Sympatric crucian carp had larger isotopic niches than allopatric conspecifics, a likely response to asymmetric competition from carp. However, carp isotopic niches were also larger in sympatry than allopatry. In the wild populations, the carp isotopic niches were always larger than crucian carp niches, and were highly divergent.

The superior competitive abilities of carp predicted in aquaria experiments were considered to be a process involved in sympatric crucian carp having larger isotopic niches than in allopatry. However, as sympatric carp also had larger niches than in allopatry, this suggests other ecological processes were also likely to be involved, such as those relating to fish prey resources. These results highlight the inherent complexity in determining how omnivorous invasive species integrate into food webs and alter their structure.
The spatial–temporal relationship of blue‐winged teal to domestic poultry: Movement state modelling of a highly mobile avian influenza host
Authors: Humphreys John M. , Douglas David C. , Ramey Andrew M. , Mullinax Jennifer M. , Soos Catherine , Link Paul , Walther Patrick , Prosser Diann J.
Published: July 2021

Migratory waterfowl facilitate long‐distance dispersal of zoonotic pathogens and are increasingly recognized as contributing to the geographic spread of avian influenza viruses (AIVs). AIVs are globally distributed and have the potential to produce highly contagious poultry disease, economically impact both large‐scale and backyard poultry producers, and raise the spectre of epidemics and pandemics in human populations.

Because migratory waterfowl behaviour varies across multiple spatial and temporal scales, the timing and distribution of wild bird AIV introductions to poultry are also heterogeneous in time and space. To help reduce economic impacts to the poultry industry and enable poultry producers to better anticipate when and where poultry outbreaks may occur, it is critically important to consider the movement ecology of the waterfowl species transporting and transmitting AIVs.

We used telemetry for a geographically widespread and common AIV host, blue‐winged teal Spatula discors (BWTE), to model reservoir host movement states with respect to backyard and commercial poultry facilities in the United States. Our modelling framework enabled us to estimate wild bird proximity to poultry facilities while concurrently assessing the influence of poultry facilities on BWTE movement state transition. Our primary objective was to estimate the likelihood of duck and poultry overlap by estimating when and where BWTE were geographically closest to poultry.

Synthesis and applications. Migratory waterfowl facilitate dispersal of the avian influenza viruses that cause highly contagious poultry disease. Movement analysis of blue‐winged teal indicates that spatio‐temporal overlap between wild birds and poultry facilities varies by season, the poultry type produced (e.g. turkey, chicken) and if the facility is a commercial or backyard operation. These findings are broadly applicable to disease ecology research and can be applied by poultry producers to improve biosecurity, enhance poultry management and prioritize disease surveillance efforts.
Interspecific interactions regulate plant reproductive allometry in cereal–legume intercropping systems
Authors: Gaudio Noémie , Violle Cyrille , Gendre Xavier , Fort Florian , Mahmoud Rémi , Pelzer Elise , Médiène Safia , Hauggaard‐Nielsen Henrik , Bedoussac Laurent , Bonnet Catherine , Corre‐Hellou Guénaëlle , Couëdel Antoine , Hinsinger Philippe , Steen Jensen Erik , Journet Etienne‐Pascal , Justes Eric , Kammoun Bochra , Litrico Isabelle , Moutier Nathalie , Naudin Christophe , Casadebaig Pierre
Published: July 2021

Calls for the application of ecological principles in agriculture have gained momentum. Intercropping systems are designed by growing two, or more, annual crop species in the same field, aiming for a better resource use efficiency. However, assembly rules for their design are lacking. Notably, it is unknown whether species performances are maximized during both the vegetative and reproductive phases given the sensitivity of reproductive allocation rules to resource limitation. Interestingly, ecological theory provides expectations regarding putative invariance of plant reproductive allometry (PRA) under non‐limiting conditions for plant growth. Here we examined whether and how PRA changes in response to plant–plant interactions in intercropping systems, which can inform both ecological theory and the understanding of the functioning of intercropping systems.

We analysed a dataset of 28 field cereal–legume intercropping trials from various climatic and management conditions across Western Europe. PRA was quantified in both mixing and single‐species situations.

Plant reproductive allometry was positively impacted in specific management conditions, leading to a greater increase in yield for a given increase in plant size. Variations in PRA were more beneficial to legumes grown in unfertilized mixtures, which explains their use as a key component in actual intercropping systems. The response for cereals was similar but less pronounced in magnitude, and was greater under resource‐limiting conditions. Focusing on intercropping conditions, hierarchical competition (indicated by biomass difference between intercropped species) appears as a strong driver of the reproductive output of a given species.

Synthesis and applications. Plant reproductive allometry (PRA) behaves in crop species in the same way as it does in wild species. However, contrary to theoretical expectations about an overall invariance of PRA, we highlighted taxon‐specific and context‐dependent effects of plant–plant interactions on PRA. This systematic deviation to PRA expectations could be leveraged to cultivate each species up to its reproductive optimum while accounting for the performance of the other, whether farmer's objective is to favour one species or to reach an equilibrium in seed production. Sowing density and cultivar choice could regulate the biomass of each component, with specific targets derived from allometric relationships, aiming for an optimal reproductive allocation in mixtures.
Functional dissection of the phosphotransferase system provides insight into the prevalence of Faecalibacterium prausnitzii in the host intestinal environment
Authors: Kang Deborah , Ham Hyeong‐In , Lee Seung‐Hwan , Cho Yong‐Joon , Kim Yeon‐Ran , Yoon Chang‐Kyu , Seok Yeong‐Jae
Published: July 2021

Faecalibacterium prausnitzii is a dominant member of healthy human colon microbiota, regarded as a beneficial gut bacterium due to its ability to produce anti‐inflammatory substances. However, little is known about how F. prausnitzii utilizes the nutrients present in the human gut, influencing its prevalence in the host intestinal environment. The phosphoenolpyruvate (PEP):carbohydrate phosphotransferase system (PTS) is a widely distributed and highly efficient carbohydrate transport system found in most bacterial species that catalyses the simultaneous phosphorylation and import of cognate carbohydrates; its components play physiological roles through interaction with other regulatory proteins. Here, we performed a systematic analysis of the 16 genes encoding putative PTS components (2 enzyme I, 2 HPr, and 12 enzyme II components) in F. prausnitzii A2‐165. We identified the general PTS components responsible for the PEP‐dependent phosphotransfer reaction and the sugar‐specific PTS components involved in the transport of two carbohydrates, N‐acetylglucosamine and fructose, among five enzyme II complexes. We suggest that the dissection of the functional PTS in F. prausnitzii may help to understand how this species outcompetes other bacterial species in the human intestine.
Proximity‐based screening tools and credit rationing: Lessons from a Cameroonian greenfield microfinance institution
Authors: Tchakoute Tchuigoua Hubert
Published: July 2021

The link between relationship‐based lending and credit availability has been extensively studied in the banking sector. However, in the context of microfinance, academic evidence of the benefits of proximity‐based lending methodologies for borrowers is scarce. The existing literature stresses only the benefits for microlenders and the effect on loan repayment performance. Therefore, this study investigates whether proximity‐based lending—joint liability contracts (group lending) and relationship‐based lending (relationship intensity, multiple‐borrowing, and proximity)—improves credit availability and therefore curbs credit rationing. Since loans are processed by loan officers, the benefit of applying proximity screening tools likely depends on loan officer characteristics, especially gender. To achieve our objective, we use a unique loan‐level dataset of over 5500 loans approved between 2007 and 2012 by a Cameroonian greenfield microfinance institution and estimate a pooled OLS regression after controlling for borrowers’ characteristics, year and industry fixed effects. The findings suggest that proximity‐based lending methodologies limit credit rationing especially by male loan officers, and that multi‐relationship borrowers tend to be more credit rationed. Our findings also suggest that both types of proximity‐based lending are complementary. Finally, our results are less sensitive to a change in the credit rationing measurement.
Truncating Optimism
Authors: KAPLAN ZACHARY , MARTIN XIUMIN , XIE YIFANG
Published: July 2021

Consensus estimates, formed by taking an average of analyst forecasts, play an important role in capital markets (e.g., provide investors with a proxy for earnings expectations). We show I/B/E/S, a prominent information intermediary, removes 6% of one‐quarter‐ahead earnings forecasts before calculating the consensus, and among the 23% of firm‐quarters with at least one forecast removed, this figure rises to 16%. We provide evidence suggesting that I/B/E/S subjectively applies policies that govern its removal decisions and accepts feedback from firms that contributes to this subjectivity. Specifically, we find optimistic forecasts are removed more frequently than pessimistic forecasts, and such asymmetry increases further when removals allow firms to meet or beat the consensus. Furthermore, we find that these effects are more pronounced when managers’ incentives to just meet or beat the consensus are stronger (i.e., higher subsequent insider sales or higher compensation delta), or managers have greater ability to influence I/B/E/S. Lastly, we demonstrate that these subjective removals benefit I/B/E/S by improving consensus accuracy, explaining why I/B/E/S is willing to be influenced by firms.
Using Google Earth Engine to Assess Temporal and Spatial Changes in River Geomorphology and Riparian Vegetation
Authors: Pu Ge , Quackenbush Lindi J. , Stehman Stephen V.
Published: July 2021

We developed a new approach using a cloud‐based remote sensing and geospatial analysis platform, Google Earth Engine, to quantify temporal changes in river channel location and adjacent riparian vegetation extent and fraction. Our new method uses publicly available 1 m aerial images and eliminates manual processing need by incorporating an automatic image classification algorithm. Classification of riparian vegetation is enhanced by increasing the temporal resolution to monthly and by mapping vegetation at high spatial resolution. We illustrate the application of our method by characterizing temporal and spatial trends in riparian vegetation and river channel position for the mainstem of the Genesee River, New York, from 2006 to 2015. Annual change in riparian vegetation extent along the Genesee River ranged from a loss of 17% to a gain of 13%, and 64 km (28%) of the river demonstrated channel migration across consecutive aerial images. Our method also successfully distinguished differences between sections of the river above and below a dam. The enhanced capacity to map vegetation monthly allowed us to identify that seasonal active vegetation fractions along the Genesee River peaked at 75% in the summer and remained lower than 25% in winter. Our method allows stakeholders and managers to process remotely sensed imagery and investigate trends in river channel and riparian vegetation dynamics over time, while reducing the costs of data processing and storage.
Is Bigger More Efficient? An Empirical Analysis of Scale Economies in Administration in South Australian Local Government*
Authors: Fellows Caillan , Dollery Brian , Tran Carolyn‐Thi Thanh Dung
Published: July 2021

A vast empirical literature has investigated economies of scale in municipal operations, especially in water and wastewater provision as well as domestic waste management. By contrast, comparatively few studies have been conducted on the extent of scale economies in local government administration. Given the stress placed on scale economies in Australian state and territory government policies aimed at the structural reform of local government through municipal mergers, including in South Australian (SA) local government, the absence of empirical research into administrative scale economies is unfortunate. To address this gap in the empirical literature, in this paper, we consider administrative scale economies in the SA local government system using four‐year panel data from 2015–2016 to 2018–2019. We find limited evidence for a relationship between administrative intensity and municipal by population size and for a difference between the administrative intensity of urban and rural councils.
Use of hydroxyethyl starch in sepsis research: A systematic review with meta‐analysis
Authors: Johansen Jes R. , Perner Anders , Brodtkorb Julie H. , Møller Morten H.
Published: July 2021

Background

After being used for more than a decade the use of hydroxyethyl starch (HES) 130/0.38–0.45 in clinical practice was discouraged because of serious adverse events including bleeding, acute kidney injury and death. But could these adverse effects have been discovered sooner? By comparing the summary effect estimates of the adverse effects of HES 130/0.38–0.45 in different study designs we aimed to disclose any signal of this.

Methods

We systematically searched MEDLINE, EMBASE and Cochrane Library and hand‐searched the reference lists of relevant studies to identify studies for inclusion. Eligible trials were randomised clinical trials (RCTs) and observational studies in patients with sepsis and randomised trials in animals with induced sepsis comparing HES 130/0.38–0.45 to any type of crystalloid. Relevant outcomes were all‐cause mortality at longest follow‐up, renal replacement therapy (RRT), acute kidney injury (AKI) and bleeding. We extracted data, conducted conventional meta‐analyses and assessed the risk of bias and the quality of evidence.

Results

We included 8 RCTs including 3,273 patients, 1 observational study including 379 patients and 5 randomised animal trials including 94 test animals. There was no suggestion of interaction in subgroup analyses comparing the different study designs for any outcomes (all‐cause mortality at longest follow‐up p = .33; RRT p = .70; AKI p = .63; bleeding p = .20).

Conclusions

We observed no interaction between the summary effect estimates of RCTs, observational studies in patients and randomised animal trials for any of the outcomes. Accordingly, we found no evidence indicating that the adverse effects of HES 130/0.38–0.45 could have been discovered sooner.

Systematic review registration

PROSPERO ID: CRD42018103422.

Protocol

Johansen JR, Perner A, Brodtkorb JH, Møller MH. Use of hydroxyethyl starch in sepsis research: Protocol for a systematic review. Acta Anaesthesiol Scand. 2019;63:814–818. https://doi.org/10.1111/aas.13345
Handling oxygenation targets in ICU patients with COVID‐19—Protocol and statistical analysis plan in the HOT‐COVID trial
Authors: Mølgaard Nielsen Frederik , Lass Klitgaard Thomas , Crescioli Elena , Rosborg Aagaard Søren , Andreasen Anne Sofie , Musaeus Poulsen Lone , Siegemund Martin , Craveiro Brøchner Anne , Bestle Morten H. , Andi Iversen Susanne , Brand Björn A. , Laake Jon Henrik , Grøfte Thorbjørn , Hildebrandt Thomas , Lange Theis , Perner Anders , Lilleholt Schjørring Olav , Steen Rasmussen Bodil
Published: July 2021

Background

Coronavirus disease (COVID‐19) primarily affects the lungs and lower airways and may present as hypoxaemic respiratory failure requiring admission to an intensive care unit (ICU) for supportive treatment. Here, supplemental oxygen remains essential for COVID‐19 patient management, but the optimal dosage is not defined. We hypothesize that targeting an arterial partial pressure of oxygen of 8 kPa throughout ICU admission is superior to targeting 12 kPa.

Methods

The Handling Oxygenation Targets in ICU patients with COVID‐19 (HOT‐COVID) trial, is an investigator‐initiated, pragmatic, multicentre, randomized, parallel‐group trial comparing a lower oxygenation target versus a higher oxygenation target in adult ICU patients with COVID‐19. The primary outcome is days alive without life‐support (use of mechanical ventilation, renal replacement therapy or vasoactive therapy) at day 90. Secondary outcomes are 90‐day and 1‐year mortality, serious adverse events in the ICU and days alive and out of hospital in the 90‐day period, health‐related quality‐of‐life at 1 year, and health economic analyses. One‐year follow‐up of cognitive and pulmonary function is planned in a subgroup of Danish patients. We will include 780 patients to detect or reject an absolute increase in days alive without life‐support of 7 days with an α of 5% and a β of 20%. An interim analysis is planned after 90‐day follow‐up of 390 patients.

Conclusions

The HOT‐COVID trial will provide patient‐important data on the effect of two oxygenation targets in ICU patients with COVID‐19 and hypoxia. This protocol paper describes the background, design and statistical analysis plan for the trial.
Clinical practice guideline on the management of septic shock and sepsis‐associated organ dysfunction in children: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
Authors: Rehn Marius , Chew Michelle S. , Olkkola Klaus T. , Sigurðsson Martin Ingi , Yli‐Hankala Arvi , Møller Morten Hylander
Published: July 2021

Background

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis‐Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis‐associated organ dysfunction.
Pain in children undergoing tonsillotomy with alternating ibuprofen and paracetamol ‐ a prospective observational study
Authors: Gude Philipp , Geldermann Niclas , Georgevici Adrian I. , Herzog‐Niescery Jennifer , Weber Thomas Peter , Vogelsang Heike , Dazert Stefan , van Ackeren Konstantin , Volkenstein Stefan
Published: July 2021

Background

The optimal pain therapy for children undergoing tonsillotomy remains unknown. Our aim was to evaluate a standard pain therapy including the alternating application of ibuprofen and paracetamol.

Methods

Pain intensity of 81 in‐patients after tonsillotomy aged 2–12 years was evaluated three times daily (mean observation 3.85 days) using the Children's and Infants’ Postoperative Pain Scale (CHIPPS) in children <5 years, or with the Faces Pain Scale‐Revised (FPS‐R) in older children. Parents completed the Parents’ Postoperative Pain Measure (PPPM‐D) in addition. Exceeding the cut‐off value in one of the scores implied the indication for an opioid rescue medication (RM). Endpoints were number of children with indication for the RM, course of pain, concordance between pain scales, and adverse events.

Results

Overall, 45.7% of children needed the RM either in the recovery room or on the ward. The rate of children having an indication for RM on the ward was 30.9%. The highest proportion of affected children was identified on the day of surgery (32.1%). Most indications were detected with the PPPM‐D only. A comparison with an earlier study showed less affected children compared to ibuprofen monotherapy on the day of surgery and the first postoperative day. Eleven children (13.6%) developed fever.

Conclusion

Although our pain therapy concept was effective from postoperative day 1 onwards, it needs improvement for the day of surgery. The overall concordance between the PPPM‐D and CHIPPS or FPS‐R was low. Fever might be a confounder for the pain intensity measurement with the PPPM‐D.
High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial
Authors: Rosén Jacob , Frykholm Peter , Fors Diddi
Published: July 2021

Background

Preoxygenation efficacy with high‐flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high‐flow nasal cannula with face mask for preoxygenation in this population.

Methods

We conducted a single‐centre, randomised, controlled trial. Forty subjects with BMI ≥ 35 kg m−2 were randomly assigned to receive 5.0 min of preoxygenation with face mask and 7 cm H2O of PEEP (PEEP group) or HFNC at 70 L min−1 (HF group). Following induction, bag‐mask ventilation continued until laryngoscopy, whereas HFNC was maintained before and during intubation. The primary outcomes were end‐tidal fraction of oxygen (EtO2) at 2.5 and 5.0 min duration of preoxygenation. Secondary outcomes included PaO2 and PaCO2 at 2.5 and 5.0 min of preoxygenation and at intubation.

Results

Mean (±SD) EtO2 was 0.89 (±0.04) versus 0.90 (±0.05) after 2.5 min (95% CI for mean difference −0.02, 0.04) and 0.93 (±0.02) versus 0.91 (±0.02) after 5.0 min of preoxygenation (95% CI for mean difference −0.03, −0.002) in the PEEP (n = 18) and HF group (n = 20), respectively. All subjects reached an EtO2 ≥ 0.85 at 5.0 min. There were no differences in mean PaO2 or PaCO2 during preoxygenation. Subjects in the HF group had a mean (±SD) apnoea time of 199 (±38) s, but no desaturation (SpO2 < 100%) occurred.

Conclusions

Face mask with PEEP was superior to HFNC for preoxygenation in obese subjects. HFNC provided adequate preoxygenation quality in all subjects and may be considered as an alternative to face mask in selected patients.

Trial registration

#ISRCTN37375068 (www.isrctn.com).
Mental health conditions in older multimorbid patients presenting to the emergency department for acute cardiac symptoms: Cross‐sectional findings from the EMASPOT study
Authors: Figura Andrea , Kuhlmann Stella L. , Rose Matthias , Slagman Anna , Schenk Liane , Möckel Martin
Published: July 2021

Background

This study aimed to (1) examine the proportion of patients presenting to an emergency department (ED) for acute cardiac symptoms with comorbid mental health conditions (MHCs) comprising current depression, generalized anxiety disorder, and panic disorder; (2) compare cardiac patients with and without MHCs regarding sociodemographic, medical, and psychological characteristics; and (3) examine recognition and treatment rates of MHCs.

Methods

Multimorbid patients, aged ≥50 years, presenting to an inner‐city ED with acute cardiac symptoms including chest pain, dyspnea, and palpitations, completed validated self‐report instruments assessing MHCs and a questionnaire collecting psychosocial and medical information. In addition, routine medical data were extracted from the electronic health record.

Results

A total of 641 patients were included in the study. Mean (±SD) age was 68.8 (±10.8) years and 41.7% were female. Based on screening instruments, 28.4% of patients were affected with comorbid MHCs. Patients reported clinically significant symptoms of depression (23.3% PHQ‐9 ≥10), generalized anxiety disorder (12.2% GAD‐7 ≥10), and panic disorder (4.7% PHQ‐PD). Patients with MHCs were more likely to be younger, female, lower educated, and unemployed. The presence of MHCs was associated with higher cardiac symptom burden and subjective treatment urgency as well as more psychosocial distress (PHQ‐stress) and impaired quality of life (SF‐12v2). Of all patients, 15.6% were identified with new or unrecognized MHCs.

Conclusions

MHCs are prevalent in nearly one‐third of patients presenting with cardinal cardiac symptoms. Thus, the ED visit offers an opportunity to identify and refer patients with MHCs to appropriate and timely care after exclusion of life‐threatening conditions.
Long‐term clinical outcomes of stereotactic radiosurgery and hypofractionated stereotactic radiotherapy using the CyberKnife® robotic radiosurgery system for vestibular schwannoma
Authors: Puataweepong Putipun , Dhanachai Mantana , Swangsilpa Thiti , Sitathanee Chomporn , Ruangkanchanasetr Rawee , Hansasuta Ake , Pairat Kumuthinee
Published: July 2021

Aim

The study aimed to evaluate the long‐term clinical outcomes of patients with vestibular schwannoma (VS) treated with stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT) with frameless robotic whole‐body radiosurgery system (CyberKnife®).

Methods

This retrospective analysis of prospectively collected data included 123 consecutive patients with VS treated at the Radiosurgery center, Ramathibodi Hospital, Bangkok, Thailand. SRS was recommended for patients with unserviceable hearing and Koos grade I–III tumors, and HSRT for patients with serviceable hearing or Koos grade III–IV tumors. Between March 2009 and December 2015, 23 patients (19%) were treated with SRS, whereas 100 (81%) received HSRT. The commonly used regimen was 12 Gy in one fraction for SRS and 18 Gy in three fractions for HSRT.

Results

After a median follow‐up of 72 months (range: 12–123 months), the 5‐year and 8‐year progression‐free survival (PFS) rates for the whole cohort were 96% and 92%, respectively. The PFS was not significantly different between the SRS and HSRT groups (p = 0.23). Among 28 patients with serviceable hearing in the HSRT group, the 5‐year and 8‐year hearing preservation rates were 87% and 65%, respectively. The rate of nonauditory complications was 14%. Koos grade III/IV was a predictor of disease progression and was associated with nonauditory complications.

Conclusion

SRS and HSRT with the CyberKnife® system provided excellent long‐term tumor control with a low rate of nonauditory complications. HSRT may result in acceptable hearing preservation rates.
The Role of the State in the Transfer of Value from Main Street to Wall Street: US Single‐Family Housing after the Financial Crisis
Authors: Christophers Brett
Published: July 2021

After 2007, many US households suffered significant financial losses when their mortgages were foreclosed upon and homes repossessed. Much of this lost value ended up in the hands of institutional investors who bought repossessed homes at the bottom of the market. Using the case of the biggest such investor, Blackstone, as an exemplar, this article argues that the state was implicated in this value transfer in several crucial ways: its failure to better assist distressed borrowers ensured the availability of large numbers of homes for investors to buy; it privileged such investors over other categories of potential buyer; and its taking of action to support recovery of the housing market coincided with such investors beginning to buy at scale. The article draws on the critical macro‐finance literature to conceptualise the state’s role in terms of the “de‐risking” of financial markets that are increasingly integral to contemporary social and economic governance.
Foetal mouth movements: Effects of nicotine
Authors: Froggatt Suzanne , Reissland Nadja , Covey Judith , Kumarendran Kumar
Published: July 2021

Aim

To assess whether foetal mouth movement frequency changes across gestation and whether there are differences between cigarette and e‐cigarette exposure conditions in comparison to a non‐exposed group of foetuses.

Method

Pregnant women underwent 4‐dimensional (4D) foetal ultrasound scans at 32 weeks (106 scans) and 36 weeks of gestational age (87 scans) at James Cook University Hospital, UK. The 4D scans were coded using the Fetal Observable Movement System (FOMS). Measures of maternal smoking status, stress, depression, anxiety, attachment and time of scan were also collected. There were four exposure groups: non‐smokers, light smokers (<10 per day), heavy smokers (11–20 per day) and e‐cigarette users.

Results

No significant differences in relative frequency of mouth movements between the exposure groups at 32‐ and 36 weeks of gestational age were found. Foetal mouth movements declined from 32 to 36 weeks of gestation for non‐exposed and e‐cigarette‐exposed foetuses.

Conclusion

Due to variability in foetal behaviour, examining mouth movements alone may not be the most appropriate method for assessing group differences. However, in line with other research, mouth movement frequency declined between 32‐ and 36 weeks of gestational age. A combination of foetal behavioural assessments is needed to assess the effects of cigarette and e‐cigarette exposure on foetal neurobehavioural development.
Effectiveness and safety of ustekinumab maintenance therapy in 103 patients with ulcerative colitis: a GETAID cohort study
Authors: Fumery Mathurin , Filippi Jérôme , Abitbol Vered , Biron Amélie , Laharie David , Serrero Melanie , Altwegg Romain , Bouhnik Yoram , Peyrin‐Biroulet Laurent , Gilletta Cyrielle , Roblin Xavier , Pineton de Chambrun Guillaume , Vuitton Lucine , Bourrier Anne , Nancey Stephane , Gornet Jean‐Marc , Nahon Stephane , Bouguen Guillaume , Viennot Stephanie , Nachury Maria , Amiot Aurelien
Published: July 2021

Background

Phase III trials have demonstrated the efficacy and safety of ustekinumab in ulcerative colitis (UC), but few real‐life long‐term data are currently available.

Aims

To assess the real‐world effectiveness and safety of ustekinumab in patients with UC.

Methods

From January to September 2019, all consecutive patients with active UC treated with ustekinumab in a GETAID centre were included. Patients were evaluated at week 52. Remission was defined as a partial Mayo Clinic score ≤2.

Results

We included 103 patients with UC (62 men; mean age: 41.2 ± 16.2 years; 52% pancolitis E3) with an insufficient response to immunosuppressants, anti‐TNFs and/or vedolizumab. At week 52, 45 (44%) patients had discontinued ustekinumab mainly due to lack of effectiveness (n = 41). The cumulative probabilities of ustekinumab persistence were 96.1%, 81.6%, 71.7% and 58.4% after 3, 6, 9 and 12 months respectively. The overall steroid‐free clinical remission rate at week 52 was 32% of whom 71% had subscores of null for rectal bleeding and stool frequency. Ten patients underwent colectomy within a median of 6.7 [4.3‐10.6] months. Adverse effects were observed in 15 (16.9%) patients; 4 (4.5%) were severe, including one patient who died from a myocardial infarction.

Conclusion

After 52 weeks, over one‐half of patients with refractory UC were still treated by ustekinumab and one‐third were in steroid‐free clinical remission.
Effect of dipeptide on intestinal peptide transporter 1 gene expression: An evaluation using primary cultured chicken intestinal epithelial cells
Authors: Tokutake Yukako , Taciak Marcin , Sato Kan , Toyomizu Masaaki , Kikusato Motoi
Published: July 2021

Peptide transporter 1 (PepT1) is a transporter responsible for absorbing dipeptide and tripeptide in enterocytes and is upregulated by dipeptide in mammals. It has not been certain whether intestinal PepT1 expression is responsive to dipeptides in chickens because of the lack of in vitro study using the cultured enterocytes. This study established a primary culture model of chicken intestinal epithelial cells (IECs) in two‐dimensional monolayer culture using collagen gel by which the response of chicken PepT1 gene expression to dipeptide stimuli was evaluated. The cultured chicken IECs showed the epithelial‐like morphology attached in a patch‐manner and exhibited positive expression of cytokeratin and epithelial cadherin, specific marker proteins of epithelial cells. Moreover, the chicken IECs exhibited the gene expression of intestinal cell type‐specific marker, villin1, mucin 2, and chromogranin A, suggesting that the cultured IECs were composed of enterocytes as well as goblet and enteroendocrine cells. PepT1 gene expression was significantly upregulated by synthetic dipeptide, glycyl‐l‐glutamine, in the cultured IECs. From the results, we herein suggested that dipeptide is a factor upregulating PepT1 gene expression in chicken IECs.
Learning from remote decentralised clinical trial experiences: A qualitative analysis of interviews with trial personnel, patient representatives and other stakeholders
Authors: Coyle Joanne , Rogers Amy , Copland Rachel , De Paoli Giorgia , MacDonald Thomas M. , Mackenzie Isla S. ,   of the Trials@Home Consortium
Published: July 2021

Aims

The aim of the study was to identify actionable learning points from stakeholders in remote decentralised clinical trials (RDCTs) to inform their future design and conduct.

Methods

Semistructured interviews were carried out with a purposive sample of stakeholders, including senior managers, trial managers, technology experts, principal investigators, clinical investigators, research scientists, research nurses, vendors, patient representatives and project assistants. The interview data were coded using a thematic approach, identifying similarities, differences and clustering to generate descriptive themes. Further refinement of themes was guided by empirical phenomenology, grounding explanation in the meanings that interviewees gave to their experiences.

Results

Forty‐eight stakeholders were interviewed. Actionable learning points were generated from the thematic analysis. Patient involvement and participant engagement were seen as critical to the success of RDCTs where in‐person contact is minimal or nonexistent. Involving patients in identifying the research question, creating recruitment materials, apps and websites, and providing ongoing feedback to trial participants were regarded as facilitating recruitment and engagement. Building strong relationships early with trial partners was thought to support RDCT conduct. Multiple modes of capturing information, including patient‐reported outcomes (PROs) and routinely collected data, were felt to contribute to data completeness. However, RDCTs may transfer trial activity burden onto participants and remote‐working research staff, therefore additional support may be needed.

Conclusion

RDCTs will continue to face challenges in implementing novel technologies. However, maximising patient and partner involvement, reducing participant and staff burden, and simplifying how participants and staff interact with the RDCT may facilitate their implementation.
Concentration‐QT modelling shows no evidence of clinically significant QT interval prolongation with capivasertib at expected therapeutic concentrations
Authors: Voronova Veronika , Cullberg Marie , Delff Philip , Parkinson Joanna , Dota Corina , Schiavon Gaia , Maroj Brijesh , Rekić Dinko , Cheung S. Y. Amy
Published: July 2021

Pharmacokinetics‐matched digital electrocardiogram data (n = 503 measurements from 180 patients) collected in a first‐in‐human, multi‐part, dose‐escalation (from 80 to 800 mg) and dose expansion (at 480 mg) phase 1 study in patients with advanced solid malignancies, were used to assess potential risk of QT prolongation associated with the AKT inhibitor capivasertib. The relationship between plasma drug concentrations and baseline‐adjusted Fridericia‐corrected QT (ΔQTcF) values was estimated using a prespecified linear mixed‐effects model. The model provided an unbiased reproduction of the experimental data set, estimating a small but positive correlation between capivasertib concentration and ΔQTcF. At the expected therapeutic dose (400 mg twice daily) the predicted mean ΔQTcF at the steady state maximum concentration was 3.97 ms with an upper limit of the 90% CI of 5.07 ms; below the 10 ms limit proposed by ICH E14 guidance. This analysis suggests that capivasertib is not expected to present a clinically significant risk for QT prolongation that is associated with pro‐arrhythmic effects.
Prophylactic corticosteroid use in patients receiving axicabtagene ciloleucel for large B‐cell lymphoma
Authors: Oluwole Olalekan O. , Bouabdallah Krimo , Muñoz Javier , De Guibert Sophie , Vose Julie M. , Bartlett Nancy L. , Lin Yi , Deol Abhinav , McSweeney Peter A. , Goy Andre H. , Kersten Marie José , Jacobson Caron A. , Farooq Umar , Minnema Monique C. , Thieblemont Catherine , Timmerman John M. , Stiff Patrick , Avivi Irit , Tzachanis Dimitrios , Kim Jenny J. , Bashir Zahid , McLeroy Jeff , Zheng Yan , Rossi John M. , Johnson Lisa , Goyal Lovely , van Meerten Tom
Published: July 2021

ZUMA‐1 (NCT02348216) examined the safety and efficacy of axicabtagene ciloleucel (axi‐cel), an autologous CD19‐directed chimaeric antigen receptor (CAR)‐T cell therapy, in refractory large B‐cell lymphoma. To reduce treatment‐related toxicity, several exploratory safety management cohorts were added to ZUMA‐1. Specifically, cohort 6 investigated management of cytokine release syndrome (CRS) and neurologic events (NEs) with prophylactic corticosteroids and earlier corticosteroid and tocilizumab intervention. CRS and NE incidence and severity were primary end‐points. Following leukapheresis, patients could receive optional bridging therapy per investigator discretion. All patients received conditioning chemotherapy (days −5 through −3), 2 × 106 CAR‐T cells/kg (day 0) and once‐daily oral dexamethasone [10 mg, day 0 (before axi‐cel) through day 2]. Forty patients received axi‐cel. CRS occurred in 80% of patients (all grade ≤2). Any grade and grade 3 or higher NEs occurred in 58% and 13% of patients respectively. Sixty‐eight per cent of patients did not experience CRS or NEs within 72 h of axi‐cel. With a median follow‐up of 8·9 months, objective and complete response rates were 95% and 80% respectively. Overall, prophylactic corticosteroids and earlier corticosteroid and/or tocilizumab intervention resulted in no grade 3 or higher CRS, a low rate of grade 3 or higher NEs and high response rates in this study population.
Perivascular fat imaging by computed tomography (CT): a virtual guide
Authors: Kotanidis Christos P. , Antoniades Charalambos
Published: July 2021

Imaging in medicine has been revolutionised by technological, computational and research advances over the past decades. Computed tomography (CT), in particular, has seen rapid evolution especially in the field of cardiovascular non‐invasive imaging. It is being recognised as the first‐line tool for the assessment of stable and unstable disease with diagnostic, prognostic and re‐stratification potential. Vascular inflammation is a key component of the atherosclerotic process and has been shown to induce molecular, transcriptional and structural changes to perivascular adipose tissue (PVAT). Being a diverse structure itself, PVAT surrounds the human vessels and is characterised by a highly rich secretome, including, amongst others, adipokines, cytokines, gaseous messengers and miRNAs It is implicated in a bidirectional interplay with the adjacent vascular wall, affecting and being affected by aspects of its biology, mainly inflammation. In this review, we discuss the current status of cardiac CT in imaging vascular inflammation through PVAT phenotyping.

LINKED ARTICLES

This article is part of a themed issue on Molecular imaging ‐ visual themed issue. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.21/issuetoc