bluuebunny/crossref_metadata_2025 huggingface dataset:
Making the municipal capital market in nineteenth‐century England†
Authors: Webster Ian
Published: May 2021

How did local authorities in nineteenth‐century England raise the money to finance the building of roads, sewers, gasworks, schools, and hospitals? The literature on local government and capital markets is silent on this question. This article reveals the size of the municipal capital market, how and why it developed, and how it performed. It shows that most of the capital came from private individuals and institutions, with central government having only a modest role. Avoiding defaults, protecting lenders, the move towards standardization, and the development of open markets were all important in improving the credibility of borrowers and reducing the cost of debt. The article also reveals that the municipal capital market shared many similarities with the wider capital market.
Target enhancement or distractor suppression? Functionally distinct alpha oscillations form the basis of attention
Authors: Schneider Daniel , Herbst Sophie K. , Klatt Laura‐Isabelle , Wöstmann Malte
Published: May 2021

Recent advances in attention research have been propelled by the debate on target enhancement versus distractor suppression. A predominant neural correlate of attention is the modulation of alpha oscillatory power (~10 Hz), which signifies shifts of attention in time, space and between sensory modalities. However, the underspecified functional role of alpha oscillations limits the progress of tracking down the neurocognitive basis of attention. In this short opinion article, we review and critically examine a synthesis of three conceptual and methodological aspects that are indispensable for a mechanistic understanding of the role of alpha oscillations for attention. (a) Precise mapping of the anatomical source and the temporal response profile of neural signals reveals distinct alpha oscillatory processes that implement facilitatory versus suppressive components of attention. (b) A testable framework enables unanimous association of alpha modulation with either target enhancement or different forms of distractor suppression (active vs. automatic). (c) Linking anatomically specified alpha oscillations to behavior reveals the causal nature of alpha oscillations for attention. The three reviewed aspects substantially enrich study design, data analysis and interpretation of results to achieve the goal of understanding how anatomically specified and functionally relevant neural oscillations contribute to the implementation of facilitatory versus suppressive components of attention.
Breast ultrasound tumour classification: A Machine Learning—Radiomics based approach
Authors: Mishra Arnab K. , Roy Pinki , Bandyopadhyay Sivaji , Das Sujit K.
Published: May 2021

Prediction of breast tumour malignancy using ultrasound imaging, is an important step for early detection of breast cancer. An efficient prediction system can be a great help to improve the survival chances of the involved patients. In this work, a machine learning (ML)—radiomics based classification pipeline is proposed, to perform this predictive modelling task, in a much more efficient manner. Multiple different types of image features of the region of interests are considered in this work, followed by a recursive feature elimination based feature selection step. Furthermore, a synthetic minority oversampling technique based step is also included in the pipeline, to deal with the class imbalance problem, that is often present in medical imaging datasets. Various ML models are considered in the subsequent model training phase, on a publicly available breast ultrasound image dataset (BUSI). From experimental analysis it has been observed that, shape, texture and histogram oriented gradients related features are the most informative, with respect to the predictive modelling task. Furthermore, it was observed that ensemble learners such as random forest, gradient boosting and AdaBoost classifiers are able to achieve significant results with respect to multiple evaluation metrics. The proposed approach achieved the state‐of‐the‐art accuracy, area under the curve, F1‐score and Mathews correlation coefficient values of 0.974, 0.97, 0.94 and 0.959, respectively, on the BUSI dataset. Such kind of impressive results suggest that the proposed approach can have a very high practical utility, in real medical diagnostic settings.
Quantification of JAK2V617F mutation load by droplet digital PCR can aid in diagnosis of myeloproliferative neoplasms
Authors: Zheng Chao‐Feng , Zhao Xiao‐Xue , Chen Xiu‐Hua , Liu Zhuang , Wang Wen‐Jun , Luo Ming , Ren Yan , Wang Hong‐Wei
Published: May 2021

Introduction

This study developed a method for quantifying the JAK2V617F mutation load in patients with myeloproliferative neoplasm (MPN) using droplet digital PCR (ddPCR), which provides a new laboratory method for diagnosing polycythemia vera (PV), essential thrombocythemia (ET), and pre‐primary myelofibrosis (pre‐PMF).

Methods

Patients with MPN who had JAK2V617F mutations from March 2013 to August 2019 were enrolled in this study. JAK2V617F mutation loads were quantified using ddPCR technology.

Results

The study examined 225 patients, including 135 with ET, 58 with PV, and 32 with PMF. JAK2V617F mutation loads significantly differed (P < .001) between the ET and PV groups and between the ET and PMF groups. Bone marrow biopsies were reclassified in accordance with the 2016 World Health Organization diagnostic criteria, which revealed 132 patients with MPN: 62 with ET, 35 with PV, 17 with pre‐PMF, and 18 with overt‐PMF. JAK2V617F mutation loads significantly differed (P < .001) between the ET and PV groups and between the ET and pre‐PMF groups. The cutoff value between the ET and pre‐PMF groups was 49.9.

Conclusion

JAK2V617F mutation loads provide an additional basis for diagnosis of ET, PV, and PMF, particularly regarding differentiation between ET and pre‐PMF.
Applying index of circulating anticoagulant to mixing tests with lupus anticoagulant screen and confirm reagents can distinguish with high specificity between lupus anticoagulants and direct factor Xa inhibitors
Authors: Kumano Osamu , Amiral Jean , Dunois Claire , Peyrafitte Marie , Moore Gary W.
Published: May 2021

Background

Lupus anticoagulants (LA) are detected by prolongation of clotting times for dilute Russell's viper venom time (dRVVT) and activated partial thromboplastin time (APTT) screening tests. Direct oral anticoagulants (DOACs) can interfere with both screening and confirmatory tests. The present study aimed to investigate the influence of direct factor Xa inhibitors (DiXaIs) on screen, confirm and mixing tests and establish a method for differentiation from other sample types.

Materials and methods

A total of 257 samples including nonanticoagulated LA positive, LA positive with DiXaIs, factor deficiency, FVIII inhibitors, warfarin and non‐APS DiXaIs were tested. APTT reagents Cephen LS/Cephen and dRVVT reagents LA1/LA2 were used, respectively, to screen/confirm the study group. Index of circulating anticoagulant (ICA) was calculated from clotting times based on the following formula as ICA screening and ICA confirmation. ICA= (1:1 Mix sample – Normal pooled plasma) / Screen patient x 100. An ICA matrix was established which suggested the presence of a DiXaI when both ICA screening and confirmation were above the cut‐off. When only ICA screening is elevated, LA is suspected.

Results

Sensitivity and specificity of the ICA matrix were 52.2% and 92.8% for DiXaIs and 38.1% and 96.7% for LA in APTT, and 61.2% and 92.9% for DiXaIs and 22.2% and 88.4% for LA in dRVVT, respectively.

Conclusion

The ICA matrix achieved high specificity with a lower apparent sensitivity for DiXaI samples comparatively to other devices but due only to less interferences: the matrix could contribute to differentiating DiXaIs from LA in samples where anticoagulation status is unknown.
Silicon attenuates abiotic stress caused by ammonium toxicity but not nitrogen deficiency in cotton plants
Authors: Leal Aguinaldo José Freitas , Barreto Rafael Ferreira , de Mello Prado Renato , da Silva Junior Gabriel Barbosa , Barreto Cláudio Ferreira , Santos Luiz Cláudio Nascimento dos , Campos Cid Naudi Silva
Published: May 2021

Although predominates in many soils, compared to , the fluctuations in the forms and concentrations of N can expose to N deficiency in plants in general and toxicity in sensitive plants. However, a strategy to mitigate nutritional disorders of N is to utilize Si. We aimed to verify if Si attenuates N deficiency and toxicity in cotton plants grown in nutrient solution. The treatments followed a 5 × 2 factorial scheme, with five concentrations of (1.0; 7.5; 15.0; 22.5 and 30.0 mmol/L) combined with the absence and presence of Si (1 mmol/L), arranged in a completely randomized design with four replications. Without Si, the largest shoot dry mass occurred at 16 mmol/L , increased by 47%, compared to 1 mmol/L and decreased by 37% compared to 30 mmol/L . With Si, the largest shoot dry mass was observed at 20 mmol/L , increased by 52% compared to 1 mmol/L and decreased by 14% compared to 30 mmol/L . In addition, in the highest concentration of , plants with Si exhibited a higher shoot dry mass relative to plants with no Si supplementation due to decreased electrolyte leakage index and increased use efficiency of N and K. Cotton plants were tolerant to high concentrations (≈15 mmol/L). Si attenuates abiotic stress caused by toxicity (30 mmol/L) but not N deficiency in cotton plants.
Development of the prediction model for hypertension in patients with idiopathic inflammatory myopathies
Authors: Qin Li , Zhang Yiwen , Yang Xiaoqian , Wang Han
Published: May 2021

Cardiac involvement is an important cause of morbidity and mortality in patients with idiopathic inflammatory myopathies (IIMs). Hypertension, an important cardiovascular risk factor for the general population, has a crucial role in heart involvement. However, few studies have focused on the hypertension associated with IIMs. This study aimed to develop and assess the prediction model for incident hypertension in patients with IIMs. A retrospective cohort study was performed on 362 patients with IIMs, of whom 54 (14.9%) were given a diagnosis of new‐onset hypertension from January 2008 to December 2018. The predictors of hypertension in IIMs were selected by least absolute shrinkage and selection operator (LASSO) regression, multivariable logistic regression, and clinically relevance, and then these predictors were used to draw the nomogram. Discrimination, calibration and clinical usefulness of the model were evaluated using the C‐index, calibration plot, and decision curve analysis, respectively. The predicting model was validated by the bootstrapping validation. The nomogram mainly included predictors such as age, diabetes mellitus, triglyceride, low‐density lipoprotein‐cholesterol (LDL‐C), antinuclear antibodies (ANA), and smoking. This prediction model demonstrated good discrimination with a C‐index of 0.754 (95%CI, 0.684 to 0.824) and good calibration. The C‐index of internal validation was 0.728, and decision curve analysis demonstrated that this nomogram was clinically useful. Clinicians can use this prediction model to assess the risk of hypertension in IIMs patients, and early preventive measures should be taken to reduce the incidence of hypertension in high‐risk patients.
Gastrodin induces lysosomal biogenesis and autophagy to prevent the formation of foam cells via AMPK‐FoxO1‐TFEB signalling axis
Authors: Tao Jun , Yang Ping , Xie Liqiu , Pu Yuwei , Guo Jiazhi , Jiao Jianlin , Sun Lin , Lu Di
Published: May 2021

Abnormal accumulation of lipids and massive deposition of foam cells is a primary event in the pathogenesis of atherosclerosis. Recent studies have demonstrated that autophagy and lysosomal function of atherosclerotic macrophages are impaired, which exacerbates the accumulation of lipid in macrophages and formation of foam cells. Gastrodin, a major active component of Gastrodia elata Bl., has exerted a protective effect on nervous system, but the effect of gastrodin on atherosclerotic vascular disease remains unknown. We aimed to evaluate the effect of gastrodin on autophagy and lysosomal function of foam cells and explored the mechanism underlying gastrodin's effect on the formation of foam cells. In an in vitro foam cell model constructed by incubating macrophages with oxygenized low‐density lipoproteins (ox‐LDL), our results showed that lysosomal function and autophagy of foam cells were compromised. Gastrodin restored lysosomal function and autophagic activity via the induction of lysosomal biogenesis and autophagy. The restoration of lysosomal function and autophagic activity enhanced cholesterol efflux from macrophages, therefore, reducing lipid accumulation and preventing formation of foam cells. AMP‐activated protein kinase (AMPK) was activated by gastrodin to promote phosphorylation and nuclear translocation of forkhead box O1 (FoxO1), subsequently resulting in increased transcription factor EB (TFEB) expression. TFEB was activated by gastrodin to promote lysosomal biogenesis and autophagy. Our study revealed that the effect of gastrodin on foam cell formation and that induction of lysosomal biogenesis and autophagy of foam cells through AMPK‐FoxO1‐TFEB signalling axis may be a novel therapeutic target of atherosclerosis.
Natural antioxidants to restore immediate bond strength to bleached enamel: Systematic review and meta‐analysis of in vitro studies
Authors: Rodríguez‐Barragué Juana , Vola‐Gelmini Joanna , Skuras‐Siedemburg Marcel , Rivera‐Gonzaga José Alejandro , Cuevas‐Suarez Carlos Enrique
Published: May 2021

Objective

To evaluate whether natural antioxidant treatment would enhance the immediate bond strength of dental adhesives to bleached enamel through a systematic review and meta‐analysis.

Materials and methods

Two reviewers performed a literature search up to November 2019 in seven databases. Only in vitro studies that evaluated the effect of the application of natural antioxidants in the bond strength of dental adhesives to bleached enamel were included. Analyses were carried out using RevMan 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A global analysis was performed with random‐effects models at a significance level of p < 0.05.

Results

Twenty‐four studies were included in the meta‐analysis. Both in‐office (p ˂ 0.001) and at‐home (p ˂ 0.001) bleaching reduced the immediate bond strength. When compared to bleached enamel, all antioxidants improved the bond strength, but only grape seed extract/proanthocyanidin and lycopene restored it to the control values (p ˃ 0.05).

Conclusion

In vitro available evidence suggests that the use of natural antioxidants can be beneficial when performing immediate resin‐based restorations after bleaching, however, these results should be taken with caution since they are based on medium and high risk of bias studies; low bias studies are needed to draw relevant conclusions.

Clinical significance

Despite the lack of clinical evidence, the present study confirms the benefits of applying natural antioxidant agents to enhance the in vitro bond strength when performing immediate esthetic restorations after bleaching. Since certain antioxidant agents proved more effective than others, clinical investigations may be focused on the ones that withhold the most promising results. The application of natural antioxidants after bleaching may enable immediate esthetic restorations to be performed.
Effect of splenectomy on the outcomes in patients with cirrhosis receiving transjugular intrahepatic portosystemic shunt
Authors: Yang Chongtu , Liu Jiacheng , Shi Qin , Huang Songjiang , Zhou Chen , Wang Yingliang , Li Tongqiang , Chen Yang , Xiong Bin
Published: May 2021

Background and Aim

Patients indicated to transjugular intrahepatic portosystemic shunt (TIPS) placement may have splenectomy history due to thrombocytopenia. This study aimed to evaluate the effect of prior splenectomy on TIPS procedure and post‐TIPS outcomes.

Methods

We conducted a longitudinal analysis based on a cohort of 284 patients with cirrhosis submitted to TIPS; 74 patients had splenectomy history (splenectomy group) and 210 did not (non‐splenectomy group). Cox proportional hazards models were used to evaluate the association between splenectomy and outcomes after TIPS. The primary outcome was shunt dysfunction. Secondary outcomes included all‐cause mortality, clinical recurrence of bleeding or ascites, and overt hepatic encephalopathy (OHE).

Results

During a median follow‐up of 16.2 months, the splenectomy group had significantly lower rates of postoperative shunt patency (85.5% vs 95.6% at 1 year and 75.2% vs 86.5% at 2 years; adjusted hazard ratio [HR] 2.53; 95% confidence interval [CI] 1.21–5.12; P = 0.01) and higher risk of OHE (adjusted HR 1.82; 95% CI 1.03–3.54; P = 0.04). But the risk of mortality (adjusted HR 0.87; 95% CI 0.41–1.87; P = 0.73) and recurrent bleeding or ascites (adjusted HR 1.17; 95% CI 0.53–2.35; P = 0.77) showed no statistical difference. Multivariate analysis confirmed splenectomy history and endoscopic therapy as independent predictors of shunt dysfunction. Besides, pre‐TIPS splenectomy increased the difficulty of TIPS procedure by complicating portal vein puncture.

Conclusions

For patients with cirrhosis submitted to TIPS, prior splenectomy complicated TIPS procedure and increased the risk of shunt dysfunction and OHE after TIPS, but was not significantly associated with the occurrence of mortality and recurrent bleeding or ascites.
sFlt‐1/PlGF ratio as a predictive and prognostic marker for preeclampsia
Authors: Jeon Hae Rin , Jeong Da Hoe , Lee Jin Young , Woo Eun Young , Shin Gwi Taek , Kim Suk‐Young
Published: May 2021

Objective

Preeclampsia is clinically unpredictable and associated with adverse outcomes. Pregnant women with suspected preeclampsia require intensive monitoring or hospitalization for elevated sFlt‐1 (soluble fms‐like tyrosine kinase‐1) to PlGF (placental growth factor) ratios before symptoms arise. We aimed to determine the sFlt‐1/PlGF ratio's usefulness in predicting adverse pregnancy outcomes in preeclampsia.

Methods

From January 2017 to February 2019, we measured the sFlt‐1/PlGF ratio in 73 singleton pregnant women suspected of preeclampsia and classified them into three groups: low‐risk (sFlt‐1/PlGF ratio < 38, n = 19), intermediate (38 ≤ ratio < 85, n = 9), and high‐risk (ratio ≥ 85, n = 32).

Results

Although the low‐ and high‐risk groups both experienced weight gain during pregnancy, their body mass index (BMI) differed after pregnancy (p = 0.004). The number of women who had been taking antihypertensive medications for chronic hypertension since early pregnancy was higher in the low‐risk group (31.6% vs. 22.2%, 6.7%). The gestational weeks at birth were lower in the high‐risk group compared to that of the low‐risk group (32.0 weeks vs. 35.79 weeks, p < 0.001). In the high‐risk group, the average neonatal weight was significantly lighter (p = 0.021), and the period of stay in the neonatal intensive care unit was longer than that in the low‐risk group (p = 0.003).

Conclusion

The sFlt‐1/PlGF ratio is a useful indicator of preeclampsia severity and can be utilized as a prognostic marker.
Molecular pathology in the cancer clinic – where are we now and where are we headed?
Authors: Guillen A. , Smallwood K. , Killick D. R.
Published: May 2021

Molecular pathology is a developing sub‐microscopic discipline of pathology that studies the effects of molecular variations and mutations on disease processes. The ultimate goal of molecular pathology in cancer is to predict risk, facilitate diagnosis and improve prognostication based on a complete understanding of the biological impact of specific molecular variations, mutations and dysregulations. This knowledge will provide the basis for customised cancer treatment, so‐called precision medicine. Rapid developments in genomics have placed this field at the forefront of clinical molecular pathology and there are already a number of well‐established genetic tests available for clinical use including PCR of antigen receptor rearrangement and KIT mutational analysis. Moving beyond tests assessing a single gene, there are significant research efforts utilising genomics to predict cancer risk, forecast aggressive behaviour and identify druggable mutations and therapeutic biomarkers. Researchers are also investigating the use of circulating cells and nucleic acid for clinically useful low morbidity genomic assessments. If we are to realise the full potential of molecular pathology and precision medicine there are a number of challenges to overcome. These include developing our understanding of the underlying biology (in particular intra‐tumoural heterogeneity), methodological standardisation of assays, provision of adequate infrastructure and production of novel therapeutics backed by high‐quality clinical data supporting the precision medicine approach. The era of molecular pathology holds the potential to revolutionise veterinary cancer care, but its impact on clinical practice will depend upon the extent to which the inherent challenges can be overcome.
Diversity of higher plants in China
Authors: Xie Dan , Liu Bo , Zhao Li‐Na , Pandey Tirtha Raj , Liu Hui‐Yuan , Shan Zhang‐Jian , Qin Hai‐Ning
Published: May 2021

The Species Catalogue of China: Volume 1: Plants (SCCP) is a new, comprehensive, hardcopy inventory of Chinese higher plants that combines several datasets and references to recent taxonomic treatments. The database, with all attached additional information, is freely accessible via the internet (http://www.sp2000.org.cn/) and on CD‐ROM, and will be updated yearly. It includes bryophytes (157 families, 599 genera, and 3167 specific and infraspecific taxa), lycophytes and ferns (41 families, 181 genera, and 2336 specific and infraspecific taxa), gymnosperms (10 families, 45 genera, and 311 specific and infraspecific taxa), and angiosperms (270 families, 3227 genera, and 35 873 specific and infraspecific taxa); in total 478 families, 4052 genera, and 41 687 specific and infraspecific taxa. Several other important statistics can also be drawn from the database, such as the distribution pattern of the four major groups of higher plants, as well as number of endemic and naturalized or cultivated genera/taxa. Entries in SCCP are also compared with Flora of China, and Flora reipublicae popularis Sinicae at the genus level. The SCCP will not only be a useful reference for floristic or biodiversity studies in China, but will also serve as a key resource to direct action and monitor progress. It is intended to be a useful resource for achieving Target 1 of the Global Strategy for Plant Conservation (GSPC).
Comparison of electromagnetic guided imagery to standard confirmatory methods for ascertaining nasogastric tube placement in children
Authors: Wathen Beth , McNeely Heidi L. , Peyton Christine , Pan Zhaoxing , Thomas Robin , Callahan Cayla , Fidanza Sara , Brown James , Neu Madalynn
Published: May 2021

Purpose

Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube.

Design and Methods

Pediatric Intensive Care Unit (PICU) patients were enrolled if they had an NGT order during the study period of April 2014 through December 2016. Patients were included if they were one through 18 years of age. An EMD trained nurse inserted the NGT using EMD guidance. An insertion questionnaire, confirming if the nurse determined the NGT to be gastric per EMD, was completed immediately after NGT placement and before confirmation via either pH testing or radiographic imaging.

Results

Forty‐five patients were enrolled in the study. Nurses reported, based on EMD, that 86.7% (n = 39) of placements were gastric. Overall agreement between EMD guided tube placement and pH testing was 58% (n = 26). The marginal distribution was significantly different between the two methods (p = .0029). When compared to radiographic confirmation, sensitivity of the pH method was 32% (95% confidence interval [CI]: 17%–51%) compared with 85% (95% CI 69%–95%) for the EMD method.

Conclusions

EMD guidance was superior to pH testing when compared with radiographic confirmation of nasogastric tube placement in children.

Practice Implications

EMD guided NGT placement is a potentially viable method for confirming nasogastric tube placement in children when done by appropriately trained clinicians. More research on EMD guided NGT placement in children is needed before any practice recommendation can be made.
Hepatitis E, what is the real issue?
Authors: Larrue Hélène , Abravanel Florence , Peron Jean‐Marie
Published: May 2021

Hepatitis E virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis with an estimated 3.3 million symptomatic cases every year and 44,000 related deaths. It is a waterborne infection in the developing countries. In these countries, HEV genotypes 1 and 2 cause large outbreaks and affect young subjects resulting in significant mortality in pregnant women and patients with cirrhosis. In developed countries, HEV genotypes 3 and 4 are responsible for autochthonous, sporadic hepatitis and transmission is zoonotic. Parenteral transmission by the transfusion of blood products has been identified as a potential new mode of transmission. HEV can also cause neurological disorders and chronic infections in immunocompromised patients. The progression of acute hepatitis E is usually asymptomatic and resolves spontaneously. Diagnosis is based on both anti‐HEV IgM antibodies in serum and viral RNA detection in blood or stools by PCR in immunocompetent patients, while only PCR is validated in immunocompromised individuals. Ribavirin is the only validated treatment in chronic infection. A vaccine has been developed in China.
Impacts of an egg intervention on nutrient adequacy among young Malawian children
Authors: Caswell Bess L. , Arnold Charles D. , Lutter Chessa K. , Iannotti Lora L. , Chipatala Raphael , Werner Elizabeth Rochelle , Maleta Kenneth M. , Stewart Christine P.
Published: May 2021

Eggs are a rich source of multiple nutrients that support child growth and development. Provision of eggs as a complementary food may improve dietary adequacy among young children at risk for undernutrition. Our objective was to test the impact of an egg intervention on the adequacy of total nutrient intakes and micronutrient density among 6‐ to 15‐month‐old Malawian children. Children 6 to 9 months old, living in Mangochi District, Malawi, were randomly assigned to the intervention group (n = 331) receiving an egg per day or a control group (n = 329) consuming their usual diet. Dietary intakes of macronutrients, vitamins and minerals were assessed using 24‐h recalls at baseline, 3‐month midline and 6‐month endline, with repeat recalls in a subsample. Usual nutrient intake and micronutrient density distributions were modelled to estimate group means and prevalence of inadequacy. Group differences at midline and endline were tested using unequal variancettests with bootstrapped standard errors. The egg intervention resulted in higher intakes of fat and protein and lower intakes of carbohydrates. The egg group had lower prevalence of inadequacy for selenium, vitamin A, riboflavin, vitamin B5, vitamin B12and choline. Micronutrient density inadequacy was lower in the egg group for vitamin A and choline at midline and endline, riboflavin at midline and vitamin B5at endline. Inadequacy of nutrient intakes or density remained highly prevalent in both groups for multiple micronutrients. Though the egg intervention increased intakes of protein and several micronutrients, total intakes and micronutrient density of multiple micronutrients remained far below recommendations.
Development of national dietary and lifestyle guidelines for pregnant women in Lebanon
Authors: Naja Farah , Ayoub Jennifer , Baydoun Samar , Nassour Sahar , Zgheib Pamela , Nasreddine Lara
Published: May 2021

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low‐ and middle‐income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed‐method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context‐specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture‐specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.
Transcription factor control of virulence in phytopathogenic fungi
Authors: John Evan , Singh Karam B. , Oliver Richard P. , Tan Kar‐Chun
Published: May 2021

Plant‐pathogenic fungi are a significant threat to economic and food security worldwide. Novel protection strategies are required and therefore it is critical we understand the mechanisms by which these pathogens cause disease. Virulence factors and pathogenicity genes have been identified, but in many cases their roles remain elusive. It is becoming increasingly clear that gene regulation is vital to enable plant infection and transcription factors play an essential role. Efforts to determine their regulatory functions in plant‐pathogenic fungi have expanded since the annotation of fungal genomes revealed the ubiquity of transcription factors from a broad range of families. This review establishes the significance of transcription factors as regulatory elements in plant‐pathogenic fungi and provides a systematic overview of those that have been functionally characterized. Detailed analysis is provided on regulators from well‐characterized families controlling various aspects of fungal metabolism, development, stress tolerance, and the production of virulence factors such as effectors and secondary metabolites. This covers conserved transcription factors with either specialized or nonspecialized roles, as well as recently identified regulators targeting key virulence pathways. Fundamental knowledge of transcription factor regulation in plant‐pathogenic fungi provides avenues to identify novel virulence factors and improve our understanding of the regulatory networks linked to pathogen evolution, while transcription factors can themselves be specifically targeted for disease control. Areas requiring further insight regarding the molecular mechanisms and/or specific classes of transcription factors are identified, and direction for future investigation is presented.
Registered nurses' experiences of working in the intensive care unit during the COVID‐19 pandemic
Authors: Bergman Lina , Falk Ann‐Charlotte , Wolf Axel , Larsson Ing‐Marie
Published: May 2021

Background

During the pandemic, increased numbers of patients requiring intensive care unit (ICU) admission required an increase in ICU capacity, including ICU staffing with competence to care for critically ill patients. Consequently, nurses from acute care areas were called in to staff the ICU along with experienced intensive care nurses.

Aims and objectives

To describe Swedish registered nurses' experiences of caring for patients with COVID‐19 in ICUs during the pandemic.

Design

Mixed method survey design.

Methods

An online questionnaire was distributed through social media to registered nurses who had been working in the ICU during the COVID‐19 outbreak. Data were collected for 1 week (May 2020) and analysed using content analysis and descriptive statistics.

Results

Of the 282 nurses who participated, the majority were ICU nurses (n = 151; 54%). Half of the nurses specialized in ICU reported that they were responsible for the ICU care of three or more patients during the pandemic (n = 75; 50%). Among non‐intensive care nurses, only 19% received introduction to the COVID‐19 ICU (n = 26). The analysis of data regarding nurses' experiences resulted in three categories: tumbling into chaos, diminished nursing care, and transition into pandemic ICU care. Participants described how patient safety and care quality were compromised, and that nursing care was severely deprioritized during the pandemic. The situation of not being able to provide nursing care resulted in ethical stress. Furthermore, an increased workload and worsened work environment affected nurses' health and well‐being.

Conclusions

The findings from the present study indicate that nurses perceived that patient safety and quality of care were compromised during the pandemic. This resulted in ethical stress among nurses, which may have affected their physical and psychosocial well‐being.

Relevance to clinical practice

The COVID‐19 pandemic had a severe impact on nurses' work environment, which could result in burnout and staff turnover.
Accuracy of automated identification of lateral cephalometric landmarks using cascade convolutional neural networks on lateral cephalograms from nationwide multi‐centres
Authors: Kim Jaerong , Kim Inhwan , Kim Yoon‐Ji , Kim Minji , Cho Jin‐Hyoung , Hong Mihee , Kang Kyung‐Hwa , Lim Sung‐Hoon , Kim Su‐Jung , Kim Young Ho , Kim Namkug , Sung Sang‐Jin , Baek Seung‐Hak
Published: May 2021

Objective

To investigate the accuracy of automated identification of cephalometric landmarks using the cascade convolutional neural networks (CNN) on lateral cephalograms acquired from nationwide multi‐centres.

Settings and sample population

A total of 3150 lateral cephalograms were acquired from 10 university hospitals in South Korea for training.

Materials and Methods

We evaluated the accuracy of the developed model with independent 100 lateral cephalograms as an external validation. Two orthodontists independently identified the anatomic landmarks of the test data set using the V‐ceph software (version 8.0, Osstem, Seoul, Korea). The mean positions of the landmarks identified by two orthodontists were regarded as the gold standard. The performance of the CNN model was evaluated by calculating the mean absolute distance between the gold standard and the automatically detected positions. Factors associated with the detection accuracy for landmarks were analysed using the linear regression models.

Results

The mean inter‐examiner difference was 1.31 ± 1.13 mm. The overall automated detection error was 1.36 ± 0.98 mm. The mean detection error for each landmark ranged between 0.46 ± 0.37 mm (maxillary incisor crown tip) and 2.09 ± 1.91 mm (distal root tip of the mandibular first molar). A significant difference in the detection accuracy among cephalograms was noted according to hospital (P = .011), sensor type (P < .01), and cephalography machine model (P < .01).

Conclusion

The automated cephalometric landmark detection model may aid in preliminary screening for patient diagnosis and mid‐treatment assessment, independent of the type of the radiography machines tested.
Effects of brief periods of clear vision on the defocus‐mediated changes in axial length and choroidal thickness of human eyes
Authors: Delshad Samaneh , Collins Michael J , Read Scott A , Vincent Stephen J
Published: May 2021

Purpose

To investigate the influence of brief, repeated periods of clear vision on the changes in axial length and choroidal thickness in response to short‐term imposed defocus.

Methods

The right eye of 16 young adults was exposed to 60 min episodes of continuous and interrupted defocus conditions (+3 DS and −3 DS) over five separate sessions, with the left eye optimally corrected for distance. For interrupted defocus, 2 min episodes of clear vision were imposed before each 15 min episode of myopic or hyperopic defocus (2/15 min). For hyperopic defocus, the effect of frequency of clear vision exposure was also assessed by imposing 1 min of clear vision before each 7.5 min of defocus (1/7.5 min). The right eye axial length and choroidal thickness were measured before, during and after each defocus condition.

Results

After 60 min of continuous hyperopic defocus the eye elongated significantly by +9 ± 9 μm (p = 0.02). When exposed to interrupted (2/15 min) hyperopic defocus, axial elongation was significantly reduced by 77% compared to continuous hyperopic defocus (p = 0.03), with a final change of only +2 ± 10 μm relative to baseline. During interrupted (1/7.5 min) hyperopic defocus, axial elongation reduced slightly compared to continuous hyperopic defocus (+6 ± 8 μm relative to baseline,p = 0.12). For continuous myopic defocus, a reduction in axial length occurred but was not statistically significant (p > 0.05). A similar pattern of response was observed for choroidal thickness changes with continuous and interrupted (1/7.5 min) hyperopic defocus conditions.

Conclusions

Brief periods of clear vision can diminish axial elongation and choroidal thinning induced by hyperopic defocus exposure in human eyes. If hyperopic defocus contributes to myopia progression in humans, then interruption with brief periods of clear vision could reduce its myopiagenic effects.
Long‐term incidence of upper extremity venous obstruction in implantable cardioverter defibrillator patients
Authors: Horlbeck Fritz W. , Eckerth Christopher , Linhart Markus , Schaefer Christian , Jakob Mark , Pingel Simon , Klarmann‐Schulz Ute , Nickenig Georg , Schwab Joerg O.
Published: May 2021

Background

Very little is known about the long‐term prevalence of severe venous obstruction and occlusion in patients with transvenous implantable cardioverter‐defibrillator leads. The objective of the current investigation was to elucidate the incidence and prevalence and to identify predisposing conditions in an ICD cohort over a long follow‐up period.

Methods

Based on a prospective database, we analyzed consecutive patients who received an ICD implantation in our hospital between 06/1988 and 2009 as well as all corresponding follow‐up data until 02/2018. Cavographies were used for analysis, and all patients with at least one device replacement and one follow‐up cavography were included.

Results

Over a mean follow‐up period of 94 ± 50 months, severe venous obstruction was found in 147 (33%) of 448 patients. Kaplan‐Meier analysis shows a severe obstruction or occlusion in 50% of patients after a period of 14.3 years. The total number of leads (p < .001, HR 2.01, CI 2.000–2.022), an advanced age (p = .004, HR 1.023 per year, CI 1.022–1.024) and the presence of dilated cardiomyopathy (p = .035, HR 1.49, CI 1.47–1.51) were predictive of venous obstruction whereas the presence of anticoagulation was not.

Conclusion

Severe obstruction of the access veins after ICD implantation occurs frequently and its prevalence shows a nearly linear increase over long‐time follow‐up. Multiple leads, an advanced age and DCM as underlying disease are associated with an increased risk of venous obstruction while the role of anticoagulation to prevent venous obstruction in ICD patients is unclear.
Group teletherapy for first‐episode psychosis: Piloting its integration with coordinated specialty care during the COVID‐19 pandemic
Authors: Wood Helen J. , Gannon Jessica M. , Chengappa K.N. Roy , Sarpal Deepak K.
Published: May 2021

Digital health has emerged in recent years as a tool to optimize care delivery and promote treatment adherence among individuals with first‐episode psychosis (FEP). Recent mandates for social distancing and sheltering in place due to the COVID‐19 pandemic have catapulted efforts to provide ongoing coordinated specialty care (CSC) on virtual platforms. While prior evidence provides support for the general implementation of virtual individual therapy, there is limited guidance and evidence for the adoption of group teletherapy. Here we describe our efforts to implement group teletherapy for two small cohorts of individuals with FEP receiving care in a coordinated specialty care clinic using methods adopted from Acceptance and Commitment Therapy. We observed high adherence with group visits as well as client satisfaction across groups. Based on our results, we have taken efforts to implement virtual group therapy more permanently in our clinic. Our experience provides guidance and a model for integration of virtual group therapy within CSC.

Practitioner points

In‐person group therapy can be adapted as an online treatment modality for individuals with first‐episode psychosis (FEP).

Group teletherapy is both accessible and satisfactory to individuals with FEP.

Group teletherapy has potential as a more standard and widespread treatment modality within coordinated specialty care for FEP.
Impulsiveness and suicide in male offenders: Examining the buffer roles of regulatory emotional self‐efficacy and flourishing
Authors: Mai Yiling , Yang Ruilai , Wu Xiaohua , Xie Zhaoming , Zhang Xin , Yang Xueling , Liu Huanhuan , Zhao Jiubo
Published: May 2021

Objectives

Although impulsiveness has been recognized as a risk factor for suicide, few studies have explored how to protect offenders with impulsiveness from the risk of suicide. This study aims to examine the relationships among impulsiveness, suicide risk, regulatory emotional self‐efficacy (RESE), and flourishing, focusing on the moderating effects of RESE and flourishing in the relationship between impulsiveness and suicide risk.

Design and methods

This is a cross‐sectional study of 941 male offenders. All participants were requested to provide some items of demographic information and to complete a package of self‐reported questionnaires measuring impulsiveness, suicide risk, RESE, and flourishing.

Results

The results indicate that impulsiveness is positively correlated with suicide risk, while RESE and flourishing are negatively correlated with impulsiveness and suicide risk. Most importantly, both RESE and its dimension managing negative affect (NEG) negatively moderate the relationship between impulsiveness and suicide risk. Flourishing and the RESE dimension expressing positive affect (POS) show no significant moderating effect on impulsiveness–suicide risk link.

Conclusions

Regulatory emotional self‐efficacy, especially its NEG dimension, can buffer the impact of impulsiveness on suicide risk in male offenders, indicating that these factors might be useful supplements in suicide prevention.

Practitioner points

Offender with higher level of RESE and flourishing show lower level of impulsiveness and suicide risk.

High level of RESE and its NEG dimension can buffer the effect of impulsiveness on suicide risk.

RESE, especially its NEG dimension might be a useful supplement for suicide prevention in offenders with high impulsiveness.
Understanding airspace in leaves: 3D anatomy and directional tortuosity
Authors: Harwood Richard , Théroux‐Rancourt Guillaume , Barbour Margaret M
Published: May 2021

The leaf intercellular airspace is a tortuous environment consisting of cells of different shapes, packing densities, and orientation, all of which have an effect on the travelling distance of molecules from the stomata to the mesophyll cell surfaces. Tortuosity, the increase in displacement over the actual distance between two points, is typically defined as encompassing the whole leaf airspace, but heterogeneity in pore dimensions and orientation between the spongy and palisade mesophyll likely result in heterogeneity in tortuosity along different axes and would predict longer traveling distance along the path of least tortuosity, such as vertically within the columnar cell matrix of the palisade layer. Here, we compare a previously established geometric method to a random walk approach, novel for this analysis in plant leaves, in four different Eucalyptus species. The random walk method allowed us to quantify directional tortuosity across the whole leaf profile, and separately for the spongy and palisade mesophyll. For all species tortuosity was higher in the palisade mesophyll than the spongy mesophyll and horizontal (parallel to the epidermis) tortuosity was consistently higher than vertical (from epidermis to epidermis) tortuosity. We demonstrate that a random walk approach improves on previous geometric approaches and is valuable for investigating CO2 and H2O transport within leaves.
COVID‐19 vaccine hesitancy among women leaving jails: A qualitative study
Authors: Geana Mugur V. , Anderson Sherri , Ramaswamy Megha
Published: May 2021

In many correctional facilities across the United States, COVID‐19 vaccine refusal rates are as high as 50%. Most women leaving jails have low SES, health literacy, and mistrust of governmental institutions, thus exacerbating existing health disparities and making women leaving jail vulnerable. Data from 25 interviews with recently released women suggest that interventions to promote vaccines to this population will have to address health education and mitigate mistrust, misinformation, and conspiracy theories.
Managing a Hybrid RDC‐DC Inventory System
Authors: Wang Tong , Yan Xiaoyue , Yang Chaolin
Published: May 2021

In this study, we study a hybrid RDC‐DC serial inventory system where the regional distribution center (RDC) replenishes its stock from an outside supplier (OS), while the distribution center (DC) faces random demand and replenishes its stock from the RDC. Unlike in the traditional serial system, the DC itself can replenish its inventory from outside as well. We firstly derive structural properties for the optimal long‐run average cost and the optimal stationary policy by vanishing discount approach, and then propose two simple and easy‐to‐implement policies. The first policy, which we call the three‐index policy, combines the characteristics of the echelon‐base‐stock policy for the serial system (Clark and Scarf. 1960. Management Sci.6(4): 475–490) and the dual‐index policy for the dual‐sourcing system (Veeraraghavan and Scheller‐Wolf. 2008. Oper. Res.56(4): 850–864). We show that the order‐up‐to level of the DC from the RDC can be computed by a newsboy fractile. A simulation‐based optimization procedure for the policy is provided. We then develop the approximate linear programming ( ALP) policy based on the three‐index policy and the multimodularity of the problem. This policy applies the linear programming approach to approximately solve the value function of the dynamic programming formulation. Numerical results show that both the three‐index policy and the ALP policy are comparable to the optimal policy computed via dynamic programming, and the latter performs slightly better. Moreover, the OS of the DC can draw considerable cost savings under both policies. We also conduct a numerical study with problem parameters calibrated using actual data from a consumer goods company in China to glen insights on the management of the system.