bluuebunny/crossref_metadata_2025 huggingface dataset:
Internal processes in decision-making (mental, emotional, cultural, ethical and spiritual) of Afghan business leaders
Authors: Ibneatheer Mujeeb ur Rahman , Rostan Pierre , Rostan Alexandra
Published: February 2021

Purpose

The purpose of this paper is to understand, which internal processes (mental, emotional, cultural, ethical and spiritual) Afghan business leaders use when making managerial decisions.

Design/methodology/approach

Primary data were collected through 1-h face-to-face interviews with Afghan business leaders. Interviews were conducted through open-ended questions in a semi-structured format. This method was considered most appropriate to acquire an understanding of senior executives’ interpretation and usage of decision-making processes. The method of analyzing data was thematic analysis where the researchers identified common themes, topics, ideas and patterns of meaning that come up repetitively. The objective of the analysis was to determine the most frequent decision-making processes by business leaders and the reasons for using these processes.

Findings

Although the usage of internal processes in decision-making are not homogeneous among Afghan business leaders, some of the processes are used more frequently than others such as mental, cultural and ethical processes. During the mental process of decision-making, the majority of leaders use intuitional decision-making, the minority using logic. Regarding the cultural dimension, the majority of leaders stated that they have an open, friendly, caring organization for each employee and horizontal culture in their organization. The minority indicated that they have a friendly culture but they also considered the processes and hierarchy in their organization. Considering the ethical process of decision-making, leaders stated that their priorities are more ethical than getting extra profit. They believe that profit will be generated while considering ethical values. As a leader noted: when you consider ethics and fulfill your obligations, the profit automatically generates. Most leaders use the internal process of emotion in their decision-making, but the usage has not been frequent. The emotional process of decision-making is more involved when the human factor is involved. For instance, one of the participants stated “I did not fire an employee that I had to because he was a needy and poor person.” About the spiritual process of decision-making, although all leaders agreed that they have used spirituality in decision-making, its usage varies. About one-third of the leaders mostly rely on spirituality or on religious teachings during the decision-making process, one-third somehow rely on spirituality or religion, about 50% of the time and one-third rely on spirituality between 25% to 30% of the time.

Originality/value

This study is pilot research as no previous research was carried out on this topic, therefore, it provides a basis of literature on the usage of internal processes on decision-making in Afghanistan. The findings may differ in other economic and national contexts.
Environmental justice research – limitations and future directions using qualitative research methods
Authors: Das Ujjaini
Published: February 2021

Purpose

The purpose of the study is to review some of the existing gaps in the third-generation of critical environmental justice (EJ) research and then propose promising combinations of theoretical concepts by adjoining (EJ) literature with other bodies of work with the use of qualitative research methods.

Design/methodology/approach

This paper is a critique of the third-generation of critical EJ literature. It demonstrates how the scope of this scholarship, particularly the third world EJ studies, can be expanded further by deploying various combinations of other theories and qualitative research methods.

Findings

Conceptually, this paper provides insights into the new directions that third world EJ theory can take by drawing from other bodies of work including the developmental state, caste, waste, informal sector and labor studies within its fold. Methodologically, the paper shows why and how qualitative research methods including single and multiple case study, participatory action research and ethnography can assist in developing these new integrations between theories.

Research limitations/implications

This research calls for the need to conduct studies in each of the new research dimension suggested in this paper in novel empirical spaces. Such studies will enable the practice of EJ and will help to advance the field of EJ scholarship forward.

Social implications

Analysis of new research combinations with qualitative research methods in new empirical spaces might create scope for practicing EJ in such spaces where various forms of environmental injustices prevail.

Originality/value

This paper identifies gaps in the third-generation of critical EJ research and proposes new research directions by combining other theories and qualitative methods.
The effects of tegaserod, a gastrokinetic agent, on voltage‐gated K+ channels in rabbit coronary arterial smooth muscle cells
Authors: An Jin Ryeol , Jung Hee Seok , Seo Mi Seon , Kang Minji , Heo Ryeon , Park Hongzoo , Song Geehyun , Jung Won‐Kyo , Choi Il‐Whan , Park Won Sun
Published: February 2021

Tegaserod, a gastroprokinetic agent, is used to treat irritable bowel syndrome. Despite its extensive clinical use, little is known about the effects of tegaserod on vascular ion channels, especially K+ channels. Therefore, we examined the effects of tegaserod on voltage‐gated K+ (Kv) channels in rabbit coronary arterial smooth muscle cells using the whole‐cell patch‐clamp technique. Tegaserod inhibited Kv channels in a concentration‐dependent manner with an IC50 value of 1.26 ± 0.31 µmol/L and Hill coefficient of 0.81 ± 0.10. Although tegaserod had no effect on the steady‐state activation curves of the Kv channels, the steady‐state inactivation curve was shifted toward a more negative potential. These results suggest that tegaserod inhibits Kv channels by influencing their voltage sensors. The recovery time constant of channel inactivation was extended in the presence of tegaserod. Furthermore, application of train steps (1 and 2 Hz) in the presence of tegaserod progressively increased the inhibition of Kv currents suggesting that tegaserod‐induced Kv channel inhibition is use (state)‐dependent. Pretreatment with a Kv1.5 subtype inhibitor suppressed the Kv current. However, additional application of tegaserod did not induce further inhibition. Pretreatment with a Kv2.1 or Kv7 inhibitor did not affect the inhibitory effect of tegaserod on Kv channels. Based on these results, we conclude that tegaserod inhibits vascular Kv channels in a concentration‐ and use (state)‐dependent manner independent of its own functions. Furthermore, the major Kv channel target of tegaserod is the Kv1.5 subtype.
Low back pain presentations to New South Wales emergency departments: Trends over time and geographical variation
Authors: Ferreira Giovanni E , Herbert Rob , Machado Gustavo C , Richards Bethan , Harris Ian A , O'Keeffe Mary , Zadro Joshua R , Maher Chris G
Published: February 2021

Objective

To determine whether rates of ED presentations because of low back pain (LBP) have increased from 2016 to 2019 in New South Wales and map the geographical distribution of ED presentations because of LBP across New South Wales.

Methods

We sourced data from the New South Wales Emergency Department Records for Epidemiology. We included all ED presentations aged 15 years and older with a diagnosis of LBP to the 178 public EDs across New South Wales from 1 January 2016 to 31 December 2019. We calculated the ratio (95% confidence interval) between the 2016 and 2019 age‐standardised rates to determine whether an increase in the rate of ED LBP presentations has occurred. To assess geographical variation, we aggregated presentations by their home postcode. We calculated age‐standardised rates per 100 000 person year for each of those areas using data from 2016 to 2019.

Results

We included 188 275 LBP presentations for patients aged 15 years or older. Their mean (standard deviation) age was 51.3 (20.0) years. From 2016 to 2019, we observed a 5.3% increase in the age‐adjusted LBP ED presentation rates (age‐standardised ratio 1.05, 95% confidence interval 1.04–1.06). We found a 20‐fold variation in LBP ED age‐standardised presentation rates across the different local government areas of New South Wales. Higher rates were mostly observed in rural and regional areas.

Conclusions

The demand for ED services because of LBP has increased in New South Wales over time, and we observed a 20‐fold variation in presentation rates across different regions.
Major pathological response after neoadjuvant immunotherapy in esophageal spindle cell carcinoma: A case report
Authors: Fu Yang , Wang Pei‐Pei , He Du , Zheng Yue , Ding Zhen‐Yu
Published: February 2021

Esophageal spindle cell carcinoma (ESpCC) is a rare subtype of esophageal carcinoma, accounting for 1% of all esophageal malignancies. The clinical outcome is unknown due to the lack of treatment options. Here, we present the case of a 60‐year‐old male with initially unresectable ESpCC, in which platinum‐based concurrent chemoradiotherapy was unsuccessful. He was subsequently treated with neoadjuvant immunotherapy and after surgery achieved a complete pathological response; therefore, neoadjuvant immunotherapy might be a novel option for ESpCC patients.
Umm an‐Nar soft‐stone vessel assemblage from Tomb QA 1‐1 (Oman) based on finds recovered from half the tomb
Authors: Rutkowski Łukasz
Published: February 2021

This article is devoted to the soft‐stone vessels retrieved from QA 1‐1, a tomb from the Umm an‐Nar period in Wadi al‐Fajj, Northwest Oman, as part of a joint Polish–Omani project in 2016–2018. To date, the excavations, although confined to half of the tomb’s interior, have yielded as many as 67 soft‐stone vessels or their fragments, which, at least for the time being, is the second‐largest collection of these items obtained from one Umm an‐Nar tomb. The article primarily aims to present the current assemblage in terms of its spatial distribution within the tomb with particular emphasis on complete specimens discovered in situ. The paper aims to provide a valuable source of comparative research and thus may contribute to further discussions on the production and circulation of soft‐stone vessels in the land of Magan, as well as the burial rites related to furnishing the deceased with them.
Organizational aspects of pediatric anesthesia and surgery between two waves of Covid‐19
Authors: Camporesi Anna , Melloni Giorgio E. M. , Diotto Veronica , Bertani Patrizia , La Pergola Enrico , Pelizzo Gloria
Published: February 2021

Background

The initial wave of the Covid‐19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. “Vittore Buzzi” Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures—with the exception of urgent/emergent ones—between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars‐CoV‐2 in every case.

Methods

Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS‐CoV ‐2 RT‐PCR testing outcomes, and comparison to same period surgeries in 2019.

Results

An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33‐2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43‐2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi‐squared P‐value < .001). Sars‐CoV‐2‐positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity.

Conclusion

We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.
Genetic architecture of four smoking behaviors using partitioned SNP heritability
Authors: Evans Luke M. , Jang Seonkyeong , Hancock Dana B. , Ehringer Marissa A. , Otto Jacqueline M. , Vrieze Scott I. , Keller Matthew C.
Published: February 2021

Background and Aims

Although genome‐wide association studies have identified many loci that influence smoking behaviors, much of the genetic variance remains unexplained. We characterized the genetic architecture of four smoking behaviors using single nucleotide polymorphism (SNP) heritability (h2SNP). This is an estimate of narrow‐sense heritability specifically estimating the proportion of phenotypic variation due to causal variants (CVs) tagged by SNPs.

Design

Partitioned h2SNP analysis of smoking behavior traits.

Setting

UK Biobank.

Participants

UK Biobank participants of European ancestry. The number of participants varied depending on the trait, from 54 792 to 323 068.

Measurements

Smoking initiation, age of initiation, cigarettes per day (CPD; count, log‐transformed, binned and dichotomized into heavy versus light) and smoking cessation with imputed genome‐wide SNPs.

Findings

We estimated that, in aggregate, approximately 18% of the phenotypic variance in smoking initiation was captured by imputed SNPs [h2SNP = 0.18, standard error (SE) = 0.01] and 12% [SE = 0.02] for smoking cessation, both of which were more than twice the previously reported estimates. Estimated age of initiation (h2SNP = 0.05, SE = 0.01) and binned CPD (h2SNP = 0.1, SE = 0.01) were substantially below published twin‐based h2 of 50%. CPD encoding influenced estimates, with dichotomized CPD h2SNP = 0.28. There was no evidence of dominance genetic variance for any trait.

Conclusion

A biobank study of smoking behavior traits suggested that the phenotypic variance explained by SNPs of smoking initiation, age of initiation, cigarettes per day and smoking cessation is modest overall.
Evaluating the effects of the Licensing Act 2003 on the characteristics of drinking occasions in England and Wales: a theory of change‐guided evaluation of a natural experiment
Authors: Stevely Abigail Kate , de Vocht Frank , Neves Rita Borges , Holmes John , Meier Petra Sylvia
Published: February 2021

Background and Aims

The Licensing Act 2003 deregulated trading hours in England and Wales. Previous evaluations have focused upon consumption and harm outcomes, finding mixed results. Several evaluations speculated on the reasons for their results, noting the role of changes in the characteristics of drinking occasions. This study aimed to test proposed mechanisms of effect for the Licensing Act 2003 by evaluating changes in characteristics of drinking occasions.

Design, Setting and Participants

Interrupted monthly time–series analysis of effects in England and Wales versus a Scottish control series, using 2001–08 data collected via 7‐day drinking occasions diaries by the market research company Kantar (n = 89 192 adults aged 18+).

Measurements

Outcomes were start‐ and end‐time of each reported occasion; variation in finish time; prevalence of pre‐loading, post‐loading and late‐night drinking; and alcohol consumption (in units).

Findings

After the introduction of the Act, occasions shifted later at night in England and Wales [finish time +11.4 minutes; 95% confidence interval (CI) = 3.6–19.2]. More occasions involved pre‐loading in England and Wales relative to Scotland (0.02% increase; 95% CI = 0.01–0.03). There was no evidence of changes in variation in finish time, post‐loading, late‐night drinking or alcohol consumption.

Conclusions

The Licensing Act 2003 in England and Wales appears to have had only limited effects on the characteristics of drinking occasions. This may help to explain its lack of substantial impacts on alcohol harms
Cardiovascular safety of the tyrosine kinase inhibitor nintedanib
Authors: Ameri Pietro , Tini Giacomo , Spallarossa Paolo , Mercurio Valentina , Tocchetti Carlo Gabriele , Porto Italo
Published: February 2021

The intracellular tyrosine kinase inhibitor nintedanib has shown great efficacy for the treatment of idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases. However, the incidence rate of myocardial infarction (MI) among participants in landmark IPF trials was remarkable, peaking at 3/100 patient‐years. Although subjects with IPF often have a high cardiovascular (CV) risk profile, the occurrence of MI in nintedanib‐treated patients may not be fully explained by clustering of CV risk factors. Nintedanib inhibits the vascular endothelial growth factor, platelet‐derived growth factor and fibroblast growth factor pathways, which play important roles in the biology of the atherosclerotic plaque and in the response of the heart to ischaemia. Hence, unwanted CV effects may partly account for nintedanib‐related MI. We review the evidence supporting this hypothesis and discuss possible actions for a safe implementation of nintedanib in clinical practice, building on the experience with tyrosine kinase inhibitors acquired in cardio‐oncology.
CKLF and IL1B transcript levels at diagnosis are predictive of relapse in children with pre‐B‐cell acute lymphoblastic leukaemia
Authors: Fitter Stephen , Bradey Alanah L. , Kok Chung Hoow , Noll Jacqueline E. , Wilczek Vicki J. , Venn Nicola C. , Law Tamara , Paisitkriangkrai Sakrapee , Story Colin , Saunders Lynda , Dalla Pozza Luciano , Marshall Glenn M. , White Deborah L. , Sutton Rosemary , Zannettino Andrew C. W. , Revesz Tamas
Published: February 2021

Disease relapse is the greatest cause of treatment failure in paediatric B‐cell acute lymphoblastic leukaemia (B‐ALL). Current risk stratifications fail to capture all patients at risk of relapse. Herein, we used a machine‐learning approach to identify B‐ALL blast‐secreted factors that are associated with poor survival outcomes. Using this approach, we identified a two‐gene expression signature (CKLF and IL1B) that allowed identification of high‐risk patients at diagnosis. This two‐gene expression signature enhances the predictive value of current at diagnosis or end‐of‐induction risk stratification suggesting the model can be applied continuously to help guide implementation of risk‐adapted therapies.
Soluble PD‐L1 is a promising disease biomarker but does not reflect tissue expression in classic Hodgkin lymphoma
Authors: Veldman Johanna , Alsada Zainab N. D. , van den Berg Anke , Plattel Wouter J. , Diepstra Arjan , Visser Lydia
Published: February 2021

Individually, tissue and soluble markers involved in the programmed cell death protein 1/programmed death‐ligand (PD‐1/PD‐L) axis have been described as biomarkers with clinical value in classical Hodgkin lymphoma (cHL). In the context of the success of immune checkpoint blockade therapy in cHL, it is interesting to discover whether plasma levels of proteins in the PD‐1/PD‐L axis are a reflection of expression by the corresponding tissue. Paired tissue and plasma samples of cHL patients were collected and analysed for PD‐1, PD‐L1 and PD‐L2 levels. In addition, vascular endothelial growth factor (VEGF) and CD83, molecules regarded to influence the expression of PD‐1, PD‐L1 and/or PD‐L2, were included. PD‐L1 was upregulated in the plasma of cHL patients compared to healthy controls and correlated well with several clinical parameters. Strong PD‐L1 expression in the tumour microenvironment contributed to high soluble (s)PD‐L1 levels, although there was no direct correlation between plasma PD‐L1 levels and total expression of PD‐L1 in corresponding cHL tissue. Interestingly, we observed a positive correlation between VEGF and PD‐1 levels in both tissue and plasma. In conclusion, although PD‐L1 is a promising soluble biomarker in cHL, its levels do not reflect the total tissue expression. Future studies focusing on PD‐L1 as a predictor for immune checkpoint treatment response, should include both biopsy and plasma samples.
Telehealth and wellness coaching: mirage or mainstay?
Authors: Rethorn Zachary D
Published: February 2021

This commentary is on the original article by Ogourtsova et al. on pages 668–674 of this issue.
Obesity as a multisystem disease: Trends in obesity rates and obesity‐related complications
Authors: Sarma Shohinee , Sockalingam Sanjeev , Dash Satya
Published: February 2021

Obesity is a chronic multisystem disease associated with increased morbidity and mortality. The increasing prevalence of obesity makes it a major healthcare challenge across both developed and developing countries. Traditional measures such as body mass index do not always identify individuals at increased risk of comorbidities, yet continue to be used in deciding who qualifies for weight loss treatment. A better understanding of how obesity is associated with comorbidities, in particular non‐metabolic conditions, is needed to identify individuals at risk in order to prioritize treatment. For metabolic disorders such as type 2 diabetes (T2D), weight loss can prevent T2D in individuals with prediabetes. It can improve and reverse T2D if weight loss is achieved early in the course of the disease. However, access to effective weight loss treatments is a significant barrier to improved health for people with obesity. In the present paper, we review the rising prevalence of obesity and why it should be classed as a multisystem disease. We will discuss potential mechanisms underlying its association with various comorbidities and how these respond to treatment, with a particular focus on cardiometabolic disease, malignancy and mental health.
Connectivity and edge effects increase bee colonization in an experimentally fragmented landscape
Authors: Griffin Sean R. , Haddad Nick M.
Published: February 2021

Though landscape corridors increase dispersal of many animals and plants, it remains unknown whether these positive effects extend to the process of colonization and establishment of new populations in fragments. Working in experimentally fragmented landscapes, we tested how two aspects of habitat fragments altered by corridors – connectivity and edge‐to‐area ratio – determine patterns of colonization by a solitary, cavity‐nesting bee Megachile rotundata. We found that though connectivity initially affected rates of nest‐site occupation, edge‐to‐area ratio ultimately determined the final patterns of patch occupation and nest building, likely due to habitat selection by our focal species. Bee colonization was also higher in patches with higher abundances of their preferred food resources, flowers from the Fabaceae family. Our results show the importance of considering the effects of both connectivity and edge on population dynamics in habitat‐based conservation.
Contrasting seasonal patterns of relative temperature and thermal heterogeneity and their influence on breeding and winter bird richness patterns across the conterminous United States
Authors: Elsen Paul R. , Farwell Laura S. , Pidgeon Anna M. , Radeloff Volker C.
Published: February 2021

Environmental heterogeneity enhances species richness by creating niches and providing refugia. Spatial variation in climate has a particularly strong positive correlation with richness, but is often indirectly inferred from proxy variables, such as elevation and related topographic heterogeneity indices, or derived from interpolated coarse‐grain weather station data. Our aim was to develop new remotely sensed metrics of relative temperature and thermal heterogeneity, compare them with proxy measures, and evaluate their performance in predicting species richness patterns. We analyzed Landsat 8's Thermal Infrared Sensor data, calculated two thermal metrics during summer and winter, and compared their seasonal spatial patterns with those of elevation and topographic heterogeneity. We fit generalized least squares models to evaluate each variable's effect in predicting seasonal bird richness using data from the North American Breeding Bird Survey. Generally speaking, neither elevation nor topographic heterogeneity were good proxies for temperature or thermal heterogeneity, respectively. Relative temperature had a non‐linear relationship with elevation that was negatively quadratic in summer, but slightly positively quadratic in winter. Topographic heterogeneity had a stronger positive relationship with thermal heterogeneity in winter than in summer. The magnitude and direction of elevation–temperature and topographic heterogeneity–thermal heterogeneity relationships in each season also varied substantially across ecoregions. Remotely sensed metrics of relative temperature and thermal heterogeneity improved the predictive performance of species richness models, and both thermal variables had significant effects on bird richness that were independent of elevation and topographic heterogeneity. Thermal heterogeneity was positively related to total breeding bird richness, migrant breeding bird richness and resident bird richness, whereas topographic heterogeneity was negatively related to total breeding richness and unrelated to migrant or resident bird richness. Because thermal and topographic heterogeneity had contrasting seasonal patterns and effects on richness, they must be carefully contextualized when guiding conservation priorities.
Use of the ADAPTE method to develop a clinical guideline for the improvement of psychoses and schizophrenia care: Example of involvement and participation of patients and family caregivers
Authors: Hurtado María M. , Quemada Casta , García‐Herrera José María , Morales‐Asencio José Miguel
Published: February 2021

Introduction

The aim of this study is to analyse different ways of participation during the development of a clinical guideline to improve the early detection of psychosis and to deploy a comprehensive treatment plan to improve prognosis and social integration.

Materials and method

The clinical guideline was developed using the ADAPTE method with the participation of 40 authors and 80 external reviewers. The process was divided into three major phases: set up, adaptation and finalization. During adaptation and completion, a total of 44 patients and 18 family caregivers were involved.

Results and conclusions

The different roles assumed by the patients and their family caregivers were described, depending on the panel in which they participated, with diverse grades of complexity: a user as author, integration of the results of qualitative research with the participation of local users and family caregivers, 13 users as individual external reviewers and the participation of users and caregiver organizations in the external review. In the guideline, contributions from patients during the qualitative research were included in an innovative way, placing them just behind the recommendations. On the other hand, the results of the family caregivers’ study were included in a specific area of uncertainty. Further, the expressed point of view was considered as the collective demands of users and family caregivers’ organizations in the cost‐benefit analysis made by the organizing committee. There were diverse ways to conduct direct patient participation during the guideline development, ensuring that their individual experiences contributed significantly to the final version.
External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi‐institutional study with 949 patients
Authors: Bozkurt Ibrahim Halil , Karakoyunlu Ahmet Nihat , Koras Omer , Celik Serdar , Sefik Ertugrul , Cakici Mehmet Caglar , Degirmenci Tansu , Imamoglu Muhammed Abdurrahim
Published: February 2021

Objectives

To externally validate and compare Resorlu‐Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S‐ReSC), Ito’s nomogram, and Retrograde Intra‐Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone‐free status and complications in a multi‐institutional study.

Materials and Methods

We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f‐URS) and laser lithotripsy for renal stones in two institutions between March‐2015 and June‐2020. The RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone‐free status and complications.

Results

Of 949 patients 603 were male and 346 were female with a mean age of 47.2 ± 14.3 (range 2‐84 years). Mean stone burden was 102.6 ± 42.2 (48‐270 mm2). All nomograms predicted stone‐free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito’s nomogram was able to predict Clavien ≥2 complications.

Conclusion

All four scoring systems (RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S.) could predict stone‐free status after f‐URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post‐operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.
Isoflurane post‐conditioning contributes to anti‐apoptotic effect after cerebral ischaemia in rats through the ERK5/MEF2D signaling pathway
Authors: Zhang Qingtong , Yin Jiangwen , Xu Feng , Zhai Jingwen , Yin Jieting , Ge Mingyue , Zhou Wenyi , Li Nian , Qin Xinlei , Li Yan , Wang Sheng
Published: February 2021

The mechanisms of brain protection during ischaemic reperfusion injury induced by isoflurane (ISO) post‐conditioning are unclear. Myocyte enhancement factor 2 (MEF2D) has been shown to promote neural survival in a variety of models, in which multiple survival and death signals converge on MEF2D and modulate its activity. Here, we investigated the effect of MEF2D on the neuroprotective effects of ISO post‐conditioning on rats after cerebral ischaemia/reperfusion (I/R) injury. Rats underwent middle cerebral artery occlusion (MCAO) surgery with ischaemia for 90 minutes and reperfusion for 24‐48 hours. After MCAO, neurological status was assessed at 12, 24 and 48 hours by the Modified Neurological Severity Score (mNSS) test. The passive avoidance test (PAT) was used to assess cognition function. Histological and neuropathological evaluations were performed with HE staining and Nissl's staining, respectively. We measured the expression of MEF2D, ERK5, GFAP and caspase‐3 by immunofluorescent staining and Western blotting, and TUNEL staining to assess the severity of apoptosis in hippocampal CA1 area. We found that MEF2D was involved in nerve protection after I/R injury, and post‐treatment of ISO significantly promoted the phosphorylation of ERK5, increased MEF2D transcriptional activity, inhibited the expression of caspase‐3 and played a role of brain protection.
Addressing challenges associated with long‐term topical treatment and benefits of proactive management in patients with psoriasis
Authors: Lebwohl M. , Thaçi D. , Warren R.B.
Published: February 2021

The majority of patients with psoriasis vulgaris (chronic plaque psoriasis) can be treated successfully with short‐term topical therapies. However, long‐term management of psoriasis with topicals is challenging and tends to take a reactive approach to disease relapse, rather than a proactive approach aimed at maintaining disease remission. Patients are often dissatisfied with the delay in treatment response and inconvenience of applying topical treatments, and therefore frequently discontinue treatment leading to poor outcomes. Relapse is common, particularly with reactive management, as underlying residual disease can remain following initial skin clearance; some patients find that their disease at relapse may be worse than their initial symptoms. This can have a detrimental effect on patient quality of life (QoL) and increase the risk of psoriasis‐associated depression. A long‐term proactive management approach, with maintenance treatment following initial treatment success, could help sustain disease remission and improve clinical and QoL outcomes for patients. Treatment with fixed‐dose calcipotriol 50 µg/g betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) is effective in the short term, providing a fast onset of action and improvements in disease at 4 weeks. Results from the Phase III PSO‐LONG study demonstrated that long‐term proactive management was superior to reactive management in prolonging time to first relapse, reducing number of relapses and increasing days in remission in adults with psoriasis vulgaris. Furthermore, Cal/BD foam was well tolerated in PSO‐LONG. No new safety concerns were identified over 52 weeks; the safety profile was consistent with that described previously. Given this, Cal/BD foam should be considered when prescribing topicals for the long‐term proactive management for patients with psoriasis.
Calcipotriol/betamethasone dipropionate foam demonstrates comparable efficacy to clinical trial data in the real world, improves patient satisfaction and is cost‐effective
Authors: Armstrong A. , Gerdes S.
Published: February 2021

Real‐world evidence studies are becoming increasingly important in providing insight into clinical effectiveness and safety, economic outcomes, patient‐reported outcomes and health‐related quality of life of treatments in the clinical setting. These studies also help to complement data reported in clinical studies. Fixed‐dose combination calcipotriol 50 µg/g plus betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) is a topical agent used for the treatment of psoriasis vulgaris. In clinical studies, Cal/BD foam has demonstrated a significantly greater efficacy and rapid onset of action compared with both single and combination formulations such as ointments and gels. To date, three observational studies have examined the real‐world efficacy and safety of Cal/BD foam in clinical practice in the United States, Germany and Spain. Data gathered from these studies reinforce the positive findings reported in clinical studies assessing Cal/BD foam for the treatment of psoriasis and demonstrate improved patient satisfaction with Cal/BD foam. Using Cal/BD foam has been shown to be cost‐effective based on results from randomised clinical trials and cost‐effective analysis. As such, Cal/BD foam has the potential to lower treatment costs by reducing the need for some patients to progress to more expensive treatments, such as phototherapy and biologics. Cal/BD foam is therefore a cost‐effective solution for the treatment of psoriasis vulgaris that should be considered when prescribing topicals.
Going the distance: Associations between adverse birth outcomes and obstetric provider distances for adolescent pregnancies in South Carolina
Authors: Purser Jessica , Harrison Sayward , Hung Peiyin
Published: February 2021

Purpose

Distances to obstetric care providers are a persistent concern, especially for rural pregnant adolescents. Births to adolescents are disproportionately affected by adverse birth outcomes (ABOs), yet little is known regarding how driving distances may impact ABOs. This study examines the association between driving distances to obstetric providers and ABOs among adolescent mothers in South Carolina.

Methods

This retrospective cross‐sectional study derived ZIP Code‐level birth statistics from mothers aged 10–19 in South Carolina using 2013–2017 statewide birth certificate data. ABOs included preterm birth and/or low birthweight. Provider distance was calculated between an obstetric provider's ZIP Code tabulated area (ZCTA) centroid and a maternal resident's ZCTA centroid. Descriptive statistics and weighted generalized linear regression were conducted.

Results

Mean provider distances to obstetric providers were similar between urban (11.76 miles) and rural adolescent mothers (12.04 miles). An increase in provider distance, on average, was associated with a decrease in ABO rates (–0.79, p= .0038); however, rural–urban differences were found. Living in a rural ZCTA was associated with a decrease in ABOs (4.94%, p = .0043). Urban ZCTAs showed a U‐shaped association with provider distance, with ABO rates decreasing until approximately 17 miles away from a provider and then increasing.

Conclusion

Rural adolescent mothers with greater distance to providers had lower ABO rates, while, in urban ZCTAs, provider distance over 17 miles was associated with higher ABO rates. Understanding what mitigates the effects of driving distance on ABOs in rural South Carolina would help inform future policy planning in underserved communities.
Nonmetropolitan COVID‐19 Incidence and Mortality Rates Surpassed Metropolitan Rates Within the First 24 Weeks of the Pandemic Declaration: United States, March 1–October 18, 2020
Authors: Matthews Kevin A. , Ullrich Fred , Gaglioti Anne H. , Dugan Susan , Chen May S. , Hall Diane M.
Published: February 2021

Purpose

This report compares COVID‐19 incidence and mortality rates in the nonmetropolitan areas of the United States with the metropolitan areas across three 11‐week periods from March 1 to October 18, 2020.

Methods

County‐level COVID‐19 case, death, and population counts were downloaded from USAFacts.org. The 2013 NCHS Urban‐Rural Classification Scheme was collapsed into two categories called metropolitan (large central, large fringe, medium, and small metropolitans) and nonmetropolitan (micropolitan/noncore). Daily COVID‐19 incidence and mortality rates were computed to show temporal trends for each of these two categories. Maps showing the ratio of nonmetropolitan to metropolitan COVID‐19 incidence and mortality rates by state identify states with higher rates in nonmetropolitan areas than in metropolitan areas in each of the three 11‐week periods.

Findings

In the period between March 1 and October 18, 2020, 13.8% of the 8,085,214 confirmed COVID‐19 cases and 10.7% of the 217,510 deaths occurred among people residing in nonmetropolitan counties. The nonmetropolitan incidence and mortality trends steadily increased and surpassed those in metropolitan areas, beginning in early August.

Conclusions

Despite the relatively small size of the US population living in nonmetropolitan areas, these areas have an equal need for testing, health care personnel, and mitigation resources. Having state‐specific rural data allow the development of prevention messages that are tailored to the sociocultural context of rural locations.
The Association of Social Determinants of Health With COVID‐19 Mortality in Rural and Urban Counties
Authors: Paul Rajib , Arif Ahmed , Pokhrel Kamana , Ghosh Subhanwita
Published: February 2021

Purpose

To identify the county‐level effects of social determinants of health (SDoH) on COVID‐19 (corona virus disease 2019) mortality rates by rural–urban residence and estimate county‐level exceedance probabilities for detecting clusters.

Methods

The county‐level data on COVID‐19 death counts as of October 23, 2020, were obtained from the Johns Hopkins University. SDoH data were collected from the County Health Ranking and Roadmaps, the US Department of Agriculture, and the Bureau of Labor Statistics. Semiparametric negative binomial regressions with expected counts based on standardized mortality rates as offset variables were fitted using integrated Laplace approximation. Bayesian significance was assessed by 95% credible intervals (CrI) of risk ratios (RR). County‐level mortality hotspots were identified by exceedance probabilities.

Findings

The COVID‐19 mortality rates per 100,000 were 65.43 for the urban and 50.78 for the rural counties. Percent of Blacks, HIV, and diabetes rates were significantly associated with higher mortality in rural and urban counties, whereas the unemployment rate (adjusted RR = 1.479, CrI = 1.171, 1.867) and residential segregation (adjusted RR = 1.034, CrI = 1.019, 1.050) were associated with increased mortality in urban counties. Counties with a higher percentage of college or associate degrees had lower COVID‐19 mortality rates.

Conclusions

SDoH plays an important role in explaining differential COVID‐19 mortality rates and should be considered for resource allocations and policy decisions on operational needs for businesses and schools at county levels.
Domain‐General Auditory Processing Partially Explains Second Language Speech Learning in Classroom Settings: A Review and Generalization Study
Authors: Saito Kazuya , Suzukida Yui , Tran Mai , Tierney Adam
Published: February 2021

To date, a growing number of studies have shown that domain‐general auditory processing, which prior work has linked to L1 acquisition, could explain various dimensions of naturalistic L2 speech proficiency. The current study examined the generalizability of this topic to L2 speech learning in classroom settings. The spontaneous speech samples of 39 Vietnamese English‐as‐a‐foreign‐language learners were analyzed for fluent and accurate use of pronunciation and lexicogrammar and linked to a range of variables in their auditory processing profiles. The results identified moderate‐to‐strong correlations between the participants’ accurate use of lexicogrammar and audio‐motor sequence integration scores (i.e., the ability to reproduce melodic/rhythmic information). However, the relationship between phonological proficiency and auditory acuity (i.e., the ability to encode acoustic details of sounds) was nonsignificant. Although the findings support the audition‐acquisition link to classroom L2 speech learning to some degree, they only suggest that this link is robust for the acquisition of lexicogrammar information.
Reading for pleasure: exploring reading culture in an Australian early years classroom
Authors: Vanden Dool Carly , Simpson Alyson
Published: February 2021

Research indicates a powerful correlation between students' reading enjoyment, motivation and achievement. This Australian case study investigates how reading for pleasure (RfP) approaches are demonstrated in the teaching of reading in a Stage 1 (6‐year‐old to 7‐year‐old students) classroom. The methodology was designed to mirror aspects of Cremin's 2014 UK‐based study, Teachers As Readers. Engaging an interpretivist paradigm, the case was analysed through three distinct but intersecting lenses, knowledge, affect and material, to develop a rich and multifaceted insight into the social world of the classroom. The study found that while the teacher's pedagogic practices for teaching reading incorporated many indicators of a RfP approach, this stemmed from personal ideologies rather than explicit knowledge of a RfP pedagogical framework. Hence, while the study indicates the positive impacts of RfP approaches on this classroom's reading culture, the efficacy of this pedagogy could be potentially limited if an explicit understanding of the theoretical framework does not underpin teachers' actions.
A deep learning algorithm proposal to automatic pharyngeal airway detection and segmentation on CBCT images
Authors: Sin Çağla , Akkaya Nurullah , Aksoy Seçil , Orhan Kaan , Öz Ulaş
Published: February 2021

Objectives

This study aims to evaluate an automatic segmentation algorithm for pharyngeal airway in cone‐beam computed tomography (CBCT) images using a deep learning artificial intelligence (AI) system.

Setting and Sample Population

Archives of the CBCT images were reviewed, and the data of 306 subjects with the pharyngeal airway were included in this retrospective study.

Material and Methods

A machine learning algorithm, based on Convolutional Neural Network (CNN), did the segmentation of the pharyngeal airway on serial CBCT images. Semi‐automatic software (ITK‐SNAP) was used to manually generate the airway, and the results were compared with artificial intelligence. Dice similarity coefficient (DSC) and Intersection over Union (IoU) were used as the accuracy of segmentation in comparing the measurements of human measurements and artificial intelligence algorithms.

Results

The human observer found the average volume of the pharyngeal airway to be 18.08 cm3 and artificial intelligence to be 17.32 cm3. For pharyngeal airway segmentation, a dice ratio of 0.919 and a weighted IoU of 0.993 is achieved.

Conclusions

In this study, a successful AI algorithm that automatically segments the pharyngeal airway from CBCT images was created. It can be useful in the quick and easy calculation of pharyngeal airway volume from CBCT images for clinical application.
Novel Rim Plating Technique for Treatment of the Inferior Pole Fracture of the Patella
Authors: He Qi‐fang , Pan Guo‐biao , Yu Ze‐feng , Yao Wang‐xiang , Zhu Liu‐long , Luo Cong‐feng , Guo Xiao‐shan
Published: February 2021

To aim of the present paper was to introduce a novel fixation technique for the treatment of inferior pole fracture of the patella. We performed a prospective observational study of consecutive cases of inferior pole fracture of the patella that were treated at our institution between January 2018 and June 2019. The patients include three men and one woman, with an average age of 47 years (range: 42–59 years). All patients were treated with the novel rim plating fixation technique for preserving the inferior pole of the patella. During the surgery, a 2.4 mm straight locking compression plate was contoured to adapt to the arc of the lower half of the patella as the rim plate. After reduction of the fracture, the rim plate was fixed to the proximal fragment of the patella through multiple locking screws, against the continuous pull of the patellar tendon. The rim plate encircles and constricts the inferior pole fragments, functioning as a compression and blocking construct. If necessary, an additional anterior tension band or mini locking plate can be used to further prevent anterior displacement of the inferior pole fragments. Under this rigid fixation, motion of the knee and full weight‐bearing were encouraged postoperatively. The patients were followed up monthly until 12 months after surgery. The time to achieve 90°pain‐free, full range of motion of the knee, and fracture healing, were recorded. Related complications were monitored, including infection, loss of reduction, fixation failure, anterior knee pain, and soft‐tissue irritation. The modified Cincinnati knee rating system was used for knee function assessment. The average operative time was 58.8 min (range: 52–63 min). The average blood loss was 59.8 mL (range: 45–71 mL). For all patients, pain‐free 90° range of motion was restored in 2–4 weeks, and the full range of motion was restored in 8–11 weeks. All patients achieved bone union in 6–9 weeks with no displacement of the fragments or breakage of the implant. No patient complained of anterior knee pain or soft‐tissue irritation. The modified Cincinnati score at 12‐month follow up demonstrated excellent outcomes in all four patients. The rim plating technique may be a feasible option for the treatment of the inferior pole fracture of the patella.