bluuebunny/crossref_metadata_2025 huggingface dataset:
A critical decision point: Short‐ and long‐term outcomes of older surgical patients admitted to a Queensland intensive care unit
Authors: Zhang Alice T. , Tan Samuel X. , Pillay Praga S. , Stewart David
Published: October 2021

Objectives

Critical care admission is a pivotal juncture for older patients undergoing surgery. We aimed to identify the in‐hospital and postdischarge outcomes of older postsurgical patients (≥65 years) admitted to the intensive care unit (ICU).

Methods

We collected clinical, morbidity and survival data on all patients aged ≥65 years postsurgically admitted to a tertiary metropolitan ICU between 2014 and 2019.

Results

Within this older cohort (n = 370), the oldest patients (≥85 years) had the highest 1‐year mortality (RR: 4.00; P < 0.001). Major surgery (RR: 5.67; P < 0.001), emergency surgery (RR: 2.89; P < 0.001) and APACHE III score ≥50 (RR: 2.63; P < 0.001) were associated with reduced 1‐year survival.

Conclusions

APACHE III score and surgery subtype are strong predictors of post‐ICU mortality and may be useful to preoperatively stratify whether surgery and subsequent ICU admission are in patients’ best interests. These data may also inform prospective discussions regarding end‐of‐life care and advanced care planning.
How Do Structural Oil Price Shocks Affect China's Investor Sentiment? The Critical Role of OPEC Oil Supply Shocks*
Authors: Jiang Yong , Ma Chao‐Qun , Weber Olaf , Ren Yi‐Shuai
Published: October 2021

This paper applies a modified structural vector autoregressive (SVAR) model to explore whether explicit structural oil price shocks affect investor sentiment in China's stock market. The results indicate that China's investor sentiment responds significantly positively to OPEC supply shocks, while it responds significantly negatively to oil‐specific demand shocks. However, China's stock investor sentiment does not respond to aggregate demand shocks and non‐OPEC supply shocks. In addition, OPEC supply shocks and oil‐specific demand shocks have greater explanatory power for variations in stock investor sentiment through variance decomposition.
Can Descriptive Representation Help the Right Win Votes from the Poor? Evidence from Brazil
Authors: Desai Zuheir , Frey Anderson
Published: October 2021

The electoral success of the Right in poor nations is typically attributed to nonpolicy appeals such as clientelism. Candidate profiles are usually ignored because if voters value class‐based descriptive representation, it should be the Left that uses it. In this article, we develop and test a novel theory of policy choice and candidate selection that defies this conventional wisdom: it is the Right that capitalizes on descriptive representation in high‐poverty areas. The Right is only competitive in poor regions when it matches the Left's pro‐poor policies. To credibly shift its position, it nominates candidates who are descriptively closer to the poor. Using a regression discontinuity design in Brazilian municipal elections, we show that Right‐wing mayors spend less on the poor than Left‐wing mayors only in low‐poverty municipalities. In high‐poverty municipalities, not only does the Right match the Left's policies, it also does so while nominating less educated candidates.
Enrichment of infant formula with long‐chain polyunsaturated fatty acids and risk of infection and allergy in the nationwide ELFE birth cohort
Authors: Adjibade Moufidath , Davisse‐Paturet Camille , Bernard Jonathan Y. , Adel‐Patient Karine , Divaret‐Chauveau Amandine , Lioret Sandrine , Charles Marie‐Aline , de Lauzon‐Guillain Blandine
Published: October 2021

Background

The new European regulations require the enrichment of formulas with docosahexaenoic acid (DHA) because of the positive effects of long‐chain polyunsaturated fatty acids (LCPUFAs) on neurodevelopment and visual acuity. In this observational study, we aimed to evaluate whether the consumption of LCPUFA‐enriched formula was associated with the risk of infection and allergy in early childhood.

Methods

Analyses involved data from 8389 formula‐fed infants from the ELFE birth cohort. Formula enrichment was identified from the list of ingredients of the formula consumed at 2 months. Infections (gastrointestinal, lower respiratory tract [LRTI], upper respiratory tract) and allergies (wheezing, itchy rash, asthma medication, food allergy) from age 2 months to 5.5 years were reported by parents during follow‐up surveys. Multivariable logistic regression models were used to assess associations between the consumption of LCPUFA‐enriched formula and the risk of infection and allergy.

Results

Among formula‐fed infants at 2 months, 36% consumed formula enriched with DHA and arachidonic acid (ARA), and 11% consumed formula additionally enriched with eicosapentaenoic acid (EPA). Enriched formula consumption was not associated with infection or allergy, except for an association between consumption of DHA/ARA/EPA‐enriched formula and lower use of asthma medications. Furthermore, as compared with non‐DHA/ARA/EPA‐enriched formula, consumption of formula with high EPA content (≥3.2 mg/100 kcal) was related to lower risk of LRTI and lower use of asthma medications.

Conclusion

This study suggests that consumption of DHA/ARA/EPA‐enriched formula (especially those with high EPA content) is associated with a lower risk of LRTI and lower use of asthma medications.
The Inverse G‐Wishart distribution and variational message passing
Authors: Maestrini Luca , Wand Matt P.
Published: October 2021

Message passing on a factor graph is a powerful paradigm for the coding of approximate inference algorithms for arbitrarily large graphical models. The notion of a factor graph fragment allows for compartmentalisation of algebra and computer code. We show that the Inverse G‐Wishart family of distributions enables fundamental variational message passing factor graph fragments to be expressed elegantly and succinctly. Such fragments arise in models for which approximate inference concerning covariance matrix or variance parameters is made, and are ubiquitous in contemporary statistics and machine learning.
Systemic antibiotics and asthma medicines dispensed to 0−12 year olds significantly decreased during the COVID‐19 pandemic in 2020
Authors: Haapanen Marjut , Renko Marjo , Artama Miia , Kuitunen Ilari
Published: October 2021

Aim

Nationwide lockdowns and social restrictions during the COVID‐19 pandemic have reduced childhood infections. We assessed how many items of systemic antibiotics and asthma medicines were dispensed to children aged 0−12 years in Finland before and during the pandemic and analysed the reimbursement costs.

Methods

The data came from the national Finnish register of reimbursable prescriptions, which is maintained by the country's Social Insurance Institution. It included all prescriptions for antibiotics and asthma medicines dispensed to children aged 0−12 years in 2019 and 2020. Prescription rates per 1000 children were calculated for each quarter and compared using rate ratios and 95% confidence intervals (95% CI).

Results

Overall dispensing for antibiotics decreased by 55.3% and was most prominent for macrolides for children aged 0−5 years (59.6%, 95% CI 60.9%−58.2%). Asthma medicines decreased by 19.8%, and the most prominent reduction was in short‐acting beta‐agonists for children aged 0−5 years (35.2%, 95% CI 36.1%−34.2%). These reduced reimbursement costs by 3.4 million Euros from 2019 to 2020.

Conclusion

This nationwide study showed that the number of antibiotics and asthma medicines decreased by 59.6% and 19.8% respectively from 2019 to 2020, generating a cost saving of 3.4 million Euros.
Exploring functional metabolites in preterm infants
Authors: Renwick Victoria L. , Stewart Christopher J.
Published: October 2021

Aim

Metabolomics is the study of small molecules that represent the functional end points of cellular reactions that can impact health. Necrotising enterocolitis (NEC) and late onset sepsis (LOS) are the main cause of death in preterm infants surviving the initial days of life.

Methods

This review will explore and summarise the current literature exploring metabolomics in preterm infants.

Results

There are a relatively limited number of studies investigating metabolomics in preterm infants with NEC and/or LOS and matched controls. Nonetheless, it is evident across longitudinally age‐related metabolomic studies that there are significant changes in metabolite profiles post‐partum and over the first year of life. Existing studies have reported associations between the metabolite profiles of serum, urine and stool in health and disease in preterm infants. Although some studies have found selected metabolites are associated with disease, the specific metabolites vary from study to study, and larger studies are required. Excitingly, recent work has also begun to untangle how microbially produced metabolites can impact immunoregulation of the infant.

Conclusion

Metabolic exploration is an emerging research area with huge potential for developing novel biomarkers and better understanding disease processes in preterm infants.
Farming lifestyle and human milk: Modulation of the infant microbiome and protection against allergy
Authors: Jackson Courtney M. , Mahmood Mustafa M. , Järvinen Kirsi M.
Published: October 2021

There has been an increased prevalence of several allergic manifestations such as food allergy, atopic eczema, allergic rhinitis and asthma. Several explanations have been proposed why this has occurred, but one of the main contributing factors may be the gradual loss of microbial exposures over time in regions where allergy is prevalent. Such exposures occur in individuals who practise a traditional farming lifestyle and are protected against allergy. Infant consumption of human milk, more commonly practised in these farming communities, may provide an alternative in combatting allergy, as it known to be beneficial to infant health. In this review, we cover human milk and its role in shaping the gut microbiome promoting the growth of beneficial bacteria like Bifidobacterium, as well as the downstream impact of the farming lifestyle, human milk and Bifidobacterium has on developing infant immunity.
COVID‐19, children, clinical trials and compassion: The ethical case for using innovative or compassionate treatments
Authors: Larcher Vic , Caplan Art , Brierley Joe
Published: October 2021

Aim

Safe, effective SARS‐CoV‐2 treatment has not yet been determined, though some drugs have favourable mortality and morbidity benefits in specific situations. No treatments have been explicitly tested in children, who are, therefore, once again therapeutic orphans.

Method

We echo calls to enrol patients, including children, into trials but those children recruited to date have largely been additions to adult studies. Few were recruited during the initial pandemic despite the emergence of PIMS‐TS/MIS‐C, which surely demands paediatric‐specific research.

Result

Must children be proscribed treatments effective in adults until child‐specific data emerges, even in a pandemic? Will appropriately powered dedicated trials ever determine specific child‐COVID‐19 treatment pathways? Is the protracted time frame to assemble such data acceptable to children with severe COVID‐19 today?

Such factors are relevant in considering whether children should have access to compassionate, innovative, pandemic‐disease treatment.

Conclusion

We argue that children should be permitted, indeed have a right, to access innovative treatments early in any future pandemic, following an individual best interests consideration. This will remain the case until formal studies powered to determine children's optimal treatment commence, when the moral duty switches to ensuring children are enrolled, with any preceding innovative‐use data made available to researchers.
Effects of two dietary crude protein levels on finishing performance, meat quality, and gene expression of market lambs
Authors: Wang Yongjie , Shelby Sarah , Apple Jason , Coffey Ken , Pohlman Fred , Huang Yan
Published: October 2021

Seventeen crossbred lambs were assigned randomly to low‐protein (LP; 8% crude protein [CP]; n = 9) and high‐protein (HP; 13% CP; n = 8) diets for 9 weeks. The final body weight, average daily feed intake (ADFI), and average daily gain (ADG) of the HP lambs were significantly higher (P < 0.05) than the LP lambs; however, gain to feed ratio (G:F) for the LP lambs was significantly higher (P < 0.05) than the HP lambs. Hot carcass weight (HCW), adjusted fat thickness, and drip loss of longissimus dorsi (LD) muscle were significantly higher (P < 0.05) for the HP than LP lambs. In contrast, instrumental color values L*, a*, b*, C*, and hue angle (H) of meat from the LP lambs scored significantly higher (P < 0.05) than the HP lambs. The LD muscle from HP lambs had significantly greater CLA of cis‐9 trans‐11 isomer (P < 0.05) than the LP lambs. The gene expression of metabolism and meat quality‐related genes of LP was significantly higher than HP (P < 0.05). These results suggest that a higher dietary CP level promotes growth performance for finishing lambs, whereas lower dietary CP level is beneficial for meat quality, especially when evaluating color characteristics in the final product.
Business Combinations under Common Control: Further Considerations
Authors: Bradbury Michael E.
Published: October 2021

This paper makes a number of observations on the International Accounting Standards Board's Discussion Paper DP/2020/2 Business Combinations under Common Control. I address issues such as the choice of the controlling party or transferred business book, the principles and objectives of the Discussion Paper, and the relationship with related party disclosures.
Business Combinations under Common Control: A Controlling Entity Cost Approach
Authors: Seah‐Tan Serene
Published: October 2021

This paper discusses the controlling entity's perspective in business combinations under common control (BCUCC) and suggests some issues for the International Accounting Standards Board (IASB) to consider in its redeliberations on the preliminary views in the Discussion Paper. The paper explains the use of a book‐value approach in practice, specifically by listed companies and pre‐listing initial public offering (IPO) candidates in Hong Kong, the relevance of the controlling entity perspective and the importance of pre‐combination information to users of the financial statements. This paper discusses the controlling entity's perspective in BCUCC and suggests some issues for the IASB to consider in its redeliberations on the preliminary views in the Discussion Paper.
Extreme droughts in oligotrophic mountain grasslands cause substantial species abundance changes and amplify community filtering
Authors: Stanik Nils , Peppler‐Lisbach Cord , Rosenthal Gert
Published: October 2021

Questions

Mountain grasslands can be strongly affected by extreme droughts such as those related to climate change. What are the impacts of extreme droughts on community composition, diversity, Ellenberg indicator scores and species groups in oligotrophic montane Nardus grasslands, and what are the associated mechanisms of vegetation change?

Location

Rhön Mountains, Germany.

Methods

Over three consecutive years, we investigated the effects of yearly droughts (April–August) in an experimental setup with rainout shelters. Owing to the coincidence of ambient extreme dry conditions in those years and our artificial rainfall reduction, we evaluated the contribution to community change of ambient drought conditions and the treatments. We analysed changes in community composition by applying redundancy analysis to species differences in comparison with the pretreatment year, and used mixed‐effects models to test for changes in community‐weighted means of Ellenberg indicator scores, sociological and functional groups.

Results

We found significant changes in species abundance and community structures in response to drought. Evenness increased, but species richness remained rather stable over time. Ellenberg indicator scores for temperature and nitrogen increased, whereas the score for moisture decreased. Simultaneously, dominant species declined and subdominants increased. Changes occurred with a time lag and were driven largely by the high ambient drought level and less by the artificial treatments.

Conclusions

Our results show that drought‐related changes in community composition in Nardus grasslands occur across community structures, characteristic species, and species groups. The post‐drought recovery of the community is shaped by community filters, which in particular allow subdominants to take advantage of newly available niches in the matrix, even if they lack strong drought tolerance. Our findings indicate a certain resilience of the community to droughts related to climate change, which suggests that the observed changes should not lead to an accelerated short‐term decline in these grasslands, but that this cannot be excluded in the long term.
Sodium‐glucose co‐transporter‐2 inhibitors in the non‐diabetic heart failure patient
Authors: Essa Hani , Walker Lauren , Sankaranarayanan Rajiv
Published: October 2021

Heart failure (HF) with reduced ejection fraction (HFrEF) is a global cause of morbidity and mortality with over 60 million estimated cases worldwide. The burden of HF care is expected to increase with an ageing population as evidenced by the fact that 80% of HF‐related hospitalizations occur in those aged above 65. Given the significant morbidity and mortality associated with HFrEF, there is a need for new prognostic therapies that have an impact on morbidity and mortality. In February of 2021, the National institute for Health and Care Excellence (NICE) released new guidance on the utility of Dapagliflozin for the management of heart failure with reduced ejection fraction (HFrEF). NICE advocated that dapagliflozin is a viable treatment option in symptomatic HFrEF patients on optimal medical management. The current list price of dapagliflozin is around £36.59 per 28‐tablet pack with an estimated annual cost of £476.98 equating to £6939 per quality‐adjusted life year. The guidance was mainly based on evidence produced from the 2019 DAPA‐HF trial. This demonstrated that in HFrEF population, the use of dapagliflozin led to a significant reduction in worsening HF events, cardiovascular, and all‐cause death. In this article, we summarize the evidence base for sodium‐glucose co‐transporter‐2 inhibitors in the non‐diabetic heart failure patient.
Saliva as a sampling matrix for therapeutic drug monitoring of gentamicin in neonates: A prospective population pharmacokinetic and simulation study
Authors: Samb Amadou , Kruizinga Matthijs , Tallahi Younes , van Esdonk Michiel , van Heel Willemijn , Driessen Gertjan , Bijleveld Yuma , Stuurman Rik , Cohen Adam , van Kaam Anton , de Haan Timo R , Mathôt Ron
Published: October 2021

Aims

Therapeutic drug monitoring (TDM) of gentamicin in neonates is recommended for safe and effective dosing and is currently performed by plasma sampling, which is an invasive and painful procedure. In this study, feasibility of a non‐invasive gentamicin TDM strategy using saliva was investigated.

Methods

This was a multicentre, prospective, observational cohort study including 54 neonates. Any neonate treated with intravenous gentamicin was eligible for the study. Up to eight saliva samples were collected per patient at different time‐points. Gentamicin levels in saliva were determined with liquid chromatography tandem mass‐spectrometry (LC–MS/MS). A population pharmacokinetic (PK) model was developed using nonlinear mixed‐effects modelling (NONMEM) to describe the relation between gentamicin concentrations in saliva and plasma. Monte Carlo simulations with a representative virtual cohort (n = 3000) were performed to evaluate the probability of target attainment with saliva versus plasma TDM.

Results

Plasma PK was adequately described with an earlier published model. An additional saliva compartment describing the salivary gentamicin concentrations was appended to the model with first‐order input (k13 0.023 h−1) and first‐order elimination (k30 0.169 h−1). Inter‐individual variability of k30 was 38%. Postmenstrual age (PMA) correlated negatively with both k13 and k30. Simulations demonstrated that TDM with four saliva samples was accurate in 81% of the simulated cases versus 94% when performed with two plasma samples and 87% when performed with one plasma sample.

Conclusion

TDM of gentamicin using saliva is feasible and the difference in precision between saliva and plasma TDM may not be clinically relevant, especially for premature neonates.
Implementing prescribing safety indicators in prisons: A mixed methods study
Authors: Abuzour Aseel S. , Magola‐Makina Esnath , Dunlop James , O'Brien Amber , Khawagi Wael Y. , Ashcroft Darren M. , Brown Petra , Keers Richard N.
Published: October 2021

Aims

To examine the prevalence of potentially hazardous prescribing in the prison setting using prescribing safety indicators (PSIs) and explore their implementation and use in practice.

Methods

PSIs were identified and reviewed by the project team following a literature review and a nominal group discussion. Pharmacists at 2 prison sites deployed the PSIs using search protocols within their electronic health record. Prevalence rates and 95% confidence intervals (CIs) were generated for each indicator. Semi‐structured interviews with 20 prison healthcare staff across England and Wales were conducted to explore the feasibility of deploying and using PSIs in prison settings.

Results

Thirteen PSIs were successfully deployed mostly comprising drug–drug interactions (n = 9). Five yielded elevated prevalence rates: use of anticholinergics if aged ≥65 years (Site B: 25.8% [95%CI: 10.4–41.2%]), lack of antipsychotic monitoring for >12 months (Site A: 39.1% [95%CI: 27.1–52.1%]; Site B: 28.6% [95%CI: 17.9–41.4%]), prolonged use of hypnotics (Site B: 46.3% [95%CI: 35.6–57.1%]), antiplatelets prescribed with nonsteroidal anti‐inflammatory drugs without gastrointestinal protection (Site A: 12.5% [95%CI: 0.0–35.4%]; Site B: 16.7% [95%CI: 0.4–64.1%]), and selective serotonin/norepinephrine reuptake inhibitors prescribed with nonsteroidal anti‐inflammatory drugs/antiplatelets without gastrointestinal protection (Site A: 39.6% [95%CI: 31.2–48.4%]; Site B: 33.3% [95%CI: 20.8–47.9%]). Prison healthcare staff supported the use of PSIs and identified key considerations to guide its successful implementation, including staff engagement and PSI 'champions'. To respond to PSI searches, stakeholders suggested contextualised patient support through intraprofessional collaboration.

Conclusion

We successfully implemented a suite of PSIs into 2 prisons, identifying those with higher prevalence values as intervention targets. When appropriately resourced and integrated into staff workflow, PSI searches may support prescribing safety in prisons.
Perinatal and postpartum care during the COVID‐19 pandemic: A nationwide cohort study
Authors: Wagner Michael , Falcone Veronica , Neururer Sabrina B. , Leitner Hermann , Delmarko Irmgard , Kiss Herbert , Berger Angelika , Farr Alex
Published: October 2021

Background

This study aimed to analyze perinatal outcomes and adverse events during the COVID‐19 pandemic's first wave to help direct decision making in future waves.

Methods

This study was an epidemiological cohort study analyzing comprehensive birth registry data among all 80 obstetric departments in Austria. Out of 469 771 records, 468 348 were considered eligible, whereof those with preterm delivery, birthweight <500 g, multiple fetuses, fetal malformations and chromosomal anomalies, intrauterine fetal death, maternal cancer, HIV infection, and/or inter‐hospital transfers were excluded. Women who delivered between January and June 2020 were then classified as cases, whereas those who delivered between January and June 2015‐2019 were classified as controls. Perinatal outcomes, postpartum hospitalization, and adverse events served as outcome measures.

Results

Of 33 198 cases and 188 225 controls, data analysis showed significantly increased rates of labor induction, instrumental delivery, obstetric anesthesia, NICU transfer, and 5‐min Apgar score below 7 during the COVID‐19 period. There was a significantly shorter length of postpartum hospitalization during the COVID‐19 period compared with the non‐COVID‐19 period (3.1 ± 1.4 vs 3.5 ± 1.5 days; P < .001). Significantly more women opted for short‐stay delivery during the COVID‐19 period (3.7% vs 2.4%; P < .001). Those who delivered during the COVID‐19 period were also more likely to experience postpartum adverse events (3.0% vs 2.6%; P < .001), which was confirmed in the logistic regression model (odds ratio, 2.137; 95% confidence interval, 1.805‐2.530; P < .001).

Conclusions

Perinatal and postpartum care during the first wave of the COVID‐19 pandemic differed significantly from that provided before. Increased rates of adverse events underline the need to ensure access to high‐quality obstetric care to prevent collateral damage.
Combination of PD‐1 inhibitor with GVD (gemcitabine, vinorelbine, liposomal doxorubicin) versus GVD regimen as second‐line therapy for relapsed/refractory classical Hodgkin lymphoma
Authors: Zhang Yu‐Chen , Wang Jin‐Ni , Ma Shu‐Yun , Cai Jun , Su Ning , Huang Hui‐Qiang , Li Zhi‐Ming , Xia Zhong‐Jun , Huang He , Liu Pan‐Pan , Xia Yi , Cai Qing-Qing
Published: October 2021

Patients with classical Hodgkin lymphoma (cHL) who do not achieve complete remission (CR) after second‐line chemotherapy have poor clinical outcomes. Besides, conventional salvage chemotherapy regimens have an unsatisfactory CR rate. The present retrospective study reports the efficacy and toxicity of the GVD (gemcitabine, vinorelbine, liposomal doxorubicin) regimen with or without programmed cell death 1 (PD‐1) inhibitor for patients with cHL who failed first‐line treatment. A total of 103 patients with cHL (GVD+PD‐1 group, n = 27; GVD group, n = 76) with response assessment based on positron emission tomography were included. The GVD+PD‐1 group tended to have a higher CR rate than GVD group (85·2% vs. 65·8%, P = 0·057) and had a better event‐free survival (EFS) (P = 0·034). Subgroup analysis showed that patients with low‐risk second‐line International Prognostic Score might benefit from the addition of PD‐1 inhibitor (GVD+PD‐1 vs. GVD, 100·0% vs. 64·7%, P = 0·028) and had better EFS than GVD alone (P = 0·016). Further analysis demonstrated that PD‐1 consolidation therapy might provide an EFS benefit (P = 0·007). The toxicity of the GVD+PD‐1 regimen was comparable to the GVD regimen, except for higher rates of hypothyroidism and autoimmune pneumonitis, which were manageable. In conclusion, combining a PD‐1 inhibitor with a GVD regimen could be a potentially effective second‐line therapy for patients with cHL.
Disentangling the factors that shape bromeliad and ant communities in the canopies of cocoa agroforestry and preserved Atlantic Forest
Authors: DaRocha Wesley , Antoniazzi Reuber , Delabie Jacques H. C. , Schroth Götz , Fernandes Geraldo W. , Neves Frederico S.
Published: October 2021

In tropical forest canopies, host tree characteristics shape epiphyte communities, and both host tree characteristics and epiphytes determine invertebrate communities, for example, ants. Tree height is among the factors most often mentioned as a strong predictor for both bromeliad and ant communities. However, many factors interact dynamically in shaping the tree–bromeliad–ant association. Here, we investigated the effects of the host tree and canopy structural characteristics on both bromeliads and ants. We sampled bromeliads on 180 trees and ants in 360 bromeliads living on a subset of 60 of those trees in a continuum of native forest fragments and agroforestry systems in the Atlantic Forest, a Brazilian biodiversity hotspot. We found that the host trees’ crown area had a positive effect on the abundance of bromeliads. Also, the introduced tree species had higher abundance of bromeliads than native tree species. Moreover, we found that the ant species composition was different between native and introduced trees. In addition, we observed a positive effect of the size of bromeliads and tree crown height on ant species richness on both bromeliad and tree scales, but there was no effect of tree height. Taken together, our findings highlight the importance of trees with large crowns for the maintenance of bromeliads, which are also associated with richer ant communities in both Atlantic Forest and agroforestry systems. These results emphasize the importance of trees with larger crowns for biodiversity conservation in both native forest fragments and agroforestry systems.

Abstract in Portuguese is available with online material.
Extracellular microRNA profiling for prognostic prediction in patients with high‐grade serous ovarian carcinoma
Authors: Yoshida Kosuke , Yokoi Akira , Matsuzaki Juntaro , Kato Tomoyasu , Ochiya Takahiro , Kajiyama Hiroaki , Yamamoto Yusuke
Published: October 2021

High‐grade serous ovarian carcinoma is a leading cause of death in female patients worldwide. MicroRNAs (miRNAs) are stable noncoding RNAs in the peripheral blood that reflect a patient’s condition, and therefore, they have received substantial attention as noninvasive biomarkers in various diseases. We previously reported the usefulness of serum miRNAs as diagnostic biomarkers. Here, we investigated the prognostic impact of the serum miRNA profile. We used the GSE106817 dataset, which included preoperative miRNA profiles of patients with ovarian malignancies. Excluding patients with other malignancy or insufficient prognostic information, we included 175 patients with high‐grade serous ovarian carcinoma. All patients except four underwent surgery and received chemotherapy as initial treatment. The median follow‐up period was 54.6 months (range, 3.5‐144.1 months). Univariate Cox regression analysis revealed that higher levels of miR‐187‐5p and miR‐6870‐5p were associated with both poorer progression‐free survival (PFS) and overall survival (OS), and miR‐1908‐5p, miR‐6727‐5p, and miR‐6850‐5p were poor prognostic indicators of PFS. The OS and PFS prognostic indices were then calculated using the expression values of three prognostic miRNAs. Multivariate Cox regression analysis showed that both indices were significantly independent poor prognostic factors (hazard ratio for OS and PFS, 2.343 [P = .015] and 2.357 [P = .005], respectively). In conclusion, circulating miRNA profiles can potentially provide information to predict the prognosis of patients with high‐grade serous ovarian carcinoma. Therefore, there is a strong demand for early clinical application of circulating miRNAs as noninvasive biomarkers.
Aberrant expression of MYD88 via RNA‐controlling CNOT4 and EXOSC3 in colonic mucosa impacts generation of colonic cancer
Authors: Tsuda Masumi , Noguchi Misa , Kurai Tsuyoshi , Ichihashi Yuji , Ise Koki , Wang Lei , Ishida Yusuke , Tanino Mishie , Hirano Satoshi , Asaka Masahiro , Tanaka Shinya
Published: October 2021

In 2020, the worldwide incidence and mortality of colorectal cancer (CRC) were third and second, respectively. As the 5‐y survival rate is low when CRC is diagnosed at an advanced stage, a reliable method to predict CRC susceptibility is important for preventing the onset and development and improving the prognosis of CRC. Therefore, we focused on the normal colonic mucosa to investigate changes in gene expression that may induce subsequent genetic alterations that induce malignant transformation. Comprehensive gene expression profiling in the normal mucosa adjacent to colon cancer (CC) compared with tissue from non‐colon cancer patients was performed. PCR arrays and qRT‐PCR revealed that the expression of 5 genes involved in the immune response, including MYD88, was increased in the normal mucosa of CC patients. The expression levels of MYD88 were strikingly increased in precancerous normal mucosa specimens, which harbored no somatic mutations, as shown by immunohistochemistry. Microarray analysis identified 2 novel RNA‐controlling molecules, EXOSC3 and CNOT4, that were significantly upregulated in the normal mucosa of CC patients and were clearly visualized in the nuclei. Forced expression of EXOSC3 and CNOT4 in human colonic epithelial cells increased the expression of IFNGR1, MYD88, NFκBIA, and STAT3 and activated ERK1/2 and JNK in 293T cells. Taken together, these results suggested that, in the inflamed mucosa, EXOSC3‐ and CNOT4‐mediated RNA stabilization, including that of MYD88, may trigger the development of cancer and can serve as a potential predictive marker and innovative treatment to control cancer development.
Pros and cons of botulinum toxin injection therapy in cerebral palsy: A qualitative study exploring caregivers' perspective
Authors: Karadag‐Saygi Evrim , Kenis‐Coskun Özge , Unalan Pemra C. , Evkaya‐Acar Ayca , Giray Esra , Akgulle Ahmet Hamdi
Published: October 2021

Background

To describe and understand the experiences and beliefs of caregivers of children with cerebral palsy following botulinum toxin injection.

Methods

A descriptive case study approach with focus group interviews was employed. A semi‐structured questionnaire was conducted to collect data. Twenty‐one caregivers of children (3–13 years old) with cerebral palsy were recruited with a maximum variation sampling strategy to gain insight through different perspectives. Qualitative analysis with verbatim transcripts was analysed using a thematic approach.

Findings

Four themes emerged from qualitative analyses: acceptance of diagnosis, perceptions about treatment, caregivers' experiences with the health environment, and feelings and thoughts after the treatment.

Conclusions

This study highlights caregivers' requests for information about the possible long‐term effect of botulinum toxin, as well as information and support to provide the best rehabilitation programme immediately after injection.
The development of a core outcomes set for self‐management interventions for patients living with obesity
Authors: Valli Claudia , Suñol Rosa , Orrego Carola , Niño de Guzmán Ena , Strammiello Valentina , Adrion Nina , Immonen Kaisa , Ninov Lyudmil , van der Gaag Marieke , Ballester Marta , Alonso‐Coello Pablo
Published: October 2021

Self‐management interventions (SMIs) can improve the life of patients living with obesity. However, there is variability in the outcomes used to assess the effectiveness of SMIs and these are often not relevant for patients. In the context of COMPAR‐EU, our aim was to develop a core outcome set (COS) for the evaluation of SMIs for patients with obesity. We followed a four steps multimethod approach: (1) the development of the initial catalogue of outcomes; (2) a scoping review of reviews on patients' values and preferences on outcomes of self‐management (SM); (3) a Delphi survey including patients and patient representatives to rate the importance of outcomes; and (4) a 2‐day consensus workshop with patients, patient representatives, healthcare professionals and researchers. The initial catalogue included 82 outcomes. Ten patients and patient's representatives participated in the Delphi survey. We identified 16 themes through the thematic synthesis of the scoping review that informed 37.80% of the outcomes on initial catalogue. Five patients, five healthcare professionals, and four researchers participated in the consensus workshop. After the consensus process, 15 outcomes were selected to be part of the final COS, and five supplementary outcomes were also provided. We developed a COS for the evaluation of SMIs in obesity with a significant involvement of patients and other key stakeholders. This COS will help improving data synthesis and increasing the value of SM research data in healthcare decision making.
Metabolically healthy obesity in children enrolled in the CANadian Pediatric Weight management Registry (CANPWR): An exploratory secondary analysis of baseline data
Authors: Damanhoury Samah , Morrison Katherine M. , Mian Rajibul , McPhee Patrick G. , Kozyrskyj Anita L. , Newton Amanda S. , Buchholz Annick , Chanoine Jean‐Pierre , Hamilton Jill , Ho Josephine , Laberge Anne‐Marie , Legault Laurent , Thabane Lehana , Tremblay Mark S. , Zenlea Ian , Ball Geoff D. C.
Published: October 2021

Our study purpose was to determine the prevalence of metabolically healthy obesity (MHO) and examine factors associated with MHO in children with obesity. This cross‐sectional study was a secondary, exploratory analysis of data that included 2–17 years old with a body mass index (BMI) ≥85th percentile from the CANadian Pediatric Weight management Registry. Children were classified as having MHO or metabolically unhealthy obesity (MUO) using consensus‐based criteria. Those with MHO had normal triglycerides, high‐density lipoprotein cholesterol, blood pressure, and fasting glucose. Logistic regression was used to examine factors associated with MHO, which included calculating odds ratios (ORs) and 95% confidence intervals (CIs). In total, 945 children were included (mean age: 12.3 years; 51% female). The prevalence of MHO was 31% (n = 297), with lower levels across increasing age categories (2–5 years [n = 18; 43%], 6–11 years [n = 127; 35%], 12–17 years [n = 152; 28%]). Children with MHO were younger, weighed less, and had lower BMI z‐scores than their peers with MUO (all p < 0.01). MHO status was positively associated with physical activity (OR: 1.18; 95% CI: 1.01–1.38), skim milk intake (OR: 1.10; 95% CI: 1.01–1.19), and fruit intake (OR: 1.12; 95% CI: 1.01–1.24) and negatively associated with BMI z‐score (OR: 0.69; 95% CI: 0.60–0.79), total screen time in hours (OR: 0.79; 96% CI: 0.68–0.92), and intake of fruit flavoured drinks (OR: 0.91; 95% CI: 0.84–0.99). These findings may help guide clinical decision‐making regarding obesity management by focusing on children with MUO who are at relatively high cardiometabolic risk.
Projecting biodiversity benefits of conservation behavior‐change programs
Authors: Selinske Matthew J. , Bekessy Sarah A. , Geary William L. , Faulkner Richard , Hames Fern , Fletcher Charlotte , Squires Zoe E. , Garrard Georgia E.
Published: October 2021

Biodiversity loss is driven by human behavior, but there is uncertainty about the effectiveness of behavior‐change programs in delivering benefits to biodiversity. To demonstrate their value, the biodiversity benefits and cost‐effectiveness of behavior changes that directly or indirectly affect biodiversity need to be quantified. We adapted a structured decision‐making prioritization tool to determine the potential biodiversity benefits of behavior changes. As a case study, we examined two hypothetical behavior‐change programs––wildlife gardening and cat containment––by asking experts to consider the behaviors associated with these programs that directly and indirectly affect biodiversity. We assessed benefits to southern brown bandicoot (Isoodon obesulus) and superb fairy‐wren (Malurus cyaneus) by eliciting from experts estimates of the probability of each species persisting in the landscape given a range of behavior‐change scenarios in which uptake of the behaviors varied. We then compared these estimates to a business‐as‐usual scenario to determine the relative biodiversity benefit and cost‐effectiveness of each scenario. Experts projected that the behavior‐change programs would benefit biodiversity and that benefits would rise with increasing uptake of the target behaviors. Biodiversity benefits were also predicted to accrue through indirect behaviors, although experts disagreed about the magnitude of additional benefit provided. Scenarios that combined the two behavior‐change programs were estimated to provide the greatest benefits to species and be most cost‐effective. Our method could be used in other contexts and potentially at different scales and advances the use of prioritization tools to guide conservation behavior‐change programs.
Balancing making a difference with making a living in the conservation sector
Authors: Pienkowski Thomas , Keane Aidan , Castelló y Tickell Sofia , Hazenbosch Mirjam , Arlidge William N. S. , Baranyi Gergő , Brittain Stephanie , de Lange Emiel , Khanyari Munib , Papworth Sarah , Milner‐Gulland E. J.
Published: October 2021

Goals play important roles in people's lives because they focus attention, mobilize effort, and sustain motivation. Understanding conservationists’ satisfaction with goal progress may provide insights into real‐world environmental trends and flag risks to their well‐being and motivation. We asked 2694 conservationists working globally how satisfied they were with progress toward goals important to them. We then explored how this satisfaction varied among groups, including demographic and occupational. Finally, we looked at respondents' experiences associated with goal‐progress satisfaction. Many (94.0%) indicated that making a meaningful contribution to conservation was an important goal for them, and over half were satisfied or very satisfied in this area (52.5%). However, respondents were generally dissatisfied with progress on collective conservation goals (e.g., stopping species loss). Some groups were more likely to report dissatisfaction than others. For instance, those in conservation for longer tended to be less satisfied with collective goal progress (log odds –0.21, 95% credibility interval [CI] –0.32 to –0.10), but practitioners reported greater satisfaction (log odds 0.38, 95% CI 0.15–0.60). Likewise, those who were more optimistic in life (log odds 0.24, 95% CI 0.17–0.32), male (log odds 0.25, 95% CI 0.10–0.41), and working in conservation practice (log odds 0.25, 95% CI 0.08–0.43) reported greater satisfaction with individual goal progress. Free‐text responses suggested widespread dissatisfaction with livelihood goals, particularly related to job security and adequate compensation. Although contributing to conservation appeared to be a source of satisfaction, slow goal progress in other areas––particularly around making a living––looked to be a source of distress and demotivation. Employers, funders, professional societies, and others should consider ways to help those in the sector make a difference while making a satisfactory living by, for example, prioritizing conservationists′ well‐being when allocating funding. This support could include avoiding exploitative practices, fostering supportive work environments, and celebrating positive outcomes.
Evolutionary patterns of chromosomal instability and mismatch repair deficiency in proximal and distal colorectal cancer
Authors: Golas Mariola Monika , Gunawan Bastian , Cakir Meliha , Cameron Silke , Enders Christina , Liersch Torsten , Füzesi Laszlo , Sander Bjoern
Published: October 2021

Aim

Colorectal carcinomas (CRCs) progress through heterogeneous pathways. The aim of this study was to analyse whether or not the cytogenetic evolution of CRC is linked to tumour site, level of chromosomal imbalance and metastasis.

Method

A set of therapy‐naïve pT3 CRCs comprising 26 proximal and 49 distal pT3 CRCs was studied by combining immunohistochemistry of mismatch repair (MMR) proteins, microsatellite analyses and molecular karyotyping as well as clinical parameters.

Results

A MMR deficient/microsatellite‐unstable (dMMR/MSI‐H) status was associated with location of the primary tumour proximal to the splenic flexure, and dMMR/MSI‐H tumours presented with significantly lower levels of chromosomal imbalances compared with MMR proficient/microsatellite‐stable (pMMR/MSS) tumours. Oncogenetic tree modelling suggested two evolutionary clusters characterized by dMMR/MSI‐H and chromosomal instability (CIN), respectively, for both proximal and distal CRCs. In CIN cases, +13q, −18q and +20q were predicted as preferentially early events, and −1p, −4 ‐and −5q as late events. Separate oncogenetic tree models of proximal and distal cases indicated similar early events independent of tumour site. However, in cases with high CIN defined by more than 10 copy number aberrations, loss of 17p occurred earlier in cytogenetic evolution than in cases showing low to moderate CIN. Differences in the oncogenetic trees were observed for CRCs with lymph node and distant metastasis. Loss of 8p was modelled as an early event in node‐positive CRC, while +7p and +8q comprised early events in CRC with distant metastasis.

Conclusion

CRCs characterized by CIN follow multiple, interconnected genetic pathways in line with the basic ‘Vogelgram’ concept proposed for the progression of CRC that places the accumulation of genetic changes at centre of tumour evolution. However, the timing of specific genetic events may favour metastatic potential.
Long‐term oxygen treatment need is less frequent in eosinophilic COPD patients
Authors: Acet‐Öztürk Nilüfer Aylin , Dilektasli Asli G. , Aydın‐Güçlü Özge , Demirdöğen Ezgi , Coşkun Funda , Ursavaş Ahmet , Karadağ Mehmet , Uzaslan Esra
Published: October 2021

Introduction

Eosinophilic airway inflammation is a recognized inflammatory pattern in subgroups of patients with chronic obstructive pulmonary disease (COPD). However, there are still conflicting results between various studies concerning the effect of eosinophils in COPD patients. Our aim with this study was to evaluate eosinophilic inflammation and its relation to the clinical characteristics in a group of COPD patients.

Methods

Stable COPD patients with FEV1% predicted < 50 or with ≥ 1 exacerbation leading to hospital admission or ≥2 moderate or severe exacerbation history were consecutively enrolled from outpatient clinics.

Results

We included 90 male COPD patients, with a mean age of 63.3 ± 9.2. Mean FEV1% predicted was 35.9 ± 11.3. Eosinophilic inflammation (eosinophil percentage ≥2%) was evident in 54 (60%) of the patients. Participants with eosinophilic inflammation were significantly older and had better FEV1 predicted % values. Eosinophilic COPD patients were characterized with better quality of life and fewer symptoms. COPD patients with noneosinophilic inflammation used supplemental long‐term oxygen therapy (LTOT) more frequently compared to patients with eosinophilic inflammation (36.1% vs. 14.8%, p = 0.01). Eosinophilic inflammation is associated with less dyspnea severity measured by mMRC (OR: 0.542 95% CI: 0.342–0.859, p = 0.009) and less LTOT use (OR: 0.334 95% CI: 0.115–0.968, p = 0.04) regardless of age, severity of airflow limitation, and having frequent exacerbation phenotype.

Conclusion

Our study supports the growing evidence for a potential role of eosinophilic inflammation phenotype in COPD with distinctive clinical characteristics. Eosinophilic inflammation is inversely associated with dyspnea severity measured by mMRC and LTOT use independently from age, total number of exacerbations, St. George Respiratory Questionnaire (SGRQ) total score and FEV1% predicted.
Primary cutaneous anaplastic large‐cell lymphoma with DUSP22‐IRF4 rearrangement following insect bites
Authors: Zhang Yaping , Chen Min , Yu Yu , Liu Xiaoyu , Liu Weiping , Jiang Lijun , Zhang Wenyan
Published: October 2021

Primary cutaneous anaplastic large‐cell lymphoma (pC‐ALCL) is distinguished from systemic anaplastic large‐cell lymphoma (S‐ALCL) with cutaneous involvement. Although pC‐ALCL is a unique entity with different genetics, clinical characteristics, and prognosis, its causes are unknown. Herein, we report the case of a Chinese woman with a 4‐month history of a gradually enlarged ulcerative mass in her right forearm following an unidentified insect bite. Biopsy revealed an extensive infiltrate with patches of large anaplastic lymphoid cells. These cells were immunohistochemically positive for CD45, CD30, and TIA‐1 and negative for CD2, CD3, CD4, CD5, CD20, CD7, CD8, and ALK‐1. DUSP22‐IRF4 rearrangement was detected; on the other hand, TP63 rearrangement was not observed by fluorescence in situ hybridization (FISH). No Epstein‐Barr virus‐encoded small RNAs (EBERs) were detected by ISH. Rearrangement of monoclonal TCR gene was found using BIOMED‐2 polymerase chain reaction. No abnormality was found on the subsequent positron emission tomography‐computed tomography (PET‐CT) scan. After five cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone (CHOP) chemotherapy, the patient achieved complete remission. This is the first report of a unique pC‐ALCL with DUSP22‐IRF4 rearrangement following an insect bite other than S‐ALCL involving the skin.