bluuebunny/crossref_metadata_2025 huggingface dataset:
Breastfeeding challenges among Thai adolescent mothers: hidden breastfeeding discontinuation experiences
Authors: Nuampa Sasitara , Chanprapaph Pharuhas , Tilokskulchai Fongcum , Sudphet Metpapha
Published: November 2020

Purpose

The purpose of this study was to explore the experiences of adolescent mothers who wean their babies from breastfeeding before the first six months from the perspective of a psychosocial aspect in the Thai context.

Design/methodology/approach

A descriptive qualitative design was applied to this study to obtain meaningful data. The adolescent mothers for the primary study and nine supplementary participants were recruited from the largest university hospital in Bangkok, Thailand. Semi-structured in-depth interviews were conducted with 20 adolescent mothers. Descriptive statistics and content analysis were used for data analysis.

Findings

The average breastfeeding duration was 3.1 months while breastfeeding exclusively lasted 1.3 months. More than half of the adolescent mothers encountered breastfeeding problems at hospitalization including sore/cracked nipples (63.6%), one side breastfeeding (27.3%) and exhaustion (9.1%). According to the content analysis, (1) breastfeeding obstacles concealed by the adolescents' dependence and (2) repetitive emotional mistakes encountered were the two main themes that emerged.

Originality/value

The influence of key family members plays a vital role in breastfeeding and psychological outcomes. Therefore, family-adolescent support programs including support from the adolescents' mothers and grandmothers may improve breastfeeding outcomes, yield positive emotions and enhance maternal attachment. Moreover, healthcare professions are important mediators to convince adolescent mothers' key family members to reach an agreement and provide suitable support.
Optimizing competitive performance of service firms in data-rich environment
Authors: Rahman Muhammad Sabbir , Hossain Md Afnan , Abdel Fattah Fadi Abdel Muniem , Akter Shahriar
Published: November 2020

Purpose

The marketing information system (MkIS) in the data-rich business environment receives all the attention these days, but as essential and perhaps even more essential is the marketing information system management capability (MkISMC). Although many service firms apprehend the return from MkIS, others clearly struggle. It seems that MkIS management capability dynamics and their direct/indirect holistic influence on service firm's competitive performance (SFCP) are unsolved in the current data-driven service economy. This study aims to conceptualize a model and test the antecedents on service firms' competitive performance.

Design/methodology/approach

This study utilizes a survey of a sizeable sample of service firms’ managers at the firm level. A total of 250 useable responses were obtained and analyzed through structural equation modeling.

Findings

Results reveal that variables under their respective direct influences are positively and significantly related. Interestingly, MkISMC has a relatively large magnitude of positive and direct effects on service firms' competitive performance. The other variables, such as the use of marketing analytics (UMAN), service innovation and management (SINM), partially mediate the effect of MkISMC on the competitive performance of service firms.

Practical implications

The findings inform practitioners that MkISMC, UMAN and SINM play a vital role in attaining service firms' competitive performance in the data-rich environment. Overall, it deepens the understanding of the mediation effect of UMAN and SINM of service firms on competitive performance.

Originality/value

The study advances theoretical understanding of resource-based view (RBV), market orientation and dynamic capability that formulate the relationship of MkISMC, UMAN and SINM in attaining SFCP in the ever-changing data-driven business economy.
Global trends in a fragile context: public–nonpublic collaboration, service delivery and social innovation
Authors: Bozic Aleksandar
Published: November 2020

Purpose

This study aims to enhance the understanding of the nature of collaboration between public and nonpublic actors in delivering social services and achieving social innovation in a fragile context, with an emphasis on the role of civil society organisations (CSOs). The paper focuses on Bosnia and Herzegovina, a Southeastern European country which has faced a turbulent post-conflict transition and experienced challenges in its social welfare policy and practice.

Design/methodology/approach

This study uses institutional theory, particularly new institutionalism and institutional networking, as a lens through which to understand public and nonpublic collaboration and social innovation within a fragile context. This study adopts a sequential mixed-method approach. Data were derived from 15 semi-structured interviews with representatives from local CSOs, international donors and public institutions, as well as a survey of 120 CSO representatives.

Findings

The collaboration and social innovation in a fragile welfare context have been initiated primarily by nonpublic actors and developed within the triple context of relations between public, civil and foreign donors’ organisations. In such a context, coercive, normative and mimetic isomorphisms act as leading drivers, but also as potential barriers of public–nonpublic collaboration and social innovation. They are triggered by influences from multiple actors, challenging power relations and external pressures on local CSOs.

Originality/value

The paper contributes to the growing research interest in the role of nonpublic actors in the provision of public services and public social innovation, but examines these issues from the perspective of a fragile context, which has thus far been overlooked in the literature.
Simulated Indigenous fire stewardship increases the population growth rate of an understorey herb
Authors: Hart‐Fredeluces G. M. , Ticktin Tamara , Lake Frank K.
Published: November 2020

Understanding how plant populations respond to multiple drivers is increasingly critical for biodiversity conservation under global change. Indigenous knowledge can provide guidance for sustainable management, but the outcome of its application in novel ecosystems is rarely known. Simulating the re‐introduction of Indigenous stewardship in contemporary contexts with population models allows for the comparison of different management scenarios and the elucidation of the mechanisms driving population outcomes.

Beargrass Xerophyllum tenax is an ecologically and culturally important understorey plant managed through fire and leaf harvest by Native Americans. We collected demographic and abiotic data on beargrass over 3 years across fire severities in nine populations and conducted an experiment to simulate Native American leaf gathering. These data were used to build integral projections models (IPMs) with soil moisture and light availability as covariates. With these IPMs, we simulated stochastic population growth rates across future fire and leaf harvest scenarios. We then decomposed our simulation results using stochastic life table response experiments (SLTREs).

The ‘no fire’ and ‘business as usual’ (180‐year fire return interval, 58% probability of high‐severity fire) scenarios resulted in lower population growth rates than ‘Indigenous fire stewardship’ (10‐year fire return interval, 10% chance of high‐severity fire). SLTREs revealed that Indigenous stewardship led to higher beargrass population growth rates due to greater fire frequency, higher adult survival and increased vegetative reproduction. Fire also interacted with harvest in the simulations; leaf harvest increased population growth rate only in combination with Indigenous fire stewardship.

Synthesis. Stochastic and retrospective population dynamics tools combined with an understanding of Indigenous management practices allow for the comparison of future socio‐ecological scenarios as well as mechanistic understanding of differences between scenarios. Simulated Indigenous stewardship supported the long‐term persistence of X. tenax populations while business as usual and no fire did not. The benefits of Indigenous stewardship to population dynamics, and the complexity of interactive effects of multiple drivers, provide further impetus for collaboration across Indigenous and western knowledge systems. Xerophyllum tenax is presented as a model system to explore the influence of Indigenous stewardship, or its absence, on population dynamics.
Long‐term empirical evidence, early warning signals and multiple drivers of regime shifts in a lake ecosystem
Authors: Su Haojie , Wang Rong , Feng Yuhao , Li Yanling , Li Yun , Chen Jun , Xu Chi , Wang Shaopeng , Fang Jingyun , Xie Ping
Published: November 2020

Catastrophic regime shifts in various ecosystems are increasing with the intensification of anthropogenic pressures. Understanding and predicting critical transitions are thus a key challenge in ecology. Previous studies have mainly focused on single environmental drivers (e.g. eutrophication) and early warning signals (EWSs) prior to population collapse. However, how multiple environmental stressors interact to shape ecological behaviour and whether EWSs were detectable prior to the recovery process in lake ecosystems are largely unknown.

We present long‐term empirical evidence of the critical transition and hysteresis with the combined pressures of climate warming, eutrophication and trophic cascade effects by fish stocking in a subtropical Chinese lake in the Yangtze floodplain. The catastrophic regime shifts are cross‐validated by 64‐year multi‐trophic level monitoring data and paleo‐diatom records.

We show that EWSs are detectable in both the collapse and recovery trajectories and that including body size information in composite EWSs requires shorter time‐series data and can improve the predictive ability of regime shifts. Although full recovery has not yet been observed, EWSs prior to recovery provide us with the opportunity to take measures for a clear‐water regime.

Climate warming and top‐down cascade effects have a negative influence on water clarity by altering lower trophic level abundance and body size, which, in turn, have a negative effect on macrophyte abundance. Furthermore, we identify a shift in the dominant driving forces from bottom‐up to top‐down after regime shifts, decoupling the relationships between nutrients and biological components and thus decreasing the efficiency of nutrient reduction.

Synthesis. This study provides new insights into ecological hysteresis under multiple external stressors and improves our understanding of trait‐based early warning signals in both the collapse and recovery processes in natural freshwater ecosystems. For management practice, our work suggests that slowing down climate warming and weakening the fish predation pressure on food webs are necessary to increase the effectiveness of nutrient reduction in the restoration of lakes.
A distinct ecotonal tree community exists at central African forest–savanna transitions
Authors: Cardoso Anabelle W. , Oliveras Imma , Abernethy Katharine A. , Jeffery Kathryn J. , Glover Sarah , Lehmann David , Edzang Ndong Josué , White Lee J. T. , Bond William J. , Malhi Yadvinder
Published: November 2020

Global change is expected to increase savanna woody encroachment as well as fire spreading into forest. Forest–savanna ecotones are the frontier of these processes and can thus either mitigate or enhance the effects of global change. However, the ecology of the forest–savanna ecotone is poorly understood. In this study, we determined whether a distinct ecotonal tree community existed between forest and savanna. We then evaluated whether the ecotonal tree community was more likely to facilitate fire spreading into the forest, woody encroachment of the savanna or the stabilisation of both forest and savanna parts of the landscape.

We sampled 28 vegetation transects across forest–savanna ecotones in a central African forest–savanna mosaic. We collected data on the size and species of all established (basal diameter >3 cm) trees in each transect. Split moving window dissimilarity analysis detected the location of borders delineating savanna, ecotone and forest tree communities. We assessed whether the ecotonal tree community was likely to facilitate fire spreading into the forest by burning experimental fires and evaluating shade and grass biomass along the transects. To decide whether the ecotone was likely to facilitate woody encroachment of the savanna, we evaluated if ecotonal tree species were forest pioneers.

A compositionally distinct and spatially extensive ecotonal tree community existed between forest and savanna. The ecotonal tree community did not promote fire spreading into forest and instead acted as a fire buffer, shading out flammable grass biomass from the understorey and protecting the forest from 95% of savanna fires. The ecotone helped stabilise the forest–savanna mosaic by allowing the fire‐dependant savanna to burn without exposing the fire‐sensitive forest to lethal temperatures.

The ecotonal tree community was comprised of many forest pioneer species that will promote woody encroachment in the savanna, especially if fire frequency is decreased.

Synthesis. A distinct fire‐buffering ecotonal tree community in this forest–savanna mosaic landscape illustrated that savanna fires are unlikely to compromise forest integrity. Conversely, suppression of fire in this landscape will likely lead to loss of savanna as the ecotone becomes the frontier of woody encroachment. Regular burning is essential for the preservation of this forest–savanna mosaic.
Anti‐carbamylated protein and peptide antibodies as potential inflammatory joint biomarkers in the relatives of rheumatoid arthritis patients
Authors: Chila‐Moreno Lorena , Rodríguez Luz‐Stella , Bautista‐Molano Wilson , Bello‐Gualtero Juan‐Manuel , Ramos‐Casallas Alejandro , Romero‐Sánchez Consuelo
Published: November 2020

Objective

Antibodies against carbamylated proteins/peptide (CarP) have been associated with severity in rheumatoid arthritis (RA) patients. However, their role in risk groups, specific targets and relation with periodontal disease (PD) is uncertain yet. The aim of this study was evaluated the association between the levels of anti‐CarP with clinical manifestation, human leukocyte antigen (HLA) alleles, periodontal activity markers, PD diagnosis, PD severity, and presence of Porphyromonas gingivalis (P gingivalis) in relatives of patients with RA.

Methods

One hundred and twenty‐four individuals with a family history of RA in first‐degree relatives (FDR) and 124 healthy individuals gender‐ and age‐matched, RA activity was assessed. Antibodies against carbamylated protein anti‐FCS‐Carp and 2 carbamylated peptides of fibrinogen were selected (anti‐Ca‐Fib2, anti‐Ca‐Fib3).

Results

Anti‐FCS‐Carp‐positive, anti‐Ca‐Fib2 and anti‐Ca‐Fib3 were more frequent in FDR than controls (25.0% vs 14.5%, 34.7% vs 15.3% and 33.1% vs 11.3%, respectively). Anti‐FCS‐CarP were associated with the HLA‐DRB1‐SE* 1402 allele (P = .035) and highly sensitive C‐reactive protein levels (P = .016), the anti‐Ca‐Fib2 antibodies were associated with the HLA‐DRB1‐SE* 1501 allele (P = .03), with non‐SE* 0901 allele (P = .01), the anti‐Ca‐Fib3 was associated with positive rheumatoid factor (P = .0012). The FDR condition was associated with the presence of anti‐Ca‐Fib3 (odds ratio [OR] =4.7; 95% CI = 1.8‐11.7; P = .001) and painful joints (OR = 2.2; 95% CI = 1.01‐4.68; P = .045); we also detected an important trend toward the presence of P gingivalis (OR = 1.9; 95% CI = 0.9‐3.7; P = .062).

Conclusion

The presence of anti‐FCS‐Carp, anti‐Ca‐Fib3 and anti‐Ca‐Fib2 antibodies may have a role for these antibodies as early biomarkers in the development of RA, probably including additional mechanisms related with other non‐SE alleles; the anti‐peptide antibodies proposed in the present study may represent a simpler way to identify antibodies directed to a specific target.
Disrupting the Rhythms of Violence: Anti‐port Protests in the City of Buenaventura
Authors: Jenss Alke
Published: November 2020

This contribution draws on rhythmanalysis and the political economy of assemblage to provide a framework for understanding the productive spatio‐temporal effects of physical violence on urban rhythms. The paper explores how Buenaventura, Colombia's biggest port city, is transformed both by the growth in container turnover, and through recurring, spatial and temporal practices of violence. What role does violence play in the relation between trade‐driven acceleration through the port, and the aquatic, tidal rhythm that historically shaped the city? The contribution mobilizes the notion of disruption to analyse the frictions emerging between infrastructural nodes of acceleration, inhabitants’ movements, and urban space. I argue that while recurring violence provides urban rhythm itself, social movements may employ the temporal instrument of disruption as a means both of political articulation and transformation within the logics of accelerated accumulation and in a context marked by violent rhythms and forced mobility.
Effect of penicillin allergy on prophylactic antibiotic administration in the parturient undergoing cesarean delivery
Authors: Lange Samantha M. , Sharpe Emily E. , Hertzfeldt Dana N. , Schroeder Darrell R. , Sviggum Hans P.
Published: November 2020

Background

Administering antibiotics is often difficult in patients with specific medication allergies. This investigation aimed to determine if a penicillin or cephalosporin allergy increased the risk for not receiving correct timing of prophylactic antibiotics at cesarean delivery. We hypothesized that patients with a penicillin or cephalosporin allergy would be less likely to receive antibiotics prior to incision for cesarean delivery.

Methods

All women undergoing cesarean delivery at Mayo Clinic Hospital, from 1 March 2008, to 28 February 2018 were retrospectively identified by electronic medical record query. Patients were grouped based on allergy status to penicillin/cephalosporins. Data recorded included the type and time of antibiotic given in relation to surgical incision. The primary outcome of this study was administration of antibiotics within 60 minutes prior to surgical incision. Characteristics potentially associated with the primary outcome were assessed using logistic regression.

Results

Of the 818 patients with a penicillin or cephalosporin allergy, 75 (9.2%) did not receive prophylactic antibiotic within 60 minutes prior to skin incision. Conversely, 326 (6.9%) of the 4744 patients without a penicillin or cephalosporin allergy did not receive their prophylactic antibiotic within 60 minutes prior to skin incision (P = .019). Patients undergoing an emergent cesarean delivery were also at an increased risk of not receiving their prophylactic antibiotic within 60 minutes prior to skin incision (P < .001).

Conclusion

Patients with a penicillin or cephalosporin allergy were less likely to receive prophylactic antibiotics within the recommended 60 minutes prior to surgical incision. Clear plans and communication are important for ensuring proper antibiotic administration at cesarean delivery to prevent surgical site infection.
Effect of deposit mobilization on the technical efficiency of rural saving and credit cooperatives: Evidence from Ethiopia
Authors: Duguma Girma Jirata , Han Jiqin
Published: November 2020

Rural Savings and Credit Cooperatives (RuSACCOs) are small‐scale financial service provider enterprises in rural areas. They foster local economic development by mobilizing deposits and lending these out to individuals, families, farmers, and small businesses in the same area. Using balanced panel data of 457 RuSACCOs from Ethiopia over the period 2014–17, we show how deposit mobilization affects technical efficiency. Our first stage efficiency estimate by Data Envelopment Analysis (DEA) Window model shows the average efficiency of RuSACCOs gradually increased over time. The second stage Tobit censored estimation and bootstrapped truncated regression results confirms our hypotheses for key and control variables effects on technical efficiency. Focusing on rapid expansion during the early life cycle affects technical efficiency. A high percentage of women membership in cooperative enterprises advances technical efficiency. Furthermore, attracting and including all segments of the local entrepreneurial class as a membership opens the possibilities for mobilizing more deposits to become efficient.
Human papilloma virus vaccination in males: A pharmacovigilance study on the Vaccine Adverse Event Reporting System
Authors: Bonaldo Giulia , Montanaro Nicola , Vaccheri Alberto , Motola Domenico
Published: November 2020

Aims

Human papilloma virus (HPV) is 1 of the most common sexually transmitted infection responsible for different types of cancer: cervical, penile, vulvar, anal and oropharyngeal. It can affect both males and females. Our aim was to enrich the knowledge on the safety profiles of HPV vaccines in the male population.

Methods

We reviewed all the reports of adverse events following immunization (AEFI) present in the US Vaccine Adverse Event Reporting System from 1 January 2006 to 30 September 2018. Statistical data mining was performed using the reporting odds ratio with 95% confidence interval in order to detect disproportionality in reporting.

Results

A total of 5493 reports of AEFI were retrieved. The events most reported and that proportionally occurred more frequently with HPV vaccines than with others in males were: syncope (n = 701, reporting odds ratio = 2.85, 95% confidence interval [1.41–5.76p), loss of consciousness (n = 425, 2.79 [1.36–5.72]) and fall (n = 272, 3.54 [2.00–6.26]).

Conclusion

Most of the AEFIs were already reported in premarketing clinical trials and acknowledged for the corresponding vaccines. A disproportionate reporting was found for some of these events including syncope. The HPV vaccines are generally well tolerated in males, although limitations own of spontaneous reporting should be considered.
The discovery of the Younger Dryas, and comments on the current meaning and usage of the term
Authors: Mangerud Jan
Published: November 2020

The Younger Dryas (YD) cold event was discovered in Denmark by Hartz and Mithers in 1904 and the term coined by Hartz in 1912. It was identified as a lacustrine clay bed containing plant macrofossils of an Arctic flora, including Dryas octopetala, and lying between Allerød and Holocene gyttjas containing a warmer flora with birch trees. The YD is unique in the sense that it is the largest and most abrupt climate change on Earth since the Last Glacial Maximum and thus within the reach of radiocarbon dating. Yet, I consider it is part of a regular Dansgaard‐Oeschger event. The term has been used for a climate event and for lithostratigraphical, biostratigraphical and several other stratigraphical units. I prefer using it as a geochronological and chronostratigraphical unit, i.e. that the YD represents a specific period of geological time and the rocks and sediments formed during this period. In the type area of southern Scandinavia, the YD chron represents the age and duration of the cold event.
Immigrant earnings returns to post‐migration education: Evidence for Canada, 1999–2013
Authors: Ci Wen , Laing Michelle , Voia Marcel , Worswick Christopher
Published: November 2020

Using the recently created Canadian Employer–Employee Dynamics Database (CEEDD), we analyze the earnings returns to investments in post secondary education by immigrants made after arrival in Canada. Fixed effects estimation results suggest that postsecondary education (PSE) in Canada increases annual earnings of men and women by 21.9% and 32.8%, respectively, for those enrolled full time and by 11.2% and 21.0% for those enrolled part time, respectively. Earnings effects of PSE are larger for immigrants admitted in the skilled worker category relative to family class immigrants and to refugees and are increasing in the level of education of the immigrants at landing. Immigrants from non‐traditional source countries generally have larger returns to PSE than immigrants from English‐language source countries, such as the US and the countries of Northwestern Europe.
The distribution of returns from land efficiency improvement in multistage production systems
Authors: Awada Lana , Phillips Peter W. B.
Published: November 2020

This paper assesses the distributional consequences of technical changes that improve the efficiency of land and of other inputs in a multifactor crop‐production system. We introduced an equilibrium displacement model (EDM) by using the specification of a factor‐augmenting approach. Given the uncertainty about the EDM parameters, a Monte Carlo simulation is used to produce a distribution of possible return measures. We found that land suppliers (likely farmers) receive a larger share (73%) of total benefits from the adoption of land‐technical change than they do from the adoption of other input technologies. Each input supplier receives a larger share of total benefits from technical change in her own input. However, this result is sensitive to the value of the parameters, especially the value of the elasticity of substitution. We applied the EDM to the case of no‐tillage (NT) to provide insight into how the aggregate return from the adoption of NT was distributed among different groups on the Canadian Prairies. The results of this study can be used by policymakers and funding agencies in order to influence landowners and farming communities to adopt environmentally sound land technologies to achieve both greater agricultural productivity and sustainability.
Pig kidney xenotransplantation: Progress toward clinical trials
Authors: Cooper David K. C. , Hara Hidetaka , Iwase Hayato , Yamamoto Takayuki , Wang Zheng‐Yu , Jagdale Abhijit , Bikhet Mohamed H. , Nguyen Huy Q. , Foote Jeremy B. , Paris Wayne D. , Ayares David , Kumar Vineeta , Anderson Douglas J. , Locke Jayme E. , Eckhoff Devin E.
Published: November 2020

Pig organ xenotransplantation offers a solution to the shortage of deceased human organs for transplantation. The pathobiological response to a pig xenograft is complex, involving antibody, complement, coagulation, inflammatory, and cellular responses. To overcome these barriers, genetic manipulation of the organ‐source pigs has largely been directed to two major aims—(a) deletion of expression of the known carbohydrate xenoantigens against which humans have natural (preformed) antibodies, and (b) transgenic expression of human protective proteins, for example, complement‐ and coagulation‐regulatory proteins. Conventional (FDA‐approved) immunosuppressive therapy is unsuccessful in preventing an adaptive immune response to pig cells, but blockade of the CD40:CD154 costimulation pathway is successful. Survival of genetically engineered pig kidneys in immunosuppressed nonhuman primates can now be measured in months. Non‐immunological aspects, for example, pig renal function, a hypovolemia syndrome, and rapid growth of the pig kidney after transplantation, are briefly discussed. We suggest that patients on the wait‐list for a deceased human kidney graft who are unlikely to receive one due to long waiting times are those for whom kidney xenotransplantation might first be considered. The potential risk of infection, public attitudes to xenotransplantation, and ethical, regulatory, and financial aspects are briefly addressed.
Adverse outcomes after major surgery in children with intellectual disability
Authors: Huang Shih‐Yu , Chang Chuen‐Chau , Lin Chao‐Shun , Yeh Chun‐Chieh , Lin Jui‐An , Cherng Yih‐Giun , Chen Ta‐Liang , Liao Chien‐Chang
Published: November 2020

Aim

To evaluate outcomes after major surgery in children and adolescents with intellectual disability.

Method

We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220 292 surgical patients aged 6 to 17 years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21 730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30‐day mortality associated with intellectual disability.

Results

Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48–3.15; p<0.001), sepsis (OR 1.67, 95% CI 1.28–2.18; p<0.001), and 30‐day mortality (OR 2.04, 95% CI 1.05–3.93; p=0.013) compared with children without intellectual disability. Children with intellectual disability also had longer lengths of hospital stay (p<0.001) and higher medical expenditure (p<0.001) when compared with children with no intellectual disability.

Interpretation

Children with intellectual disability experienced more complications and higher 30‐day mortality after surgery when compared with children without intellectual disability. There is an urgent need to revise the protocols for the perioperative care of this specific population.

What this paper adds

Surgical patients with intellectual disability are at increased risk of postoperative pneumonia, sepsis, and 30‐day mortality.

Intellectual disability is associated with higher medical expenditure and increased length of stay in hospital after surgical procedures.

The influence of intellectual disability on postoperative outcomes is consistent in both sexes and those aged 10 to 17 years.

Low income and a history of fractures significantly impacts postoperative adverse events for patients with intellectual disability.
Sunflower syndrome: a poorly understood photosensitive epilepsy
Authors: Geenen Kennedy R , Patel Sandip , Thiele Elizabeth A
Published: November 2020

Sunflower syndrome is a rare photosensitive epilepsy which has received little attention in recent medical literature. The historical cases documenting the epilepsy's stereotyped handwaving motion in front of light characterized the behavior as self‐inducing seizures via mimic of stroboscopic effect. However, the relationship between handwaving episodes and attendant generalized electroencephalogram abnormalities, and an appreciation of the compulsive attraction the sun and other light sources hold for these patients, suggest the handwaving motion may be a part of the seizure rather than a mechanism of self‐induction. The lack of awareness of Sunflower syndrome often leads to misdiagnosis. The seizures are often refractory to traditional anticonvulsant medication, and patients resort to behavioral intervention, such as hats and sunglasses, to reduce handwaving episodes. Further study is required to determine the syndrome's natural history and to identify more effective treatment options.

What this paper adds

Sunflower syndrome is a rare condition that is often misdiagnosed.

Awareness of the clinical and electroencephalogram characteristics of Sunflower syndromemay reduce the prevalence of misdiagnosis.
Impact of routine clinic measurement of serum C‐peptide in people with a clinician‐diagnosis of type 1 diabetes
Authors: Foteinopoulou Evgenia , Clarke Catriona A. L. , Pattenden Rebecca J. , Ritchie Stuart A. , McMurray Emily M. , Reynolds Rebecca M. , Arunagirinathan Ganesan , Gibb Fraser W. , McKnight John A. , Strachan Mark W. J.
Published: November 2020

Aims/hypothesis

The aim of this study was to determine the impact of the routine use of serum C‐peptide in an out‐patient clinic setting on individuals with a clinician‐diagnosis of type 1 diabetes.

Methods

In this single‐centre study, individuals with type 1 diabetes of at least 3 years duration were offered random serum C‐peptide testing at routine clinic review. A C‐peptide ≥200 pmol/L prompted further evaluation of the individual using a diagnostic algorithm that included measurement of islet cell antibodies and genetic testing. Where appropriate, a trial of anti‐diabetic co‐therapies was considered.

Results

Serum C‐peptide testing was performed in 859 individuals (90% of the eligible cohort), of whom 114 (13.2%) had C‐peptide ≥200 pmol/L. The cause of diabetes was reclassified in 58 individuals (6.8% of the tested cohort). The majority of reclassifications were to type 2 diabetes (44 individuals; 5.1%), with a smaller proportion of monogenic diabetes (14 individuals; 1.6%). Overall, 13 individuals (1.5%) successfully discontinued insulin, while a further 16 individuals (1.9%) had improved glycaemic control following the addition of co‐therapies. The estimated total cost of the testing programme was £23,262 (~€26,053), that is, £27 (~€30) per individual tested. In current terms, the cost of prior insulin therapy in the individuals with monogenic diabetes who successfully stopped insulin was approximately £57,000 (~€64,000).

Conclusions/interpretation

Serum C‐peptide testing can easily be incorporated into an out‐patient clinic setting and could be a cost‐effective intervention. C‐peptide testing should be strongly considered in individuals with a clinician‐diagnosis of type 1 diabetes of at least 3 years duration.
Cholinergic modulation of Up–Down states in the mouse medial entorhinal cortex in vitro
Authors: Hay Y. Audrey , Jarzebowski Przemyslaw , Zhang Yu , Digby Richard , Brendel Viktoria , Paulsen Ole , Magloire Vincent
Published: November 2020

Cholinergic tone is high during wake and rapid eye movement sleep and lower during slow wave sleep (SWS). Nevertheless, the low tone of acetylcholine during SWS modulates sharp wave ripple incidence in the hippocampus and slow wave activity in the neocortex. Linking the hippocampus and neocortex, the medial entorhinal cortex (mEC) regulates the coupling between these structures during SWS, alternating between silent Down states and active Up states, which outlast neocortical ones. Here, we investigated how low physiological concentrations of acetylcholine (ACh; 100–500 nM) modulate Up and Down states in a mEC slice preparation. We find that ACh has a dual effect on mEC activity: it prolongs apparent Up state duration as recorded in individual cells and decreases the total synaptic charge transfer, without affecting the duration of detectable synaptic activity. The overall outcome of ACh application is excitatory and we show that ACh increases Up state incidence via muscarinic receptor activation. The mean firing rate of principal neurons increased in around half of the cells while the other half showed a decrease in firing rate. Using two‐photon calcium imaging of population activity, we found that population‐wide network events are more frequent and rhythmic during ACh and confirmed that ACh modulates cell participation in these network events, consistent with a role for cholinergic modulation in regulating information flow between the hippocampus and neocortex during SWS.
Nietzsche, Spinoza, and Etiology (On the Example of Free Will)
Authors: Yonover Jason Maurice
Published: November 2020

In this paper I clarify a major affinity between Nietzsche and Spinoza that has been neglected in the literature—but that Nietzsche was aware of—namely a tendency to etiology. Etiologies provide follow‐up, second‐order explanations of first‐order matters that have already otherwise been decided. The example I take up here is Nietzsche's and Spinoza's rejections of free will—and especially their etiologies concerning how we wrongly come to think that we may boast of such a capacity. In working through the former (i.e., their rejections of free will) in order to make my central metaphilosophical point regarding the latter (i.e., their accounts of why we generally affirm that we have free will), I shed important new light on Nietzsche's relation to Spinoza. I also further our understanding of what role such second‐order accounts play within each of their larger projects on their own terms.
Recovery disparity between coral cover and the physical functionality of reefs with impaired coral assemblages
Authors: González‐Barrios F. Javier , Cabral‐Tena Rafael A. , Alvarez‐Filip Lorenzo
Published: November 2020

The ecology and structure of many tropical coral reefs have been markedly altered over the past few decades. Although long‐term recovery has been observed in terms of coral cover, it is not clear how novel species configurations shape reef functionality in impaired reefs. The identities and life‐history strategies of the corals species that recover are essential for understanding reef functional dynamics. We used a species identity approach to quantify the physical functionality outcomes over a 13 year period across 56 sites in the Mexican Caribbean. This region was affected by multiple stressors that converged and drastically damaged reefs in the early 2000s. Since then, the reefs have shown evidence of a modest recovery of coral cover. We used Bayesian linear models and annual rates of change to estimate temporal changes in physical functionality and coral cover. Moreover, a functional diversity framework was used to explore changes in coral composition and the traits of those assemblages. Between 2005 and 2018, physical functionality increased at a markedly lower rate compared to that of coral cover. The disparity between recovery rates depended on the identity of the species that increased (mainly non‐framework and foliose‐digitate corals). No changes in species dominance or functional trait composition were observed, whereas non‐framework building corals consistently dominated most reefs. Although the observed recovery of coral cover and functional potential may provide some ecological benefits, the long‐term effects on reef frameworks remain unclear, as changes in the cover of key reef‐building species were not observed. Our findings are likely to be representative of many reefs across the wider Caribbean basin, as declines in coral cover and rapid increases in the relative abundance of weedy corals have been reported regionally. A coral identity approach to assess species turnover is needed to understand and quantify changes in the functionality of coral reefs.
Weissella cibaria short‐fermented liquid sourdoughs based on quinoa or amaranth flours as fat replacer in focaccia bread formulation
Authors: Bavaro Anna Rita , Di Biase Mariaelena , Conte Amalia , Lonigro Stella Lisa , Caputo Leonardo , Cedola Annamaria , Del Nobile Matteo Alessandro , Logrieco Antonio Francesco , Lavermicocca Paola , Valerio Francesca
Published: November 2020

Production of the traditional Italian Focaccia bread (FcBread) requires reformulation to meet the new rules for healthier foods. We tested the applicability of a short‐fermented (15 h) liquid sourdough (LS) (dough yield, DY, 250), obtained using quinoa (Q) or amaranth (Am) flour fermented with a Weissella cibaria strain (C43‐11) producing exopolysaccharides (EPS) as fat replacer in yeast‐leavened FcBread. The LSs were applied during the FcBread‐making process at industrial pilot plant, reducing the added fat amount by 20% (FcBread‐QLS and FcBread‐AmLS) and products were compared with reference samples not containing EPS. All the products were analysed for physico‐chemical properties (pH, TTA, organic acids, protein content and profile, instrumental colour), textural properties, sensory quality and glycemic index. The application of both pseudo‐cereal‐based W. cibaria LSs in FcBread allowed obtaining products with a reduced amount of fat, increased protein amount, mainly due to the albumin and glutenin/glutelin fractions, reduced glycemic index, improved texture and preserved in the traditional sensory profile of ‘focaccia’.
How the Global and Gulf Financial Crises Affected Pakistan: Ten‐year Review0
Authors: Javed Sajid Amin , Shaukat Badiea , Ahmad Iftikhar
Published: November 2020

We show that the impact of global financial crisis (GFC) on Pakistan's economy mainly transmitted through Gulf Financial Crisis (GCC). In this regard, we assess the effects of both the global and Gulf financial crises on remittances, workers' emigration, return migration, national savings and foreign investment. Applying Exploratory Data Analysis (EDA) before (2000–07) and after GFC (2008–18), we demonstrate that Pakistan witnessed remarkably low FDI inflows and labour force emigration along with higher return migration rates after the crises. Investment from the UAE and other Gulf countries declined eightfold immediate after the global financial crisis, contributing considerably to the decline of the country's GDP growth during 2008–10. There was significant curtailment in emigration volumes and spurts in return migration after 2012, because of the Gulf oil price crisis. The positive trend in remittances until 2015 seems to be influenced by post‐9/11 anti‐money laundering legislation and depreciation of the rupee.
Improvement of clinical and immunological parameters after allergen‐specific immunotherapy in atopic dermatitis
Authors: Hajdu K. , Kapitány A. , Dajnoki Z. , Soltész L. , Baráth S. , Hendrik Z. , Veres I. , Szegedi A. , Gáspár K.
Published: November 2020

Background

Allergen immunotherapy (AIT) is considered a curative treatment in some atopic diseases, but in AD contradictory clinical results exist and the action of AIT has not been elucidated. In the literature, there is no evidence for parallel investigations of permeability barrier, cutaneous and blood immune responses after AIT in AD.

Objectives

The objective was to investigate immune parameters in the blood and skin and to detect clinical and barrier changes after AIT in AD.

Methods

Mild‐to‐moderate AD patients (n = 14) with concomitant allergic rhinitis to house dust mites were selected. All patients received topical treatment, while eight patients were randomly selected for adjuvant AIT also. At baseline and after 6 months, clinical, barrier and immunological investigations (serum and skin tests) were performed. In selected patients, biopsies from atopy patch tests (APTs) were analysed by immunohistochemistry for AD‐relevant immune cells and mediators.

Results

In the adjuvant AIT group, clinical parameters and barrier functions improved significantly. Blood immune parameters displayed no significant changes. Post‐AIT APT became negative in all patients in the AIT group, but remained positive in the non‐AIT group. Cutaneous dendritic cell and T‐cell recruitment decreased significantly after allergen challenge in the AIT group, but no significant changes in skin or serum immunoglobulin E levels or prick test (SPT) reactivity were detected.

Conclusions

Allergen immunotherapy is a beneficial adjuvant treatment for sensitized AD patients. AIT improves not only clinical symptoms, but also permeability barrier functions. The effect of AIT on sensitization should be detected by APT, not by SPT.
Effects of forest canopy gaps on the ground‐layer plant community depend on deer: Evidence from a controlled experiment
Authors: Burton Julia I , Mladenoff David J , Forrester Jodi A , Clayton Murray K
Published: November 2020

Questions: How do deer mediate the response of forest ground‐layer plant communities to canopy gap size?

Location: Flambeau River State Forest in north central Wisconsin, USA (47°37.4ʹ N, 90°47.8ʹ W).

Method: We examined responses of resources, growth forms and temporal guilds to factorial combinations of canopy gap treatments consisting of a range of gap sizes (80, 200 and 380 m2), and deer (Odocoileus virginianus) exclusion (0.64 ha fenced exclosures) 4 years following gap creation (3 years following deer exclusion). We contrasted responses in central and transition zones.

Results: In the absence of deer, forb productivity increased from pre‐treatment levels, particularly where light transmittance and soil moisture were high. In contrast, forb productivity decreased in the presence of deer. These effects were stronger among forbs with early‐ and late‐summer leafing phenology than spring ephemeral, and evergreen species. In contrast, deer amplified increases in graminoid productivity, which were related primarily to light transmittance. Deer did not alter responses of ferns, shrubs, trees seedlings or vines. Canopy gaps increased community heterogeneity among gap sizes and zones, but only in the absence of deer. This was related to the effects of deer on the composition and diversity of gap specialists.

Conclusions: The maintenance of biodiversity in northern temperate forest ground‐layer plant communities by canopy gap dynamics appears to hinge on deer herbivory, even at relatively modest populations of deer and a productive site. Conversely, increases in resource availability within gaps may function to mitigate some negative effects of deer on forb productivity. Effects may be transient, as species turnover to shrub‐ and sapling‐dominated communities and canopy closure may cause communities to converge in the future. However, populations of undefended gap specialists remain particularly sensitive.
Evidence for the plant recruitment of beneficial microbes to suppress soil‐borne pathogens
Authors: Liu Hongwei , Li Jiayu , Carvalhais Lilia C. , Percy Cassandra D. , Prakash Verma Jay , Schenk Peer M. , Singh Brajesh K.
Published: November 2020

An emerging experimental framework suggests that plants under biotic stress may actively seek help from soil microbes, but empirical evidence underlying such a ‘cry for help’ strategy is limited.

We used integrated microbial community profiling, pathogen and plant transcriptive gene quantification and culture‐based methods to systematically investigate a three‐way interaction between the wheat plant, wheat‐associated microbiomes and Fusarium pseudograminearum (Fp).

A clear enrichment of a dominant bacterium, Stenotrophomonas rhizophila (SR80), was observed in both the rhizosphere and root endosphere of Fp‐infected wheat. SR80 reached 3.7 × 107 cells g−1 in the rhizosphere and accounted for up to 11.4% of the microbes in the root endosphere. Its abundance had a positive linear correlation with the pathogen load at base stems and expression of multiple defence genes in top leaves. Upon re‐introduction in soils, SR80 enhanced plant growth, both the below‐ground and above‐ground, and induced strong disease resistance by boosting plant defence in the above‐ground plant parts, but only when the pathogen was present.

Together, the bacterium SR80 seems to have acted as an early warning system for plant defence. This work provides novel evidence for the potential protection of plants against pathogens by an enriched beneficial microbe via modulation of the plant immune system.
Ethylene, not ABA, is closely linked to the recovery of gas exchange after drought in four Caragana species
Authors: Yao Guang‐Qian , Li Feng‐Ping , Nie Zheng‐Fei , Bi Min‐Hui , Jiang Hui , Liu Xu‐Dong , Wei Yang , Fang Xiang‐Wen
Published: November 2020

Drought is a cyclical phenomenon in natural environments. During dehydration, stomatal closure is mainly regulated by abscisic acid (ABA) dynamics that limit transpiration in seed plants, but following rehydration, the mechanism of gas exchange recovery is still not clear. In this study, leaf water potential (ψleaf), stomatal conductance (gs), leaf hydraulic conductance (Kleaf), foliar ABA level, ethylene emission rate in response to dehydration and rehydration were investigated in four Caragana species with isohydric (Caragana spinosa and C. pruinosa) and anisohydric (C. intermedia and C. microphylla) traits. Two isohydric species with ABA‐induced stomatal closure exhibited more sensitive gs and Kleaf to decreasing ψleaf than two anisohydric species which exhibited a switch from ABA to water potential‐driven stomatal closure during dehydration. Following rehydration, the recovery of gas exchange was not associated with a decrease in ABA level but was strongly limited by the degradation of the ethylene emission rate in all species. Furthermore, two anisohydric species with low drought‐induced ethylene production exhibited more rapid recovery in gas exchange upon rehydration. Our results indicated that ethylene is a key factor regulating the drought‐recovery ability in terms of gas exchange, which may shape species adaptation to drought and potential species distribution.