bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of clinical symptoms, radiological changes and pulmonary function data 4 months after COVID‐19
Authors: Labarca Gonzalo , Henríquez‐Beltrán Mario , Lastra Jaime , Enos Daniel , Llerena Faryd , Cigarroa Igor , Lamperti Liliana , Ormazabal Valeska , Ramirez Carlos , Espejo Eric , Canales Nicole , Fuentes Fabiola , Horta Gloria , Fernandez‐Bussy Sebastian , Nova‐Lamperti Estefania
Published: June 2021

Background

Coronavirus disease 2019 (COVID‐19) ranges from asymptomatic disease to respiratory failure and requires invasive mechanical ventilation (IMV). Data about the sequelae after infection are scarce. The study aims to describe the prevalence of symptoms, pulmonary function tests (PFTs), and radiological changes after four months of follow‐up.

Methods

A prospective, cross‐sectional, multicentre study was performed. Patients with different illness severities were consecutively included (mild; moderate: hospitalized without IMV; severe: hospitalized with IMV). Clinical variables, health‐related quality of life (HRQoL), PFT (spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO)), and (CT) scans of the chest were obtained. The association between the risk of sequelae (DLCO <80%) and altered CT was analysed using logistic regression adjusted for confounding variables.

Results

60 patients (18 mild, 17 moderate, and 25 severe) were included. Fatigue was found in 11% of the mild, 47% of the moderate and 36% of the severe group. Altered DLCO (mild: 5.5%, moderate: 41%, severe: 28%, p < .05) and change in HRQoL (mild: 50%, moderate: 94%, severe: 60%), while the severe group showed a higher prevalence of altered CT (88% vs. 64%). Awake prone position (APP) and high‐flow nasal cannula (HFNC) was independently associated with altered DLCO, Odds ratio (OR) 7.28 (CI, 1.10‐47.81; p < .05), and altered CT, OR 9.50 (CI, 1.26‐71.5; p < .05). Besides, prolonged time in IMV was associated with altered CT, OR 1.24 (CI, 1.05‐1.46; p < .05).

Discussion

It is common to find sequelae in symptoms, radiology, and PFT. In our series, the use of APP+HFNC and days on IMV were associated with an increased risk of sequelae.
Effects of sedative psychotropic drugs combined with oxycodone on respiratory depression in the rat
Authors: Xu Lin , Krishna Ashok , Stewart Sharron , Shea Katherine , Racz Rebecca , Weaver James L. , Volpe Donna A. , Pilli Nageswara R. , Narayanasamy Suresh , Florian Jeffry , Patel Vikram , Matta Murali K. , Stone Marc B. , Zhu Hao , Davis Michael C. , Strauss David G. , Rouse Rodney
Published: June 2021

Following a decision to require label warnings for concurrent use of opioids and benzodiazepines and increased risk of respiratory depression and death, the US Food and Drug Administratioin (FDA) recognized that other sedative psychotropic drugs may be substituted for benzodiazepines and be used concurrently with opioids. In some cases, data on the ability of these alternatives to depress respiration alone or in conjunction with an opioid are lacking. A nonclinical in vivo model was developed that could detect worsening respiratory depression when a benzodiazepine (diazepam) was used in combination with an opioid (oxycodone) compared to the opioid alone based on an increased arterial partial pressure of carbon dioxide (pCO2). The current study used that model to assess the impact on respiration of non‐benzodiazepine sedative psychotropic drugs representative of different drug classes (clozapine, quetiapine, risperidone, zolpidem, trazodone, carisoprodol, cyclobenzaprine, mirtazapine, topiramate, paroxetine, duloxetine, ramelteon, and suvorexant) administered alone and with oxycodone. At clinically relevant exposures, paroxetine, trazodone, and quetiapine given with oxycodone significantly increased pCO2 above the oxycodone effect. Analyses indicated that most pCO2 interaction effects were due to pharmacokinetic interactions resulting in increased oxycodone exposure. Increased pCO2 recorded with oxycodone‐paroxetine co‐administration exceeded expected effects from only drug exposure suggesting another mechanism for the increased pharmacodynamic response. This study identified drug‐drug interaction effects depressing respiration in an animal model when quetiapine or paroxetine were co‐administered with oxycodone. Clinical pharmacodynamic drug interaction studies are being conducted with these drugs to assess translatability of these findings.
Predicting current and future global distribution of invasive Ligustrum lucidum W.T. Aiton: Assessing emerging risks to biodiversity hotspots
Authors: Montti Lía , Velazco Santiago José Elías , Travis Justin M. J. , Grau H. Ricardo
Published: June 2021

Aim

Biological invasions represent one of the main anthropogenic drivers of global change with a substantial impact on biodiversity. This impact can be particularly acute in biodiversity hotspots. Ligustrum lucidum W.T. Aiton is a tree species native of China that, from as early as the eighteenth century, has been introduced broadly around the globe, becoming a serious invasive species. We aim to predict L. lucidum's current and future potential distributions at a global scale and assess the degree to which biodiversity hotspots are at risk of invasion.

Location

All continents.

Methods

Using global presence data, climatic and edaphic variables, we developed an ensemble model to predict current and future periods (2050 and 2080) global distribution of L. lucidum. Susceptible countries and hotspots of biodiversity were identified.

Results

Important regions within China and neighbouring countries are likely to be environmentally suitable, but they are not currently occupied. Biodiversity hotspots in South America are highlighted as being at current risk of invasion. Notably, climate change may increase risks across large extents of biodiversity hotspots, mainly in South America and Africa, especially by 2080 period.

Main conclusions

Current and future potential distribution of L. lucidum overlaps with biodiversity hotspots worldwide. Control of L. lucidum is a challenge once established. Thus, species distribution modelling helps to identify risk areas, guiding their early detection in current or future suitable areas. Our findings can be useful as a guide to develop region‐specific invasion management strategies to prevent and/or control this species' spread.
A descriptive cost‐analysis of MYX.1/MCRN003, a phase 2 clinical trial evaluating high‐dose weekly carfilzomib, cyclophosphamide, and dexamethasone in relapsed and refractory multiple myeloma
Authors: Monteith Bethany E. , Venner Christopher P. , Cheung Matthew C. , Pater Joe , Shepherd Lois , Richardson Harriet , Reece Donna , Gul Engin , Lalancette Marc , Castonguay Vincent , Kukreti Vishal , Tiedemann Rodger , Phua Chai , Bhella Sita , Dudebout Jill , Sherry Max , Yen Hope , Chen Bingshu E. , Hay Annette E.
Published: June 2021

Background

The prevalence of multiple myeloma is increasing and there is a need to evaluate escalating therapy costs (Canadian Cancer Statistics A, 2020). The MYX.1 phase II trial showed that high‐dose weekly carfilzomib, cyclophosphamide, and dexamethasone (wKCD) is efficacious in relapsed and refractory disease. We conducted a descriptive cost analysis, from the perspective of the Canadian public healthcare system, using trial data.

Methods

The primary outcome was the mean total cost per patient. Resource utilization data were collected from all 75 trial patients over a trial time horizon. Costs are presented in Canadian dollars (2020).

Results

The cost of treatment was calculated from the time of patient (pt) enrollment until the second data lock. The mean total cost was $203 336.08/pt (range $17 891.27‐$505 583.55) Canadian dollars (CAD, where 1 CAD = 0.67 Euro (EUR)) and $14 081.45/pt per cycle. The median number of cycles was 15. The predominant cost driver was the cost of chemotherapy accounting for an average of $179 332.78/pt or $12 419.17/pt per cycle. Carfilzomib acquisition accounted for the majority of chemotherapy costs – $162 471.65/pt or $11 251.50/pt per cycle. Fifty‐six percent (56%) of patients had at least one hospitalization during the trial period with an average cost of $12 657.86 per hospitalization. Three patients developed thrombotic microangiopathy (TMA) with an average cost of $18 863.32/pt including the cost of hospitalizations and therapeutic plasma exchange.

Conclusions

High‐dose wKCD is an active triplet regimen for relapsed and refractory multiple myeloma (RRMM) associated with reduced total cost compared with twice‐weekly carfilzomib‐based regimens.
Bimodal expression of potential drug target CLL‐1 (CLEC12A) on CD34+ blasts of AML patients
Authors: Ngai Lok Lam , Ma Connie Y. , Maguire Orla , Do An D. , Robert Alberto , Logan Aaron C. , Griffiths Elizabeth A. , Nemeth Michael J. , Green Cherie , Pourmohamad Tony , van Kuijk Bo J. , Snel Alexander N. , Kwidama Zinia W. , Venniker‐Punt Bianca , Cooper James , Manz Markus G. , Gjertsen Bjørn T. , Smit Linda , Ossenkoppele Gert J. , Janssen Jeroen J. W. M. , Cloos Jacqueline , Sumiyoshi Teiko
Published: June 2021

Objectives

This study aims to retrospectively assess C‐lectin‐like molecule 1 (CLL‐1) bimodal expression on CD34+ blasts in acute myeloid leukemia (AML) patients (total N = 306) and explore potential CLL‐1 bimodal associations with leukemia and patient‐specific characteristics.

Methods

Flow cytometry assays were performed to assess the deeper immunophenotyping of CLL‐1 bimodality. Cytogenetic analysis was performed to characterize the gene mutation on CLL‐1‐negative subpopulation of CLL‐1 bimodal AML samples.

Results

The frequency of a bimodal pattern of CLL‐1 expression of CD34+ blasts ranged from 8% to 65% in the different cohorts. Bimodal CLL‐1 expression was most prevalent in patients with MDS‐related AML (P = .011), ELN adverse risk (P = .002), NPM1 wild type (WT, P = .049), FLT3 WT (P = .035), and relatively low percentages of leukemia‐associated immunophenotypes (P = .006). Additional immunophenotyping analysis revealed the CLL‐1− subpopulation may consist of pre‐B cells, immature myeloblasts, and hematopoietic stem cells. Furthermore, (pre)‐leukemic mutations were detected in both CLL‐1+ and CLL‐1− subfractions of bimodal samples (N = 3).

Conclusions

C‐lectin‐like molecule 1 bimodality occurs in about 25% of AML patients and the CLL‐1− cell population still contains malignant cells, hence it may potentially limit the effectiveness of CLL‐1‐targeted therapies and warrant further investigation.
Citizen‐centered financial reporting translation: The preparers’ perspective
Authors: Bracci Enrico , Biondi Lucia , Kastberg Gustaf
Published: June 2021

In recent years, the urge to make public sector organizations accountable has resulted in a wide range of citizen‐centered financial reporting tools that aim to overcome the limits of traditional financial reporting. To date, the debate on these public accountability innovations has mainly focused on the reasons underpinning their adoption from the users’ perspective, while how preparers affect accountability in the process of constructing such documents is empirically less investigated. By drawing on Callon's concept of translation, this paper aims to analyze how the preparers of citizens‐centered financial reports perceive and translate public accountability into practice. In fact, localized translation of public accounting innovation may reveal divergences and ambiguity inherent in the public accountability principles shaped by concurring actors, events, and technologies. The research is qualitative and interpretative, through a longitudinal case study in a municipality, observing the process of construction of a citizen‐centered financial reporting tool (i.e., Popular Financial Reporting—PFR). The originality of the paper lies in its contribution to the debate about how public accountability tools are translated into practice by providing evidence of the dynamics that lead an organization along the implementation path. Our findings confirm that the output of the process is the result of the interaction of different networks of interest. Consequently, the final document may vary consistently from the initial project and the general principles of the framework followed.
The effect of nursing intervention based on the staged behaviour change on recovery, quality of life, and self‐efficacy of diabetic patients with scalds
Authors: Li Cuikun , Chen Zhihua , Gao Bingquan , Yang Mingming , Ren Liqing , Li Juan , Zhang Yulan , Yang Meng
Published: June 2021

This study aimed to explore the impact of nursing intervention based on staged behaviour change (SBC) on the quality of life (QoL) and self‐efficacy of diabetic patients with scalds. From January 2020 to January 2021, a total of 82 consecutive cases with diabetes and scalds were prospectively enrolled in this study. They were divided into the SBC group (41 cases were given SBC‐based nursing intervention) and the control group (41 cases were given routine intervention) using the random number table method. The granulation tissue growth time and wound healing time were compared between the two groups. Pain intensity, QoL, self‐efficacy, and score of wound exudation at 3, 7, and 15 days after intervention were observed. The granulation tissue growth time and wound healing time of the SBC group were lower than those of the control group with statistical difference (P < 0.05). The 3‐, 5‐, and 7‐day pain intensity of the SBC group were all lower than those of the control group, with statistical difference (P < 0.05, respectively). Before intervention, there were no significant differences in mental health, role emotional, social function, vitality status, physical pain, role physical, physical function, and general health between the two groups (P > 0.05, respectively). After intervention, the above indicators of the SBC group were significantly higher than those of the control group (P < 0.05, respectively). Before intervention, there were no significant differences between the two groups in communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake and nutrition (P > 0.05, respectively). After intervention, the above indicators in the SBC group were all significantly higher than those in the control group (P < 0.05, respectively). The score of wound exudation of the SBC group was lower than that of the control group after intervention (P < 0.05). SBC‐based nursing intervention can effectively improve the QoL and self‐efficacy of diabetic patients with scalds and can effectively promote wound healing, and can be recommended for clinical use.
A call for caution regarding infection‐acquired COVID‐19 immunity: The potentially unintended effects of “immunity passports” and how to mitigate them
Authors: Green Ricky , Biddlestone Mikey , Douglas Karen M.
Published: June 2021

Research suggests that emerging information about infection‐acquired COVID‐19 immunity should be interpreted with caution. The introduction of “immunity passports” that would enable people who have recovered from COVID‐19 to travel freely and return to work may therefore have detrimental consequences if not managed carefully. In two studies, we examined how perceived (suspected or imagined) recovery from COVID‐19, and the concept of immunity passports, influence people’s intentions to engage in behaviors aimed to reduce the spread of COVID‐19. We also consider ways to lessen potential negative effects. In Study 1 (N = 1604), participants asked to imagine that they had recovered from COVID‐19 reported lower social distancing intentions compared to a control condition. Participants who suspected (versus imagined) that they had recovered from past infection did not report lower preventative intentions compared to the control condition, even at high levels of certainty of past infection. In Study 2 (N = 1732), introducing the idea of immunity passports also reduced social distancing intentions compared to a control condition. The latter effect was, however, attenuated when cautious information about the equivocal science on COVID‐19 was also presented to participants. Participants who suspected that they had COVID‐19 in the past (compared to the control condition) revealed a similar pattern of results, but only at higher levels of certainty of past infection. Caution regarding infection‐acquired COVID‐19 immunity and immunity passports will be crucial in the COVID‐19 response. Implications for premature pandemic announcements, as well as their potential remedies, are discussed.
LXN deficiency regulates cytoskeleton remodelling by promoting proteolytic cleavage of Filamin A in vascular endothelial cells
Authors: He Guozhang , Kan Shuang , Xu Shaohua , Sun Xuchen , Li Rong , Shu Wei , Chen Ming
Published: June 2021

Endothelial cells (ECs) respond to blood shear stress by changing their morphology is important for maintaining vascular homeostasis. Studies have documented a relationship between endothelial cell shape and the stress flow, and however, the mechanism underlying this cytoskeletal rearrangement due to shear stress remains uncertain. In this paper, we demonstrate that laminar shear stress (LSS) significantly reduces latexin (LXN) expression in ECs. By using siRNA and cell imaging, we demonstrated that LXN knockdown results in the morphologic change and F‐actin remodelling just like what LSS does in ECs. We further demonstrate that LXN interacts with Filamin A (FLNA) and regulates FLNA proteolytic cleavage and nuclei translocation. By constructing LXN‐/‐ mice and ApoE‐/‐LXN‐/‐ double knockout mice, we evaluated the effect of LXN knockout on aortic endothelium damage in mice. We found that LXN deficiency significantly improves vascular permeability, vasodilation and atherosclerosis in mice. Our findings provide confident evidence, for the first time, that LXN is a novel regulator for morphological maintenance of ECs, and LXN deficiency has a protective effect on vascular homeostasis. This provides new strategies and drug targets for the treatment of vascular diseases.
Prefrailty, impairment in physical function, and risk of incident heart failure among older adults
Authors: Segar Matthew W. , Singh Sumitabh , Goyal Parag , Hummel Scott L. , Maurer Mathew S. , Forman Daniel E. , Butler Javed , Pandey Ambarish
Published: June 2021

Objective

Evaluate the association between prefrailty and the risk of heart failure (HF) among older adults.

Design, setting, and participants

This prospective, community‐based cohort study included participants from the Atherosclerotic Risk in Communities study who underwent detailed frailty assessment using Fried Criteria and physical function assessment using the Short Performance Physical Battery (SPPB) score. Individuals with prevalent HF and frailty were excluded.

Main outcomes and measures

Adjusted association between prefrailty (vs robust), physical function measures (SPPB score, grip strength, and gait speed), and incident HF (overall and HF subtypes, HF with reduced [HFrEF, EF < 50%] and preserved ejection fraction [HFpEF]) were assessed using Cox proportional hazards models.

Results

Among 5210 participants (mean age 75 years, 58% women), 2565 (49.2%) were identified as prefrail. In cross‐sectional analysis, prefrail individuals had a higher burden of chronic myocardial injury (troponin, Std β = 0.08 [0.05–0.10]) and neurohormonal stress (NT‐ProBNP, Std β = 0.03 [0.02–0.05]) after adjustment for potential confounders. Over a median follow‐up of 4.6 years, there were 232 (4.5%) HF events (HFrEF: 102; HFpEF: 97). Prefrailty was associated with an increased risk of HF after adjusting for potential clinical confounders and cardiac biomarkers (aHR [95% CI] = 1.65 [1.24–2.20]). Among HF subtypes, prefrailty was associated with an increased risk of HFpEF but not HFrEF (aHR [95% CI] = 1.73 [1.11–2.70] and 1.38 [0.90–2.10], respectively). A lower SPPB score was also associated with an increased risk of overall HF and HFpEF, but not HFrEF. Among individual components, increased gait speed were associated with a lower risk of HFpEF, but not HFrEF.

Conclusions and relevance

Subtle abnormalities in physiological reserve (prefrailty) and impairment in physical function (SPPB) were both significantly associated with a higher risk of incident HF, particularly HFpEF. These findings highlight the potential role of routine assessment of geriatric syndromes for early identification of HF risk.
Do nonobese patients with Behçet’s disease have insulin resistance?
Authors: Cebeci Kahraman Filiz , Kayataş Kadir , Savaş Erdoğan Sevil , Onsun Nahide
Published: June 2021

Background

Some studies have investigated the relationship between Behçet's disease (BD) and insulin resistance; however, since they did not exclude obese patients from their sample, it remains unclear whether BD itself causes insulin resistance independently of obesity.

Methods

The study included 60 patients with BD and 45 age‐, gender‐, and body mass index (BMI)–matched healthy controls. Obese patients with a BMI of ≥30 kg/m² were excluded. Insulin resistance according to the homeostasis model assessment for insulin resistance (HOMA‐IR) and quantitative insulin sensitivity check index (QUICKI), fasting plasma glucose, and one‐hour and two‐hour plasma glucose in the oral glucose tolerance test (OGTT 1‐h and OGTT 2‐h PG, respectively) were evaluated in all patients.

Results

The mean fasting plasma glucose levels and the rate of those with impaired glucose tolerance according to OGTT 2‐h PG were significantly higher in the BD patients compared to the controls. The rates of those with insulin resistance according to HOMA‐IR and QUICKI were significantly higher in the BD patients than in the controls. When compared to the control group, the rates of those with impaired fasting glucose and impaired glucose tolerance were significantly higher, and the mean QUICKI value was significantly lower in the active group, in contrast to the inactive group.

Conclusions

Insulin resistance occurs in BD patients independently of obesity. In the follow‐up of BD patients, especially in the active phase, not only fasting blood glucose but also other diagnostic tests for insulin resistance should be added to the examination panels.
Critical COVID‐19 is associated with distinct leukocyte phenotypes and transcriptome patterns
Authors: Christensen E. E. , Jørgensen M. J. , Nore K. G. , Dahl T. B. , Yang K. , Ranheim T. , Huse C. , Lind A. , Nur S. , Stiksrud B. , Jenum S. , Tonby K. , Holter J. C. , Holten A. R. , Halvorsen B. , Dyrhol‐Riise A. M.
Published: June 2021

Background

Prognostic markers for disease severity and identification of therapeutic targets in COVID‐19 are urgently needed. We have studied innate and adaptive immunity on protein and transcriptomic level in COVID‐19 patients with different disease severity at admission and longitudinally during hospitalization.

Methods

Peripheral blood mononuclear cells (PBMCs) were collected at three time points from 31 patients included in the Norwegian SARS‐CoV‐2 cohort study and analysed by flow cytometry and RNA sequencing. Patients were grouped as either mild/moderate (n = 14), severe (n = 11) or critical (n = 6) disease in accordance with WHO guidelines and compared with patients with SARS‐CoV‐2‐negative bacterial sepsis (n = 5) and healthy controls (n = 10).

Results

COVID‐19 severity was characterized by decreased interleukin 7 receptor alpha chain (CD127) expression in naïve CD4 and CD8 T cells. Activation (CD25 and HLA‐DR) and exhaustion (PD‐1) markers on T cells were increased compared with controls, but comparable between COVID‐19 severity groups. Non‐classical monocytes and monocytic HLA‐DR expression decreased whereas monocytic PD‐L1 and CD142 expression increased with COVID‐19 severity. RNA sequencing exhibited increased plasma B‐cell activity in critical COVID‐19 and yet predominantly reduced transcripts related to immune response pathways compared with milder disease.

Conclusion

Critical COVID‐19 seems to be characterized by an immune profile of activated and exhausted T cells and monocytes. This immune phenotype may influence the capacity to mount an efficient T‐cell immune response. Plasma B‐cell activity and calprotectin were higher in critical COVID‐19 while most transcripts related to immune functions were reduced, in particular affecting B cells. The potential of these cells as therapeutic targets in COVID‐19 should be further explored.
Hardness Development in Resin Composite Core Materials
Authors: Lien Wen , Roberts Howard , Vandewalle Kraig
Published: June 2021

Purpose

To investigate the hardness characteristics of 13 contemporary resin core materials.

Materials and methods

Specimens (n = 12) were fabricated using stainless steel molds with top surfaces of dual‐cure products photopolymerized while additional groups were allowed to self‐cure. Twelve Knoop hardness indentations 500 microns apart were obtained of photopolymerized top and bottom sample surfaces as well as the self‐cured sample surface with the mean recorded as the representative sample hardness. Testing was completed at 10 minutes, 1 hour, and 24 hours. In addition, hardness values were compared to that obtained from polished coronal dentin samples. Mean data between groups were analyzed with Kruskal‐Wallis/Dunn's, within groups with repeated measures ANOVA/Tukey's.

Results

Hardness results were material dependent. All but two products demonstrated a 0.8 bottom/top Knoop hardness ratio at 10 minutes. Product's self‐cure cure reaction did not attain hardness similarity with any photopolymerized top surfaces and while some materials were found to have similar dentin hardness to resin top surface ratio similarity, only one product had hardness equal to or greater than that of dentin during any time period.

Conclusions

Under this study's conditions, hardness development was material dependent and all but two products demonstrated adequate hardness‐derived degree of cure assessment at 10 minutes after preparation. Self‐cured samples demonstrated hardness increase; however, no self‐cured material achieved hardness similarity to photopolymerized top surfaces. None of the materials achieved hardness similarity to dentin and only one product demonstrated hardness greater than that of dentin.
Incidence, severity and clinical manifestations of juvenile dermatomyositis among Maori and Pacific Island compared to European children
Authors: Concannon Anthony , Han Dug Yeo
Published: June 2021

Aim

To describe the incidence, demographics, diagnostic clinical manifestations and long‐term outcomes of juvenile dermatomyositis (JDM) in Maori and Pacific Island compared to European children.

Methods

A chart review was conducted of children with JDM seen by the Starship Rheumatology service between 2000 and 2020. Diagnostic clinical manifestations, demographics, disease course and significant complications were collated. The incidence, clinical manifestations and severity of JDM were determined and compared between ethnic groups, in particular Maori and Pacific Island, and European children.

Results

The overall incidence of JDM was 0.24/100 000 per year with no significant ethnic variation. Maori children were less likely to achieve a clinical response (71 vs. 100%, P = 0.08), Maori and Pacific less likely to achieve clinical remission (56 vs. 40%, P = 0.69), with Maori (71 vs. 44%, P = 0.37) and Maori and Pacific (60 vs. 44%, P = 0.69) children more likely to follow a chronic course compared to European children. Calcinosis (50 vs. 13%, P = 0.07), cutaneous vasculopathy (30 vs. 0%, P = 0.05) and interstitial lung disease (30 vs. 6%, P = 0.26) were more common in Maori and Pacific compared to European children.

Conclusion

The incidence of JDM among a cohort of New Zealand children was established, with Maori and Pacific children more likely to experience a chronic continuous disease course, calcinosis, cutaneous vasculopathy and interstitial lung disease compared to European children.
Progression from sepsis to septic shock and time to treatments in preterm infants with late‐onset sepsis
Authors: Gorantiwar Sujit , de Waal Koert
Published: June 2021

Aim

Late‐onset sepsis (LOS) in preterm infants can progress rapidly from minimal clinical signs and symptoms to septic shock which is associated with high mortality. The aim of this study was to describe the progression from sepsis to septic shock and evaluate our management performance with emphasis on time to treatments.

Methods

This was a retrospective observational study including preterm infants ≤32 weeks gestation with LOS and septic shock defined as the requirement of fluids and vasopressors. Physiological changes and time to first diagnostics and treatments were determined from the point of first appearance of clinical signs and symptoms of sepsis (TONSET).

Results

During the 10‐year observational period, 279 infants developed LOS and 25 (8.9%) progressed to septic shock. The median (interquartile range) time from TONSET to blood culture, administering antibiotics, fluid bolus and vasopressors was 8.4 (4.8–12.2), 9.2 (5.6–12.4), 14.6 (9.5–34.5) and 22.0 (14.6–44.7) h, respectively. Hypotension and raised lactate were prominent physiological changes in the progression to septic shock. Fluid bolus and vasopressors were administered when blood pressure was 20 and 41% below to what was normal before the infant became unwell. Vasopressors significantly increased blood pressure and heart rate. Mortality rate was 40% with no difference in time to treatments between survivors and non‐survivors.

Conclusion

Clinical recognition of the onset of sepsis in preterm infants remains difficult and contributes to delay of treatment. Once recognised, early administration of antibiotics, fluid bolus and vasopressors should be prioritised.
Spatial organization, behaviour and feeding habits of red squirrels: differences between an urban park and an urban forest
Authors: Krauze‐Gryz D. , Gryz J. , Brach M.
Published: June 2021

Red squirrels (Sciurus vulgaris) successfully inhabit cities, utilize urban structures and adapt to alternative food sources such as supplemental anthropogenic feeding. Here, we compared two urban populations: one in a busy park and another in an urban forest. The first was expected to be highly influenced by human presence (and food delivered by park visitors), and the other was hypothesized to be unaffected by human disturbance. Our goal was to determine how they differed in terms of spatial organization, behaviour and food habits. The populations were monitored using radio‐tagging. Squirrels in the park had significantly smaller home ranges than those in the forest. In both areas, they had multi‐nuclear home ranges, but the number of nuclei in the park was lower than that in the forest. This probably reflects more homogenous food availability (i.e. supplemental feeding). Squirrels in the park spent more time on the ground throughout the year than squirrels in the forest. This was probably related to their dependence on human‐supplemented food. Park squirrels often interacted with park visitors throughout the year – this involved approaching and taking food in 60% of the interactions. Hazelnuts and walnuts (food most often supplied by humans) dominated the diet of park squirrels, whereas pine and hornbeam seeds dominated the diet of forest squirrels. Overall, the study showed how living in the park with year‐round access to supplementary food changed the spatial organization and behaviour of red squirrels compared to that of the population from the urban forest reserve.
Policy designs for interorganizational coordination: Lessons from failures in governing the mining sector in Colombia and Ecuador
Authors: Cisneros Paúl
Published: June 2021

Scholars of mining policies are beginning to understand how the most recent boom in commodity prices (2000–2014) influenced the institutional development of the mining sector in Latin America. We contribute to this literature by studying the design, dynamics, and outcomes of interorganizational coordination in Colombia and Ecuador. Our findings show that, despite their divergent policies, both countries failed to integrate the mining sector's three main policy games—formalizing artisan and small‐scale operations, increasing the number of large‐scale projects, and tackling illegal extraction. Several characteristics of the design of coordination initiatives influenced policy failure—the reliance on hierarchy mechanisms to motivate coordination, the lack of specificity of the coordination mandates, and the lack of specific resources for coordination. Contextual factors also shaped the dynamics and outcomes of coordination. The limited geographical spread of artisanal and small‐scale mining and of illegal extraction, the environmental sector's weakness, and the creation of a multilayered structure for public‐sector coordination contributed to policy effectiveness in Ecuador. On the other hand, the ample spread of artisanal and small‐scale mining and of illegal extraction, the lack of a clear coordinating structure, and the environmental sector's growing vigor contributed to sustained policy failure in Colombia.
Genomic, karyological and morphological changes of South American garlics (Ipheion) provide insights into mechanisms of speciation in the Pampean region
Authors: Sassone Agostina B. , Hojsgaard Diego H. , Giussani Liliana M. , Brassac Jonathan , Blattner Frank R.
Published: June 2021

Speciation proceeds through mechanisms that promote reproductive isolation and shape the extent of genetic variation in natural populations, and thus its study is essential to understand the evolutionary processes leading to increased biodiversity. Chromosomal rearrangements are known to facilitate reproductive isolation by hybrid sterility and favour speciation events. The genusIpheion(Amaryllidaceae, Allioideae) is unique as its species exhibit a remarkable karyological variability but lack population‐level genetic data. To unveil the diversification processes acting upon the formation of new lineages withinIpheionin the Pampas of South America, we combined morphology and karyology approaches with genotyping‐by‐sequencing. Our phylogenomic and population genomics results supported the taxonomic division ofIpheioninto three morphological and genetically well‐differentiated groups. The origin ofIpheion uniflorumwas traced back to its current southern distribution area in the southern Pampean region (in Argentina), from where it had expanded to the north reaching Uruguay. Our results further suggested that chromosome rearrangements and ploidy shifts had triggered speciation events, first during the origin ofI.uniflorumand later during its subsequent diversification intoI.recurvifoliumandI.tweedieanum, in both cases reinforced by extrinsic factors and biogeographical settings. The current study illustrates the analytical power of multidisciplinary approaches integrating phylo‐ and population genomics with classic analyses to reveal evolutionary processes in plants.
Cross‐scene pavement distress detection by a novel transfer learning framework
Authors: Li Yishun , Che Pengyu , Liu Chenglong , Wu Difei , Du Yuchuan
Published: June 2021

Deep learning has achieved promising results in pavement distress detection. However, the training model's effectiveness varies according to the data and scenarios acquired by different camera types and their installation positions. It is time consuming and labor intensive to recollect labeled data and retrain a new model every time the scene changes. In this paper, we propose a transfer learning pipeline to address this problem, which enables a distress detection model to be applied to other untrained scenarios. The framework consists of two main components: data transfer and model transfer. The former trains a generative adversarial network to transfer existing image data into a new scene style. Then, attentive CutMix and image melding are applied to insert distress annotations to synthesize the new scene's labeled data. After data expansion, the latter step transfers the feature extracted by the existing model to the detection application of the new scene through domain adaptation. The effects of varying degrees of knowledge transfer are also discussed. The proposed method is evaluated on two data sets from two different scenes with more than 40,000 images totally. This method can reduce the demand for training data by at least 25% when the model is applied in a new scene. With the same number of training images, the proposed method can improve the model accuracy by 26.55%.
Randomized controlled trial of home biofeedback therapy versus office biofeedback therapy for fecal incontinence
Authors: Xiang Xuelian , Sharma Amol , Patcharatrakul Tanisa , Yan Yun , Karunaratne Tennekoon , Parr Rachel , Ayyala Deepak Nag , Hall Patricia , Rao Satish S. C.
Published: June 2021

Background

Biofeedback therapy is useful for treatment of fecal incontinence (FI), but is not widely available and labor intensive. We investigated if home biofeedback therapy (HBT) is non‐inferior to office biofeedback therapy (OBT).

Methods

Patients with FI (≥1 episode/week) were randomized to HBT or OBT for 6 weeks. HBT was performed daily using novel device that provided resistance training and electrical stimulation with voice‐guided instructions. OBT consisted of six weekly sessions. Both methods involved anal strength, endurance, and coordination training. Primary outcome was change in weekly FI episodes. FI improvement was assessed with stool diaries, validated instruments (FISI, FISS, and ICIQ‐B), and anorectal manometry using intention‐to‐treat analysis.

Key Results

Thirty (F/M = 26/4) FI patients (20 in HBT, 10 in OBT) participated. Weekly FI episodes decreased significantly after HBT (Δ ± 95% confidence interval: 4.7 ± 1.8, compared with baseline, p = 0.003) and OBT (3.7 ± 1.6, p = 0.0003) and HBT was non‐inferior to OBT (p = 0.2). The FISI and FISS scores improved significantly in HBT group (p < 0.02). Bowel pattern, bowel control, and quality of life (QOL) domains (ICIQ‐B) improved significantly in HBT arm (p < 0.023). Resting and maximum squeeze sphincter pressures significantly improved in both HBT and OBT groups and sustained squeeze pressure in HBT, without group differences.

Conclusions & Inferences

Home biofeedback therapy is non‐inferior to OBT for FI treatment. Home biofeedback is safe, effective, improves QOL, and through increased access could facilitate improved management of FI.
Contribution of adhesion proteins to Aggregatibacter actinomycetemcomitans biofilm formation
Authors: Danforth David R. , Melloni Marcella , Tristano Jake , Mintz Keith P.
Published: June 2021

Aggregatibacter actinomycetemcomitans is a Gram‐negative bacterium associated with periodontal disease and multiple disseminated extra‐oral infections. Colonization of these distinct physiological niches is contingent on the expression of specific surface proteins during the initiation of developing biofilms. In this investigation, we studied fimbriae and three well‐characterized nonfimbrial surface proteins (EmaA, Aae, and ApiA/Omp100) for their contribution to biofilm formation. Mutations of these proteins in multiple strains covering four different serotypes demonstrated variance in biofilm development that was strain dependent but independent of serotype. In a fimbriated background, only inactivation of emaA impacted biofilm mass. In contrast, inactivation of emaA and/or aae affected biofilm formation in nonfimbriated A. actinomycetemcomitans strains, whereas inactivation of apiA/omp100 had little effect on biofilm formation. When these genes were expressed individually in Escherichia coli, all transformed strains demonstrated an increase in biofilm mass compared to the parent strain. The strain expressing emaA generated the greatest mass of biofilm, whereas the strains expressing either aae or apiA/omp100 were greatly reduced and similar in mass. These data suggest a redundancy in function of these nonfimbrial adhesins, which is dependent on the genetic background of the strain investigated.
Pharmacokinetic concepts for dexmedetomidine target‐controlled infusion pumps in children
Authors: Morse James D. , Cortinez Luis Ignacio , Anderson Brian J.
Published: June 2021

Pharmacokinetic parameter estimates are used in mathematical equations (pharmacokinetic models) to describe concentration changes with time in a population and are specific to that population. Simulation using these models and their parameter estimates can enrich understanding of drug behavior and serve as a basis for study design. Pharmacokinetic concepts are presented pertaining to future designs of dexmedetomidine target‐controlled infusion pumps in children. This manuscript provides the pediatric anesthesiologist with an understanding of the nuances that should be considered when using target‐controlled infusion pumps; how the central volume may differ between populations, how clearance changes with age, and the impact of adverse effects on dose. In addition, the ideal loading dose and rate of delivery to achieve target concentration without adverse cardiovascular effects are reviewed, and finally, dose considerations for obese children, based on contact‐sensitive half‐time, are introduced. An understanding of context‐sensitive half‐time changes with age enables anesthetic practitioners to better estimate duration of effect after cessation of dexmedetomidine infusion. Use of these known pharmacokinetic parameters and covariate information for the pediatric patient could readily be incorporated into commercial target‐controlled infusion pumps to allow effective and safe open‐loop administration of dexmedetomidine in children.
Homophonic Reports and Gradual Communication
Authors: Picazo Claudia
Published: June 2021

Pragmatic modulation makes contextual information necessary for interpretation. This poses a problem for homophonic reports and inter‐contextual communication in general: of co‐situated interlocutors, we can expect some common ground, but non‐co‐situated interpreters lack access to the context of utterance. Here I argue that we can nonetheless share modulated contents via homophonic reports. First, occasion‐unspecific information is often sufficient for the recovery of modulated content. Second, interpreters can recover what is said with different degrees of accuracy. Homophonic reports and inter‐contextual communication are often successful because the reporting context does not demand full accuracy.
Driven to Extremes: Donald Trump's Extraordinary Impact on the 2020 Elections
Authors: Jacobson Gary C.
Published: June 2021

Reactions to the divisive person and presidency of Donald Trump dominated voting decisions in the 2020 elections, which consequently set new records for electoral continuity, party loyalty, nationalization, polarization, and presidential influence on the down‐ballot vote choices, to the point where local factors such as incumbency, candidate quality, and campaign spending barely registered in the congressional election results. Evaluations of Trump’s leadership in the national crises besetting the United States in 2020 were assimilated almost entirely into existing attitudes toward the president, limiting the impact of these events. The Democrats achieved unified control of the government, but by the narrowest of margins, and the political configuration that had emerged from Trump’s election in 2016 remained largely intact. Republicans’ responses to Trump’s seditious efforts to nullify Biden’s victory promise to extend his influence through the 2022 elections and beyond.
Market structure and bank conduct in Lesotho
Authors: Moshoeshoe Ramaele , Thokoa Katleho
Published: June 2021

Lesotho's banking industry is highly concentrated and is perceived to be uncompetitive. However, high market concentration does not necessarily imply a lack of competition in the market. Until now, there is no evidence supporting the view that the industry is uncompetitive. Therefore, this paper uses monthly bank‐level data from 2013:10 to 2019:5, and employs the Panzar‐Rosse H‐statistic and the Boone indicator to examine competition in Lesotho's banking industry. We find that the industry acts as a ‘monopoly’ or a ‘perfectly colluding oligopoly’. We, therefore, argue that policy makers should set up the long anticipated antitrust agency to oversee conduct in this industry, and all other industries to improve societal welfare.
Determiners and the Development of Grammatical Nominalization in Nivaĉle*
Authors: Otero Manuel A. , Payne Doris L. , Vidal Alejandra
Published: June 2021

Nivaĉle, a Mataco‐Mataguayan language of the South American Chaco, exhibits right branching syntax often involving determiners. The determiners express visibility, proximity, existence, have temporal implications, and mark abstract referents and nominalized clauses. This paper proposes that headless relative clauses arose by using determiners in grammatical nominalization via an amalgam source construction, while a certain complement clause structure may have arisen by using a determiner as a cataphoric pronoun before a co‐referent clause. As background for the historical argument, we first introduce the determiners and predicating versus referring expressions. We then discuss the role of the determiners in grammatical nominalization to create headless relatives, and then the complement clause structure headed by ka=. Employing comparative Mataguayan data, we propose historical scenarios that may have yielded the two constructions.
Fertility on ice: an overview of fertility preservation for children and adolescents with cancer
Authors: Hartigan Lucia , Glover Louise E , Wingfield Mary
Published: June 2021

Key content

Continued advances in oncology treatments have led to better survival rates for children and young adults with cancer.

An important ‘late effect’ of cancer treatment is the loss of fertility.

Although many survivors of childhood cancers go on to conceive without difficulty, the potential loss of fertility is a concern for children and young adults with cancer, their parents and caregivers.

We review current options for fertility preservation (FP) for prepubertal and postpubertal girls and boys, including oocyte cryopreservation, ovarian tissue cryopreservation, sperm cryopreservation and testicular tissue cryopreservation.

Learning objectives

To understand the different FP methods available for children and adolescents, the barriers to FP and ethical and psychological considerations

To raise awareness of the importance of early discussions about FP with patients who are at risk of infertility from their cancer treatment.

Ethical Issues

Autotransplantation of ovarian tissue in survivors of haematological malignancies, particularly leukaemia, carries a strong risk of re‐introducing the malignancy and should be avoided.

Clinicians must consider suitability of the patient for FP, taking into account emotional maturity, patient and parent desire for FP and the physical fitness of the patient, including their immunosuppressive state.