bluuebunny/crossref_metadata_2025 huggingface dataset:
An investigation and implementation framework of Lean Green and Six Sigma (LG&SS) strategies for the manufacturing industry in India
Authors: Gandhi Jaivesh , Thanki Shashank , Thakkar Jitesh J.
Published: March 2021

Purpose

The Indian manufacturing sector currently contributes 16–17% to gross domestic product (GDP) and gives employment to around 12% (2014) of the country's workforce. Among the various initiatives planned under Atma Nirbhar Bharat and “Make in India”, the Indian government aims to increase the share of the manufacturing sector to country's GDP to 25% by 2025. To ensure sustainable growth of the Indian manufacturing industries in global market, successful and implementation of strategies such as lean manufacturing, green manufacturing along with six sigma are crucial. This research aims at identification and analysis of barriers to successful implementation of integrated Lean Green Six Sigma (LG&SS) strategies.

Design/methodology/approach

Based on an evaluative literature review and expert's opinion, this research identifies 18 barriers to lean, green and six sigma implementation in the manufacturing industry in India. The inter-relationships among the barriers is identified using an integrated approach of ISM (interpretive structural modelling) and Fuzzy Matrice d’Impacts Croisés Multiplication Appliquée á un Classement (MICMAC).

Findings

ISM helps to derive key managerial insights and implementation plan based on the identified inter-relationships among the barriers. Fuzzy MICMAC analysis classifies the barriers into four categories, namely, autonomous, driver, dependent and linkage to understand their relative impact on the implementation of LG&SS practices in the Indian manufacturing industry. “Lack of cooperation and mutual trust between management and employees”, “The scarcity of time and work pressure”, “lack of continuous improvement work culture” and “lack of cooperation from suppliers” that forms the top most level of the model. “Weak legislation” is a highly significant barrier to LG&SS implementation in the Indian manufacturing industries.

Practical implications

It is expected that the findings of this research will help the Indian manufacturing industry to derive a sustainable competitive advantage through an effective implementation of LG&SS practices.

Originality/value

This study can be seen as the first attempt in investigating barriers to successful implementation of lean, green and six sigma strategies in the Indian manufacturing industries using ISM and fuzzy MICMAC analysis.
Smart tourism destinations: a systematic review
Authors: Shafiee Sanaz , Rajabzadeh Ghatari Ali , Hasanzadeh Alireza , Jahanyan Saeed
Published: March 2021

Purpose

This study aims to present a systematic review of smart tourism articles using a meta-synthesis method. Effective systematic reviews are essential for assisting stakeholders in implementing smart destinations. A systematic comprehension of studies on smart tourism is needed regarding the various components of smart tourism destinations, the metrics to map these components and their expected results. This study creates a framework for understanding how smart tourism destinations are theorized and developed.

Design/methodology/approach

Based on the meta-synthesis approach, this study collects, analyzes and synthesizes relevant research in smart tourism published in online databases by following a predetermined review protocol.

Findings

This study contributes to the discourse on smart tourism destinations by increasing the knowledge on the subject of smart destinations in regard to different categories. The selected articles were analyzed according to the proposed research questions and classified into three main categories: components, measurement and outputs. This study presents a new archetype for developing smart destinations and addresses efforts to bridge the gap in this research field.

Practical implications

This paper is noteworthy for stakeholders because it provides a comprehensive vision into the components that influence the growth of smart destinations. The advantage of the proposed methodology is that it creates a framework for understanding how smart destinations are theorized. Furthermore, it is helpful to use qualitative methodologies that efficiently allow the analysis of related literature and that also offer conceptual insights.

Originality/value

The findings provide information that can be used to help shape a fully conceptualized understanding of the smart destinations concept and can also prove important in providing a guide for policymakers and stakeholders in the tourism industry who seek to intelligently develop tourism destinations.
Entrepreneurial ecosystems during COVID-19: the survival of small businesses using dynamic capabilities
Authors: Rashid Sumayya , Ratten Vanessa
Published: March 2021

Purpose

The world is going through a global crisis after the outbreak of coronavirus (COVID-19) in most areas of the world. Businesses particularly small ones do not work in isolation but instead are embedded in an entrepreneurial ecosystem that is dependent on environmental conditions. The disruptive changes from COVID-19 have caused serious damage to the global economy, so it is up to entrepreneurs to bring equilibrium by introducing change. This paper adopts the lens of dynamic capabilities to study how small business entrepreneurs are trying to survive and grow in an entrepreneurial ecosystem affected by coronavirus.

Design/methodology/approach

Using qualitative research methods, 20 Pakistani entrepreneurs have been interviewed in order to assess how the entrepreneurial ecosystem in an emerging economy has been affected by COVID-19. This enables a contemporary and realistic understanding about the way small business entrepreneurs have adjusted to a crisis.

Findings

From the data analysis, the three main dimensions of dynamic capabilities for small business entrepreneurs emerge, which involve a sensing, seizing and transforming capability.

Research limitations/implications

The findings suggest that small businesses utilise the following strategies to cope with change: emergent humanitarian crisis, carte blanche agile business models and effectual business functions. These findings contribute to the literature about the challenges of current crises and how businesses can cope in this situation using a dynamic capabilities perspective.

Practical implications

The findings contribute to the ability of small businesses to cope during the current pandemic situations and anticipate how to manage future crises. Furthermore, the entrepreneurial practices exercised by small businesses are also presented that represent an innovative way to understand crisis management techniques by entrepreneurs in emerging economies.

Social implications

These findings contribute to the literature about the challenges of current crises and how businesses can cope in this situation using a dynamic capabilities perspective.

Originality/value

By drawing on the existing literature of COVID-19's impact on businesses, the theoretical contribution of this paper highlights the applicability of dynamic capabilities on small businesses to survive during the global crisis.
Empirical analysis of urban youth unemployment in Ethiopia
Authors: Berhe Mesfin Welderufael
Published: March 2021

Lack of adequate jobs and long unemployment duration becomes a challenge for urban youth in Ethiopia. This study empirically examines youth unemployment and its determinants in urban Ethiopia. It aims to examine the incidences and durations of youth unemployment and their determinant factors. In addition to logistic regression model, a nonparametric Kaplan–Meier survival analysis and Cox proportional hazards model are used. The results indicate that both the incidence and duration of youth unemployment is higher in urban Ethiopia. The hazards model shows that the hazard rate of leaving unemployment are significantly related to individual characteristics such as age and educational level of the youth, and labor market factors such as experience and job market information. Gender and regional disparities are observed. Young women exit unemployment much slower than men and the exit rate increases with age. Big and relatively more urbanized regions have a higher incidence and longer duration of unemployment spells than the small regions. Finally, based on the results, the study suggests that there is a need to adopt target policies that will promote skills and employment opportunities for the youth. Providing entrepreneurship training and startup capital to encourage youth to create rather than seek jobs is critical in this regard.
Identification of differentially expressed circular RNAs associated with thymoma
Authors: Wu Qingjun , Luo Xuanmei , Li Hexin , Zhang Lili , Su Fei , hou Shifang , Yin Jian , Zhang Wei , Zou Lihui
Published: March 2021

Background

Thymomas and thymic carcinomas are the most common tumor types among anterior mediastinal lesions. However, the relationship between molecular aberrations and thymoma patients are poorly understood, especially abnormal changes in the expression profiles of circRNAs. The purpose of the present study was to investigate the expression profiles of circRNAs in thymoma patients and their possible roles in the pathogenesis of thymoma.

Methods

Diseased tissues and surrounding normal thymic tissues in two thymoma patients were collected for circRNA sequencing. The top four upregulated circRNAs were selected as candidates and further validated with RT‐PCR in 20 thymoma patients. Gene ontology and signal transduction network analyses of circRNA‐related mRNAs were performed to analyze the functional properties. Survival analysis of their parental genes were also carried out to evaluate the clinical value of differentially expressed circRNA.

Results

A total of 73 circRNAs were differentially expressed in thymoma tissues using high‐throughput sequencing. Among these circRNAs, hsa_circ_0001173, hsa_circ_0007291, hsa_circ_0003550, and hsa_circ_0001947 were significantly upregulated in thymoma tissues compared with normal thymic tissues. We identified that these four circRNA‐related mRNAs were involved in cell–cell adhesion, MAPK pathways, and TNF pathway, which may contribute to the pathological immune disorder in thymoma. Finally, we also found that SCAP (hsa_circ_0007291 parental gene) and AFF2 (hsa_circ_0001947 parental gene) were all significantly related with progression‐free survival (PFS) of thymoma patients in a Kaplan‐Meier plot (p‐value <0.05).

Conclusions

The expression levels of hsa_circ_0001173, hsa_circ_0007291, hsa_circ_0003550, and hsa_circ_0001947 were significantly upregulated and positively correlated with immune imbalance in thymoma patients.
Are wildfires affecting seed germination in cactus? An experimental assessment
Authors: Roca Julieta , Jaureguiberry Pedro , Gurvich Diego E.
Published: March 2021

Cacti are conspicuous plants across arid and semi‐arid ecosystems of the American continent and are currently under threat due to human pressures, such as habitat loss, illegal collection and changes in fire regimes. Although much of their habitat is highly fire prone, there are strikingly few studies on their germination response to fire cues. The aim of this work was to analyse the effect of heat shock (simulating wildfires) on the ‘germination %’ and the ‘mean germination time’ of 13 cactus species of two growth forms (six columnar and seven globose) from a fire‐prone cactus diversity hotspot in Córdoba Mountains, central Argentina. We also analysed the effect of growth form and seed mass on species responses. Seeds were subjected to the following treatments: 70°C/5 min, 70°C/10 min, 105°C/5 min, 105°C/10 min and a control (i.e. no heat). Germination decreased under at least one treatment in seven species, increased in three species, had contrasting changes in one species, and showed no effect of treatments in two species. Germination was faster in eight species, slower in one species and showed no effects of treatments in four species. Germination was significantly higher for globose species following the 70°C/10 min treatment and for columnar species under the treatment of 110°C/10 min; while germination time did not differ between growth forms. Seed mass did not have a significant effect on germination, and only affected germination time under the 70ºC treatments, under which lighter seeds germinated faster than heavier seeds. Our results show that the studied species exhibited a high diversity of responses, with most of the species presenting tolerance to heat shock, and that under certain conditions growth form and seed mass are important traits related to species responses to heat shock treatments.
Effect of climatic factors on urinary cortisol and peripheral blood leukocytes in lambs grazing on a semi‐natural grassland in the Hokuriku District of Japan
Authors: Asano Keigo , Takamatsu Erina , Numata Hana , Nitta Momoyo , Ishida Motohiko
Published: March 2021

The effects of climatic factors on stress and immune functions of grazing lambs in summer and autumn in the Hokuriku District of Japan were evaluated by determining urinary cortisol (U‐COR) levels and peripheral blood leukocyte populations and comparing those with lambs kept indoors. Two groups of five lambs, consisting of those grazed on a semi‐natural grassland (GRL) and those housed indoors in a domestic animal shelter (INL), were maintained at from July to October. The temperature–humidity index at each location was indicative of heat stress during summer; however, the U‐COR elevation was not observed in both groups. The elevation was observed in GRL in autumn and was higher than INL in October. Climatic conditions in autumn were characterized by high humidity and a sudden drop in temperature. U‐COR was positively correlated with the relative humidity. The GRL was exposed to low‐nutrient conditions for a relatively long time. The CD4+/CD8+ T cell ratio in GRL decreased in October. Subsequently, the total leucocyte, including granulocytes, monocytes, and lymphocytes, sharply increased. The responses indicated an immune deficiency caused by immunosuppression because of a low nutrition caused by grazing and high‐stress conditions in autumn.
Spatial factor modeling: A Bayesian matrix‐normal approach for misaligned data
Authors: Zhang Lu , Banerjee Sudipto
Published: March 2021

Multivariate spatially oriented data sets are prevalent in the environmental and physical sciences. Scientists seek to jointly model multiple variables, each indexed by a spatial location, to capture any underlying spatial association for each variable and associations among the different dependent variables. Multivariate latent spatial process models have proved effective in driving statistical inference and rendering better predictive inference at arbitrary locations for the spatial process. High‐dimensional multivariate spatial data, which are the theme of this article, refer to data sets where the number of spatial locations and the number of spatially dependent variables is very large. The field has witnessed substantial developments in scalable models for univariate spatial processes, but such methods for multivariate spatial processes, especially when the number of outcomes are moderately large, are limited in comparison. Here, we extend scalable modeling strategies for a single process to multivariate processes. We pursue Bayesian inference, which is attractive for full uncertainty quantification of the latent spatial process. Our approach exploits distribution theory for the matrix‐normal distribution, which we use to construct scalable versions of a hierarchical linear model of coregionalization (LMC) and spatial factor models that deliver inference over a high‐dimensional parameter space including the latent spatial process. We illustrate the computational and inferential benefits of our algorithms over competing methods using simulation studies and an analysis of a massive vegetation index data set.
The diagnostic and therapeutic challenges of Grade 3B follicular lymphoma
Authors: Barraclough Allison , Bishton Mark , Cheah Chan Y. , Villa Diego , Hawkes Eliza A.
Published: March 2021

Grade 3B follicular lymphoma (G3B FL) is rare, accounting for only 5–10% of FLs. Not only has it been routinely excluded from clinical trials, but data published on diagnosis, outcomes, choice of therapies and role of imaging are conflicting. With the advent of increasingly diverse treatment options for low‐grade (G1–3A) FL, and the molecular subcategorisation of high‐grade B‐cell lymphomas, characterisation and treatment of G3B FL is ever more important as extrapolation of data becomes more difficult. New data have emerged exploring unique genetic characteristics, specific features on positron emission tomography imaging, choice of therapy, and outcomes of G3B FL in the current era. The present review will summarise and appraise these new data, and offer recommendations based on current evidence.
Deep learning approach to predict lymph node metastasis directly from primary tumour histology in prostate cancer
Authors: Wessels Frederik , Schmitt Max , Krieghoff‐Henning Eva , Jutzi Tanja , Worst Thomas S. , Waldbillig Frank , Neuberger Manuel , Maron Roman C. , Steeg Matthias , Gaiser Timo , Hekler Achim , Utikal Jochen S. , von Kalle Christof , Fröhling Stefan , Michel Maurice S. , Nuhn Philipp , Brinker Titus J.
Published: March 2021

Objective

To develop a new digital biomarker based on the analysis of primary tumour tissue by a convolutional neural network (CNN) to predict lymph node metastasis (LNM) in a cohort matched for already established risk factors.

Patients and Methods

Haematoxylin and eosin (H&E) stained primary tumour slides from 218 patients (102 N+; 116 N0), matched for Gleason score, tumour size, venous invasion, perineural invasion and age, who underwent radical prostatectomy were selected to train a CNN and evaluate its ability to predict LN status.

Results

With 10 models trained with the same data, a mean area under the receiver operating characteristic curve (AUROC) of 0.68 (95% confidence interval [CI] 0.678–0.682) and a mean balanced accuracy of 61.37% (95% CI 60.05–62.69%) was achieved. The mean sensitivity and specificity was 53.09% (95% CI 49.77–56.41%) and 69.65% (95% CI 68.21–71.1%), respectively. These results were confirmed via cross‐validation. The probability score for LNM prediction was significantly higher on image sections from N+ samples (mean [SD] N+ probability score 0.58 [0.17] vs 0.47 [0.15] N0 probability score, P = 0.002). In multivariable analysis, the probability score of the CNN (odds ratio [OR] 1.04 per percentage probability, 95% CI 1.02–1.08; P = 0.04) and lymphovascular invasion (OR 11.73, 95% CI 3.96–35.7; P < 0.001) proved to be independent predictors for LNM.

Conclusion

In our present study, CNN‐based image analyses showed promising results as a potential novel low‐cost method to extract relevant prognostic information directly from H&E histology to predict the LN status of patients with prostate cancer. Our ubiquitously available technique might contribute to an improved LN status prediction.
Early postoperative acute myocardial infarction in kidney transplant recipients: A nested case‐control study
Authors: Deeb Maya , Gupta Nikita , Overgaard Christopher B. , Li Yanhong , Famure Olusegun , Joseph Kim S.
Published: March 2021

Introduction

The epidemiology of early acute myocardial infarctions after kidney transplantation has not been well characterized. This study sought to examine the incidence, risk factors, and clinical outcomes of early acute myocardial infarctions or EAMI in kidney transplant recipients.

Methods

A total of 1976 patients who underwent kidney transplantation at our center from Jan 1, 2000, to Sept 30, 2016, were included. A nested case‐control design was used to study EAMI risk factors using a conditional logistic regression model. A Cox proportional hazards model was used to assess the association of EAMI with death‐censored graft failure, death with graft function, and total graft failure.

Results

Seventy four patients had an EAMI within 3 months post‐transplant. Based on univariable analyses, risk factors for EAMI included age and recipient history of diabetes mellitus or coronary artery disease. After adjustment, recipient history of coronary artery disease was the only independent predictor for EAMI (OR 3.76, p < .001). Patients who experienced EAMI were more likely to experience death‐censored graft failure, death with graft function, and total graft failure.

Conclusion

While the incidence of EAMI in kidney transplant recipients is relatively low, these data show that EAMI has profound long‐term effects on morbidity and mortality.
Optimizing cardiovascular imaging in Staphylococcus aureus endocarditis
Authors: Shah Sangeeta , Gupta Tripti , White Christopher J , Jain Surma , Ramee Emily , Qamruddin Salima , Kemmerly Sandra A.
Published: March 2021

Introduction

The shift toward value‐based health care drives physicians to examine opportunities to optimize use of healthcare resources. There is discordance between providers’ use of cardiovascular imaging (CVI) in assessing patients for infective endocarditis (IE) with Staphylococcus aureus bacteremia (SAB). An evidence‐based algorithm was created to minimize variation of CVI use. The primary objective was to ensure sensitivity of the algorithm to recommend CVI in patients suspected of IE.

Methods

A retrospective review evaluated patients at Ochsner Medical Center who developed SAB between 1/1/13 and 12/31/14. Predefined patient demographics, use of CVI, outcomes, and 12‐week follow‐up for readmission after first positive blood culture were collected from chart review. The created algorithm was applied retrospectively to determine its sensitivity and specificity in recommending the right CVI test.

Results

181 patients admitted were admitted with SAB, of which 114 (63%) were male. There were 115 TTEs and 55 TEEs performed. Out of 15 patients diagnosed with IE, 3 were found on TTE and 12 were found on TEE. The algorithm would have recommended a TEE in all 15 patients who had high‐risk features for IE and a true diagnosis of IE, suggesting a sensitivity of 100% and specificity of 74.7% for the algorithm to have recommended a highly sensitive CVI modality.

Conclusion

This algorithm optimizes CVI for diagnosing IE in patients with SAB. As healthcare adapts to a value‐based system, use of best‐practice algorithms will promote consistency in practice among providers and help optimize patient outcomes and use of resources.
Architecture of an effective convolutional deep neural network for segmentation of skin lesion in dermoscopic images
Authors: Arora Ginni , Dubey Ashwani Kumar , Jaffery Zainul Abdin , Rocha Alvaro
Published: March 2021

The segmentation of dermoscopic‐based skin lesion images is considered to be challenging owing to various factors. Some of the most tangible reasons include poor contrast near the affected skin lesion, the fuzzy and unpredictable lesion limits, the presence of variations in noise, and capturing images under different conditions. This paper aims to develop an efficient segmentation model for dermoscopic images of different skin lesions based on deep learning. This paper proposes the 11‐layer convolutional deep neural network with two segmentation models trained from start to finish and do not depend on any previous information about the data. The viability, efficiency, and speculation ability of the models are evaluated on the ISIC2018 database. The proposed model achieves 0.903 accuracy and 0.820 Jaccard index in the segmentation of skin lesions. The model shows better performance compared to other image segmentation techniques from the leaderboards of ISIC2018 using deep learning.
Copper, Zinc and Lead Isotopic Delta Values and Isotope Ratios of Various Geological and Biological Reference Materials
Authors: Jeong Hyeryeong , Ra Kongtae , Choi Jin Young
Published: March 2021

Copper, Zn and Pb isotope ratios are important tracers for understanding geological and biological processes. We present optimised column separation methods using an anion exchange resin for Cu and Zn, and a Pb‐specific resin for Pb, and provide Cu, Zn and Pb isotope data for thirty‐three commercially available geological and biological reference materials (RMs) using MC‐ICP‐MS. Our measurement procedures can be applied to various environmental samples. The Cu, Zn and Pb yields were higher than 99.2%, and isotopic fractionation did not occur during column separation. Copper and Zn delta values of AGV‐2, BCR‐2, BIR‐1a, BHVO‐2, GSP‐2, NOD‐A‐1, NOD‐P‐1, DOLT‐4, BCR‐414, BCR‐279 and NIST SRM 1573a were in good agreement with previously reported values. The intermediate measurement precision for Cu and Zn delta values was better than ± 0.02‰ (2s). The δ65CuNIST976, δ66ZnJMCand206Pb/207Pb values determined in this study ranged from −0.19 to +0.73‰, −0.96 to +1.00‰ and 1.1172 to 1.2263, respectively. The δ66ZnJMCvariability (Δ66Znmax–min) in this study was relatively larger than that of δ65CuNIST976variability (Δ65Cumax–min). A combination of Cu, Zn and Pb isotopes can be used as potential environmental tracers to track the origins of these elements in the environment as well as to understand their influence on organisms.
Subcutaneous implantable cardioverter‐defibrillator electrode fracture: Follow‐up, troubleshooting, and evaluation
Authors: Kella Danesh K. , Stambler Bruce S.
Published: March 2021

The subcutaneous‐implantable cardioverter‐defibrillator (S‐ICD) and its electrode were developed to avoid long‐term complications of transvenous leads in the vasculature. We report a case of unexpected, inappropriate S‐ICD shocks due to oversensing of high‐amplitude, nonphysiologic, electrical noise artifacts that were not preceded by high‐impedance alerts or sensing electrogram noise detections. Following explant, high‐magnification X‐ray imaging of the S‐ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode‐header interface. Clinicians should be aware of a potential for fatigue failure fracture of the S‐ICD electrode. Recommendations for systematic S‐ICD follow‐up and troubleshooting are discussed.
Angiotensin‐converting enzyme inhibitors increase anti‐fibrotic biomarkers in African Americans with left ventricular hypertrophy
Authors: A. Romero Cesar , Mathew Shobi , Wasinski Benjamin , Reed Brian , Brody Aaron , Dawood Rachelle , Twiner Michael J. , McNaughton Candace D. , Fridman Rafael , Flack John M. , Carretero Oscar A. , Levy Phillip D.
Published: March 2021

Angiotensin‐converting enzyme inhibitors (ACEi) are part of the indicated treatment in hypertensive African Americans. ACEi have blood pressure‐independent effects that may make them preferred for certain patients. We aimed to evaluate the impact of ACEi on anti‐fibrotic biomarkers in African American hypertensive patients with left ventricular hypertrophy (LVH). We conducted a post hoc analysis of a randomized controlled trial in which hypertensive African American patients with LVH and vitamin D deficiency were randomized to receive intensive antihypertensive therapy plus vitamin D supplementation or placebo. We selected patients who had detectable lisinopril (lisinopril group) in plasma using liquid‐chromatography/mass spectrometry analysis and compared them to subjects who did not (comparison group) at the one‐year follow‐up. The pro‐fibrotic marker type 1 procollagen C‐terminal propeptide (PICP) and the anti‐fibrotic markers matrix metalloproteinase‐1 (MMP‐1), tissue inhibitor of metalloproteinases 1 (TIMP‐1), telopeptide of collagen type I (CITP), and N‐acetyl‐seryl‐aspartyl‐lysyl‐proline (Ac‐SDKP) peptide were measured. Sixty‐six patients were included, and the mean age was 46.2 ± 8 years. No difference was observed in the number and intensity of antihypertensive medications prescribed in each group. Patients with detectable lisinopril had lower blood pressure than those in the comparison group. The anti‐fibrotic markers Ac‐SDKP, MMP‐1, and MMP‐1/TIMP‐1 ratio were higher in patients with detectable ACEi (all p < .05). In a model adjusted for systolic blood pressure, MMP‐1/TIMP‐1 (p = .02) and Ac‐SDKP (p < .001) levels were associated with lisinopril. We conclude that ACEi increase anti‐fibrotic biomarkers in hypertensive African Americans with LVH, suggesting that they may offer added benefit over other agents in such patients.
Association of glycosylated haemoglobin HbA1c levels with outcome in patients with COVID‐19: A Retrospective Study
Authors: Yuan Shuai , Li Huaping , Chen Chen , Wang Feng , Wang Dao Wen
Published: March 2021

Patients with hyperglycemia tend to be susceptible to Coronavirus disease 2019 (COVID‐19). However, the association of HbA1c level with outcome of COVID‐19 patients was unclear. We performed a retrospective study of 2880 cases of COVID‐19 admitted in Tongji Hospital, Wuhan, China, among which 922 had detected the HbA1c levels. We found that COVID‐19 patients with either lower levels of HbAlc (3%‐4.9%) or higher levels of HbAlc (≥6%) were associated with elevated all‐cause mortality. Meanwhile, we observed that HbAlc levels were highly correlated with haemoglobin (Hb) and total cholesterol (TC) (P < .0001), moderately correlated with albumin (ALB) and high‐sensitive C reaction protein (hs‐CRP) (0.0001 < P<.001), and relatively low correlated with low‐density lipoprotein cholesterol (LDL‐C) (.001 < P<.01). These associated cofactors might together contribute to the clinical outcome of COVID‐19 patients. Furthermore, the mortality was higher in COVID‐19 patients with newly diagnosed diabetes mellitus (DM) compared with COVID‐19 patients with history of DM. Moreover, in patients with history of DM, the mortality was decreased in patients treated with anti‐hyperglycaemic drugs. In summary, our data showed that the in‐hospital mortality was increased in COVID‐19 patients with lower or higher levels of HbAlc. Meanwhile, initiation of appropriate anti‐hyperglycaemic treatment might improve the clinical outcome in COVID‐19 patients.
A potential role for overdominance in the maintenance of colour variation in the Neotropical tortoise beetle, Chelymorpha alternans
Authors: Strickland Lynette R. , Fuller Rebecca C. , Windsor Donald , Cáceres Carla E.
Published: March 2021

The presence of persistent polymorphisms within natural populations elicits the question of how such polymorphisms are maintained. All else equal, genetic drift and natural selection should remove genetic variants from populations. Disassortative mating and overdominance are potential mechanisms for maintaining variation within populations. Here, we consider the potential role of these mechanisms in maintaining variation in colour pattern in the tortoise beetle, Chelymorpha alternans. Five colour morphs distinguished by elytral and pronotal coloration are largely determined by a single locus of large effect with four segregating alleles. As many as four morphs co‐occur in natural populations. We first assessed whether disassortative mating might maintain this polymorphism. To test for assortative and disassortative mating, we paired females with two males, one with the same colour pattern as the female and one with a different colour pattern and examined the colour patterns of the offspring. We found strong evidence for random mating as a function of colour pattern. We next assessed whether differences in offspring survival among assortative and disassortative male‐female pairs maintain colour variation. Crosses involving disassortative pairings had significantly higher offspring survival during development and resulted in more adult progeny. This result is consistent with the effects of overdominance, whereby outcrossed individuals have higher fitness than their homozygous counterparts. Overall, differences in offspring survival appear to play a greater role in maintaining polymorphisms than nonrandom mating in species.
Genomic characterization of selfing in the cyclic parthenogen Daphnia magna
Authors: Cornetti Luca , Fields Peter D. , Ebert Dieter
Published: March 2021

Inbreeding refers to the fusion of related individuals' gametes, with self‐fertilization (selfing) being an extreme form of inbreeding—involving gametes produced by the same individual. Selfing is expected to reduce heterozygosity by an average of 50% in one generation; however, little is known about the empirical variation on a genome level surrounding this figure and the factors that affect variation. We selfed genotypes of the cyclic parthenogen Daphnia magna and analysed whole genomes of mothers and selfed offspring, observing the predicted 50% heterozygosity reduction on average. We also saw substantial variation around this value and significant differences among mother–offspring pairs. Crossover analysis confirmed the known trend of recombination occurring more often towards the telomeres. This effect was shown, through simulations, to increase the variance of heterozygosity reduction compared to when a uniform distribution of crossovers was used. Similarly, we simulated inbred line production after several generations of selfing and we observed higher variance in achieved homozygosity when we consider a higher recombination rate towards the telomeres. Our empirical and simulation study highlights that the expected mean values of heterozygosity reduction show remarkable variation, which can help understand, for example, differences among inbred individuals.
In the landscape of SARS‐CoV‐2 and fresh fruits and vegetables: The fake and hidden transmission risks
Authors: Benkeblia Noureddine
Published: March 2021

From the first notification reporting to the WHO a cluster of coronavirus in Wuhan City (China), over 114 million cases of SARS‐CoV‐2 have been confirmed, with more than 2,530,000 deaths, and over 400,000 new cases and 10,000 deaths daily. Numerous viruses are susceptible to contaminate crops during growth, harvesting, handling, marketing and minimally processing, and these steps share one common factor which is human. Different studies showed that viruses might persist on different crops for periods of 2 to 14 days under different conditions such as refrigeration, household and freezing. Little is known on SARS‐CoV‐2, but preliminary studies showed that this virus might survive 24 hr on cardboard and 72 hr on plastic, materials used in fruits and vegetables packaging. Based on preliminary data, there is no evidence of food or food packaging being associated with transmission of SARS‐CoV‐2. Certainly, to date there is no scientific evidence that SARS‐CoV‐2 might be transmitted by a contact with, or the ingestion of contaminated fresh or minimally processed fruits and vegetables. However, this risk even though being considered improbable, it cannot be “completely and definitely” discarded or ignored, particularly where the virus is spreading in the word. Some agencies indicated that in case some commodities and handlers are contaminated among the multiple people involved from the farm to the table, a cross‐contamination may occur, and the risk of the contamination of food, food contact materials, and packaging from infected but asymptomatic workers should not be discarded even though considered “Very Low = meaning very rare but cannot be excluded.”
Estimating the number of new hepatitis C infections in Australia in 2015, prior to the scale‐up of direct‐acting antiviral treatment
Authors: Palmer Anna Y , Wilkinson Anna , Aitken Campbell , Dietze Paul , Dore Gregory J , Maher Lisa , Sacks‐Davis Rachel , Stoove Mark , Wilson David , Hellard Margaret , Scott Nick
Published: March 2021

Background and Aim

The recent downward revision of the estimated number of people living with chronic hepatitis C in Australia means that the annual number of new hepatitis C infections should also be revised. We aimed to estimate the annual number of new hepatitis C infections among people who inject drugs (PWID) in Australia in 2015, prior to the introduction of direct‐acting antiviral (DAA) treatment for hepatitis C, as an updated baseline measure for assessing the impact of DAAs on hepatitis C incidence over the next 10 years.

Methods

A systematic review identified articles estimating hepatitis C incidence rates among PWID between 2002 and 2015. Reported incidence rates were adjusted to account for unrepresentative needle and syringe program (NSP) coverage among study participants compared with PWID overall. The total number of PWID in Australia and the hepatitis C RNA prevalence among PWID were taken from published estimates. The annual number of new infections was estimated by multiplying the pooled NSP coverage‐adjusted incidence rate by the number of susceptible PWID in 2015.

Results

Five studies were included, with unadjusted incidence rates ranging from 7.6 to 12.8 per 100 person‐years. The overall pooled incidence rate (after adjusting for NSP coverage) was 9.9 per 100 person‐years (95% confidence interval: 8.3–11.8). This led to an estimate of 4126 (range 2499–6405) new hepatitis C infections in 2015.

Conclusions

Our updated estimate provides an important baseline for evaluating the impact of hepatitis C elimination efforts and can be used to validate outcomes of future modeling studies.
The prevalence of burnout, risk factors, and job‐related stressors in gastroenterologists: A systematic review
Authors: Ong John , Swift Carla , Bath Michael , Ong Sharon , Lim Wanyen , Al‐Naeeb Yasseen , Shankar Arun , Dan Yock Young
Published: March 2021

Background and Aims

Burnout is an important occupational hazard, and the scale of the problem within gastroenterology remains poorly understood. The primary objective of this study was to understand the prevalence of burnout in gastroenterology and ascertain if there was a common prevalence within the field. The secondary objective was to identify factors and job‐related stressors that commonly contribute to burnout in gastroenterologists.

Methods

Systematic searches were conducted in PubMed, Scopus, Cochrane, and PsycINFO by two reviewers independently for articles published to 1 September 2020. The primary outcome measure was the reported prevalence of burnout in gastroenterologists. The secondary outcome measures were (i) the prevalence of non‐somatic burnout symptoms (emotional exhaustion, depersonalization, and low personal accomplishment) and (ii) the frequency of risk factors and stressors reported in studies. Data were presented, and limited meta‐analyses discussed.

Results

Data were extracted from 11 studies. 54.5% (6/11) of these studies reported the prevalence of burnout in gastroenterologists; this ranged from 18.3% to 64.4%. Similar to burnout prevalence, burnout symptoms showed geographical variation and were common in gastroenterologists (up to 63.9%). Factors associated with work volume, age, and female gender were the three most frequently reported risk factors for increased levels of stress and burnout in 72.7% (8/11), 54.5% (6/11), and 45.5% (5/11) of studies, respectively. Significant methodological and clinical heterogeneity was observed.

Conclusions

Burnout and its non‐somatic symptoms are common in gastroenterologists, but the syndrome is understudied within the field. Further research and good quality data are needed to help address the problem.
Low speech rate but high gesture rate during conversational interaction in people with Cornelia de Lange syndrome
Authors: Pearson E. , Nielsen E. , Kita S. , Groves L. , Nelson L. , Moss J. , Oliver C.
Published: March 2021

Background

Cornelia de Lange syndrsome (CdLS) is a rare genetic syndrome with notable impaired expressive communication characterised by reduced spoken language. We examined gesture use to refine the description of expressive communication impairments in CdLS.

Methods

During conversations, we compared gesture use in people with CdLS to peers with Down syndrome (DS) matched for receptive language and adaptive ability, and typically developing (TD) individuals of similar chronological age.

Results

As anticipated the DS and CdLS groups used fewer words during conversation than TD peers (P < .001). However, the CdLS group used twice the number of gestures per 100 words compared with the DS and TD groups (P = .003).

Conclusions

Individuals with CdLS have a significantly higher gesture rate than expected given their level of intellectual disability and chronological age. This result indicates the cause of reduced use of spoken language does not extend to all forms of expressive communication.
Clusterin inhibits Aβ42 aggregation through a “strawberry model” as detected by FRET‐FCS
Authors: Xu Lingwan , Tian Shijun , Peng Xianglei , Hua Ying , Yang Wenxuan , Chen Longwei , Liu Shilei , Wu Wenzheng , Zhao Jiang , He Jinsheng , Wu Liqing , Yang Jingfa , Zheng Yanpeng
Published: March 2021

Extracellular plaque deposits of β‐amyloid peptide (Aβ) are one of the main pathological features of Alzheimer's disease (AD). The aggregation of Aβ42 species, especially Aβ42 oligomers, is still an active research field in AD pathogenesis. Secretory clusterin protein (sCLU), an extracellular chaperone, plays an important role in AD pathogenesis. Although sCLU interacts directly with Aβ42 in vitro and in vivo, the mechanism is not clear. In this paper, His‐tagged sCLU (sCLU‐His) was cloned, expressed and purified, and we applied florescence resonance energy transfer‐fluorescence correlation spectroscopy (FRET‐FCS) to investigate the direct interaction of sCLU‐His and Aβ42 at the single‐molecule fluorescence level in vitro. Here, we chose four different fluorescently labeled Aβ42 oligomers to form two different groups of aggregation models, easy or difficult to aggregate. The results showed that sCLU‐His could form complexes with both aggregation models, and sCLU‐His inhibited the aggregation of Aβ42/RB ~ Aβ42/Atto647 (easy to aggregate model). The complexes were produced as the Aβ42/Label adhered to the sCLU‐His, which is similar to a “strawberry model,” as strawberry seeds are dotted on the outer surface of strawberries. This work provided additional insight into the interaction mechanism of sCLU and Aβ42.

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Silver linings: Observed reductions in aggression and use of restraints and seclusion in psychiatric inpatient care during COVID‐19
Authors: Martin Krystle , Arbour Simone , McGregor Carolyn , Rice Mark
Published: March 2021

Accessible Summary

What is known about the subject?

In a survey conducted by the World Health Organization (WHO) in the summer of 2020, 93% of countries worldwide acknowledged negative impacts on their mental health services.

Previous research during the H1N1 pandemic in 2009 established an increase of patient aggression in psychiatric facilities.

What the paper adds to existing knowledge?

Despite expected worsening of mental health, our hospital observed reductions in aggressive behaviour among inpatients and subsequent use of coercive interventions by staff in the months following Covid‐19 pandemic restrictions being implemented.

The downward trend in incidents observed during the pandemic has suggested that aggression in mental health hospitals may be more situation‐specific and less so a factor of mental illness.

What are the implications for practice?

We believe that the reduction in aggressive behaviour observed during the pandemic is related to changes in our organization that occurred in response to concerns about patient well‐being; our co‐design approach shifted trust, choice and power. Therefore, practices that support these constructs are needed to maintain the outcomes we experienced.

Rather than return to normal in the wake of the pandemic, we are strongly encouraged to sustain the changes we made and continue to find better ways to support and work with the individuals who rely on or use our services.

The global COVID‐19 pandemic has dramatically changed the operation of health care such that many services were put on hold as patients were triaged differently, people delayed seeking care, and transition to virtual care was enacted, including in psychiatric facilities. Most of the media dialogue has been negative; however, there have been some silver linings observed. Coinciding with the pandemic has been a reduction in aggressive incidents at our psychiatric hospital, along with the decreased need to use restraints and seclusion to manage behaviour. In this paper, we are taking stock of the changes that have occurred in response to the pandemic in an attempt to share our learnings and offer suggestions so that health care does not necessarily return to “normal”.
Estimating purine derivatives and nitrogen compound excretion using total urine collection or spot urine samples in grazing heifers
Authors: da Silva Júnior Jarbas Miguel , Rodrigues João Paulo Pacheco , Valadares Filho Sebastião de Campos , Detmann Edenio , Paulino Mário Fonseca , Rennó Luciana Navajas
Published: March 2021

The study aimed to evaluate the excretion of purine derivatives (PDs) and nitrogen compounds (NCs) and their ratios with creatinine in supplemented Zebu heifers kept on pastures by comparing total urine collection and spot sampling. Five Nelore heifers (400 ± 15 kg) were used in a 5 × 5 Latin square design. The treatments were the amount of concentrate (220 g of crude protein/kg dry matter) offered (0, 3, 6, 9 and 12 g/kg BW). In each period, the total urine collection was performed continuously for 3 days (subsampled at intervals of 4 h, 00:00–04:00 h, 04:00–08:00 h, 08:00–12:00 h, 12:00–16:00 h, 16:00–20:00 h and 20:00–24:00 h). The spot urine samplings were performed (in each period) for 24 h (0, 4, 8, 12, 16 and 20 h). Creatinine, total urinary nitrogen (UN), urea nitrogen (UreaN), allantoin and uric acid were analysed. Creatinine excretion was 23.01 ± 0.19 mg/kg BW and was not affected by collection day, treatment or their interactions (p > 0.05). Treatments affected (p < 0.05) PD excretions, however did not affect the ratio PD:creatinine (p > 0.05). Treatments and collection time affected (p < 0.05) NC excretion, whereas the UN:creatinine and UreaN:creatinine ratios were not affected (p > 0.05). Creatinine excretion and the PD:creatinine ratios in the urine samples estimated by the total or spot sampling were not different (p > 0.05). However, sampling method affected (p < 0.05) the UN:creatinine and UreaN:creatinine (p < 0.05) ratios. Creatinine can adequately estimate urinary excretion in grazing heifers, and a single spot urine sample at any time of the day can be used to estimate PD excretion in grazing heifers. But two spot urine samples are needed for proper NC excretion estimations in grazing heifers’ urine.
Contrasting levels of genetic predictability in the evolution of resistance to major classes of fungicides
Authors: Hawkins Nichola J. , Fraaije Bart A.
Published: March 2021

The evolution of resistance has been seen across all major classes of xenobiotics, including antimicrobial drugs and agricultural pesticides. This repeated emergence of resistance is a case of phenotypic parallel evolution, but often the parallelism extends to the molecular level too, with multiple species gaining the same mutation in response to the same chemical treatment. We review the degree of repeatability in target‐site resistance mutations affecting different classes of site‐specific agricultural fungicides used in crop protection, comparing the extent to which resistance in different pathogen species has evolved via the same or different mutations. For all major fungicide target sites, substantial levels of molecular parallel evolution can be seen, with at least one mutation recurring in over 50% of species. Target‐site mutations appear to be most repeatable in cytochrome b, target site of quinone‐outside inhibitor fungicides, and least predictable for CYP51, target site of the azoles. Intermediate levels of repeatability are seen for the MBC target site β‐tubulin, and the SDHI target site succinate dehydrogenase. Repeatability may be lower where there are selective trade‐offs between resistance and pleiotropic fitness penalties, or differing levels of cross‐resistance across members of a fungicide class; or where single mutations confer only partial resistance, and epistatic interactions between multiple mutations result in a rugged fitness landscape. This affects the predictive power of in vitro mutation studies, and has practical implications for resistance monitoring strategies and diagnostic methods.