bluuebunny/crossref_metadata_2025 huggingface dataset:
Real‐world estimate of the value of one metabolic equivalent in a population of patients planning major surgery
Authors: Douglas Ned , Andrews Grace , Altamimi Hassanain , Wang Andrew , Basto Jarrod , Smith Robert E. R. , Taylor Hugh E.
Published: May 2021

Background

One metabolic equivalent (MET) is equal to resting oxygen consumption. The average value for one MET in humans is widely quoted as 3.5 mL/kg/min. However, this value was derived from a single male participant at the end of the 19th century and has become canonical. Several small studies have identified varied estimates of one MET from widely varying populations. The ability of a patient to complete 4 MET (or 14 mL/kg/min) is considered an indicator of their fitness to proceed to surgery.

Aims

To define a typical value of one MET from a real‐world patient population, as well as determine factors that influenced the value.

Methods

A database of cardiopulmonary exercise testing (CPET) was interrogated to find a total of 1847 adult patients who had undergone CPET testing in the previous 10 years. From this database, estimates of oxygen consumption (VO2) at rest and at the anaerobic threshold and several other variables were obtained. The influence of age, body mass index (BMI), sex and the use of beta‐blockers was tested.

Results

The median resting VO2 at rest was 3.6 mL/kg/min (interquartile range (IQR): 3.0–4.2). Neither sex, age >65 years or the use of beta‐blockers produced a significant difference in resting VO2, while those with a BMI >25 kg/m2 had a significantly lower VO2 at rest (3.4 mL/kg/min vs 4.0 mL/kg/min; P < 0.001).

Conclusions

The estimate of 3.6 mL/kg/min for resting VO2 presented here is consistent with the previous literature, despite this being the first large study of its kind. This estimate can be safely used for pre‐operative risk stratification.
Serum anion gap revisited: a verified reference interval for contemporary use
Authors: Chionh Chang Yin , Poh Cheng Boon , Roy Debajyoti M. , Koduri Sreekanth , Chow Bing Lun , Tan Pei Ting , Tin Aung Soe , Kam Jia Wen , Lau Chin Shern , Hoo See Ping , Phua Soon Kieng , Aw Tar Choon
Published: May 2021

Background

The anion gap (AG) is often used to evaluate acid–base disorders. The reference interval for normal AG is used to differentiate between raised (gap) or normal AG (non‐gap) acidosis. Historically accepted AG values may not be valid with the evolution of modern analytical techniques and the reference interval requires revalidation.

Aims

To determine the reference interval for AG based on current laboratory techniques.

Methods

During a health‐screening exercise, 284 participants with no major illnesses volunteered surplus blood for analysis. The samples were tested in an internationally accredited clinical laboratory. AG was calculated by [Na+] − [Cl−] − [HCO3−] and AGK by [Na+] + [K+] − [Cl−] − [HCO3−]. The reference interval was determined at 2.5th–97.5th percentiles. Analysis was further undertaken for a subcohort of 156 individuals with no suboptimal health indicators.

Results

Median age was 35 years, body mass index 23.4 kg/m2 and the glomerular filtration rate was 106 mL/min/1.73 m2. Median AG was 13 mmol/L and the reference interval for normal AG is 10–18 mmol/L with a 99% level of confidence. Statistically significant differences in AG were detected for sex, race, obesity and serum albumin, but the difference was 1 mmol/L between subgroups. The reference interval was the same for the sub‐cohort of 156 individuals. Median AGK was 17.7 mmol/L and reference interval was 14.6–22.5 mmol/L.

Conclusions

The AG reference interval of 10–18 mmol/L is valid for laboratories with similar reference intervals for electrolytes. Lower values expected with current laboratory techniques were not observed. The median AG of 13 mmol/L may be used to differentiate gap acidosis, non‐gap acidosis or mixed acid–base disorders.
Clinical and financial burden of spinal infections in people who inject drugs
Authors: Ananda Roshan A. , Attwood Lucy O. , Lancaster Reece , Jacka David , Jhoomun Tanya , Danks Andrew , Woolley Ian
Published: May 2021

Background

People who inject drugs (PWID) are known to be at increased risk of infectious diseases including bacterial and blood‐borne viral infections. However, there is limited literature surrounding the burden of spinal infections as a complication of injecting drug use (IDU).

Aims

To quantify the clinical and financial burden of IDU‐related spinal infections.

Methods

Retrospective chart review of adult PWID with spinal infections requiring hospital admission to a tertiary health service in Melbourne, Australia between 2011 and 2019.

Results

Fifty‐seven PWID with 63 episodes of spinal infections were identified with a median hospital stay of 47 days (interquartile range (IQR) 16; range 4–243 days). One‐third of episodes required neurosurgical intervention and 11 (17%) episodes required intensive care unit admission (range 2–17 days). Staphylococcus aureus was the most common causative pathogen, present in three‐quarters of all episodes (n = 47). The median duration of antibiotic regime was 59 days (IQR 42) and longer courses were associated with known bacteraemia (P = 0.048), polymicrobial infections (P = 0.001) and active IDU (P = 0.066). Predictors of surgery include neurological symptoms at presentation (relative risk (RR) 2.6; P = 0.010), inactive IDU status (RR 3.0; P = 0.002), a diagnosis of epidural abscess (RR 4.1; P = 0.001) and spinal abscess (RR ∞; P < 0.001). Completion of planned antimicrobial therapy was reported in 51 (82%) episodes. Average expenditure per episode was  A$61 577.

Conclusions

Spinal infections in PWID are an underreported serious medical complication of IDU. Although mortality is low, there is significant morbidity with prolonged admissions, large antimicrobial requirements and surgical interventions generating a substantial cost to the health system.
Macrophage‐fibroblast circuits in the spleen
Authors: Bellomo Alicia , Gentek Rebecca , Golub Rachel , Bajénoff Marc
Published: May 2021

Macrophages are an integral part of all organs in the body, where they contribute to immune surveillance, protection, and tissue‐specific homeostatic functions. This is facilitated by so‐called niches composed of macrophages and their surrounding stroma. These niches structurally anchor macrophages and provide them with survival factors and tissue‐specific signals that imprint their functional identity. In turn, macrophages ensure appropriate functioning of the niches they reside in. Macrophages thus form reciprocal, mutually beneficial circuits with their cellular niches. In this review, we explore how this concept applies to the spleen, a large secondary lymphoid organ whose primary functions are to filter the blood and regulate immunity. We first outline the splenic micro‐anatomy, the different populations of splenic fibroblasts and macrophages and their respective contribution to protection of and key physiological processes occurring in the spleen. We then discuss firmly established and potential cellular circuits formed by splenic macrophages and fibroblasts, with an emphasis on the molecular cues underlying their crosstalk and their relevance to splenic functionality. Lastly, we conclude by considering how these macrophage‐fibroblast circuits might be impaired by aging, and how understanding these changes might help identify novel therapeutic avenues with the potential of restoring splenic functions in the elderly.
Dread and solace: Talking about perinatal mental health
Authors: Law Susan , Ormel Ilja , Babinski Stephanie , Plett Donna , Dionne Emilie , Schwartz Hannah , Rozmovits Linda
Published: May 2021

Perinatal mental health issues are a global public health challenge. Worldwide, it is estimated that 10% of pregnant women, and 13% of women who have just given birth, experience a mental disorder. Yet, for many reasons – including stigma, limited access to services, patients’ lack of awareness about symptoms, and inadequate professional intervention – actual rates of clinical and subclinical perinatal mental health issues are likely higher. Studies have explored experiences such as postpartum depression, but few involve a wider‐ranging exploration of a variety of self‐reported perinatal mental health issues through personal narrative. We conducted 21 narrative interviews with women, in two Canadian provinces, about their experiences of perinatal mental health issues. Our aim was to deepen understanding of how individual and cultural narratives of motherhood and perinatal mental health can be sources of shame, guilt, and suffering, but also spaces for healing and recovery. We identified four predominant themes in women’s narrative: feeling like a failed mother; societal silencing of negative experiences of motherhood; coming to terms with a new sense of self; and finding solace in shared experiences. These findings are consistent with other studies that highlight the personal challenges associated with perinatal mental health issues, particularly the dread of facing societal norms of the ‘good mother’. We also highlight the positive potential for healing and self‐care through sharing experiences, and the power of narratives to help shape feelings of self‐worth and a new identity. This study adheres to the expectations for conducting and reporting qualitative research.
Kotahitanga and koinonia in shalom as the objective of the mission of God
Authors: Matenga Jay
Published: May 2021

Evangelical theology and the missions that flowed from it was born in an era of high colonialism, shaped by enlightenment dualism and scientific method, under the influence of industrialization. As evangelical Christianity’s centre of gravity shifted south, global North dominance over its theology and missiology persisted, translated into new tongues. This paper, sensing a tipping point in evangelical thought as we emerge out of global pandemic disruption, proposes an alternative framing of church and missions from the collectivist perspective shared by those less affected by the influence of Western industrialization and individualism. It proposes that both the means and the objective of the mission of God should be common unity in‐Christ. It shifts focus from the Great Commission to the Great Commitment, which emphasizes being one and holding fast to that unity for the joy that awaits those who persevere in mutuality. Along the way, the demonstration of whole‐of‐life covenantal community in‐Christ serves as our witness to the world, which provides those of us in‐Christ with an opportunity to explain the hope that we have and invite others to join us in the experience of God’s shalom goodness.
Coupling of diffusion and chemical stress: The case of ion exchange in glass
Authors: Macrelli Guglielmo , Mauro John C. , Varshneya Arun K.
Published: May 2021

The chemical strengthening of glass results from an ion exchange process in which smaller alkali ions in a glass are replaced with larger alkali ions from a molten salt bath. This interdiffusion process leads to a buildup of chemical stress in the glass. However, traditional modeling of the ion exchange process has not fully accounted for interaction effects between mass diffusion and the chemical stress developed during the process. In this study, we develop the general theory of coupling between diffusion and stress, resulting in a single flux equation with a concentration‐ and stress‐dependent interdiffusion coefficient. We apply the theory to the specific cases of chemically strengthened soda lime silicate and aluminosilicate glasses, demonstrating the impact of interaction terms on concentration profiles and interdiffusion coefficient. Following a phenomenological approach, this study demonstrates the effect of the interdiffusion on stress generation and vice versa to account for deviations from the simple expressions published hitherto in the literature.
Protocol for a mixed‐method systematic review on challenges perceived by final‐year undergraduate nursing students in a clinical learning environment
Authors: Ali Siti Hajar , Ahmad Rahman Nurul Husna , Mohd Shariff Noorsuzana , Karim Jalina , Chin Kok Yong
Published: May 2021

Aims

To determine the challenges perceived by final‐year nursing students in the clinical learning environment.

Design

Data‐based convergent mixed‐method systematic review.

Methods

Three electronic databases (Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature) will be used in the identification stage. The first search will use the search string for each database to identify relevant studies. The articles retrieved will be screened by year of publication, article type and language. Abstracts and full‐text of selected studies will be screened for eligibility independently by a minimum of two reviewers. The reference lists will be manually screened to identify additional publications. The quality assessment will be conducted by two reviewers using the Mixed Methods Appraisal Tools. Quantitative and mixed‐method studies will be transformed into qualitative. A thematic approach will be used to synthesize and report the data. Ethics approval and funding have been approved in April 2020.

Discussion

This study will synthesize the types of challenges perceived by final‐year undergraduate nursing students in different clinical learning environments across the country.

Impact

The proposed study findings will help nursing education stakeholders and faculty provide assistance to final‐year nursing students in their transition year to become registered nurses.
Linking foraging and breeding strategies in tropical seabirds
Authors: Soanes L. M. , Green J. A. , Bolton M. , Milligan G. , Mukhida F. , Halsey L. G.
Published: May 2021

The archetypal foraging behaviour of tropical seabirds is generally accepted to differ from that of their temperate and polar breeding counterparts, with the former exhibiting less predictable foraging behaviour associated with the less predictable prey of the tropical marine environment. Similarly, temperate and polar species have predictable, annual breeding seasons, enabling them to profit during periods of the year when prey availability is highest, while tropical seabird species exhibit considerable variability in their breeding strategies. Until now, the reasons for such variation in breeding strategies between tropical seabirds are yet to be investigated. We hypothesise that while some tropical species breed asynchronously in response to unpredictable fluctuations in prey availability, others adopt a seasonal breeding strategy for the same reasons that temperate and polar species do. Consequently, the predictability of seabird foraging behaviour in the tropics may be related to breeding strategy, with populations that breed seasonally exhibiting more predictable foraging behaviour than those that breed aseasonally. To test these predictions, we used GPS tracking to examine the foraging behaviour of two closely related tropical seabird species that colonise the same island yet exhibit markedly different breeding strategies: the asynchronously breeding brown booby Sula leucogaster and the seasonal breeding masked booby Sula dactylatra. We obtained tracks for 251 birds over five years. We found that brown boobies forage less predictably than masked boobies, indicated by larger core foraging areas, lower levels of foraging area overlap between individuals and exhibit more variability between breeding periods. Our results challenge the view that the foraging behaviour of tropical seabirds is always less predictable than that of seabirds breeding in temperate and polar regions and highlight the considerable variability in the breeding and foraging strategies adopted by tropical seabirds which demand further exploration.
Effectiveness of ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy (the “upgraded 2C3L” approach) for catheter ablation of persistent atrial fibrillation
Authors: Lai Yiwei , Liu Xiaoxia , Sang Caihua , Long Deyong , Li Mengmeng , Ge Weili , Liu Xiangfei , Lu Zhibing , Guo Qi , Jiang Chao , Zuo Song , Jiang Chenxi , Bai Rong , Tang Ribo , Guo Xueyuan , Li Songnan , Liu Nian , Wang Wei , Zhao Xin , Li Changyi , Du Xin , Dong Jianzeng , Ma Changsheng
Published: May 2021

Introduction

Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI).

Methods and Results

The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, ethanol infusion into the vein of Marshall was first performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63 (95.5%) and 101 (80.8%) patients in groups 1 and 2, respectively (p = .006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 vs. 12.59 min, p < .001) and MI (7.0 vs. 11.8 min, p < .001) and required less cardioversion (50 [78.5%] vs. 113 [90.4%], p = .007). During the 12‐month follow‐up, 58 (87.9%) patients were free from atrial fibrillation/atrial tachycardia in group 1 compared with 81 (64.8%) in group 2 (p < .001). In multivariate cox regression, the “upgraded 2C3L” procedure is associated with a lower recurrence rate (hazard ratio = 0.27, 95% confidence interval = 0.12–0.59).

Conclusion

Compared with the conventional “2C3L” approach, the “upgraded 2C3L” approach has higher effectiveness for ablation of PeAF.
Virulence and immunogenicity of blue catfish alloherpesvirus in channel, blue and blue × channel hybrid catfish
Authors: Venugopalan Arun , Griffin Matt J. , Wise David J. , White Danielle’ , Ford Lorelei , López‐Porras Adrián , Camus Alvin C. , Hanson Larry A.
Published: May 2021

Blue catfish alloherpesvirus (BCAHV) is a novel virus isolated from the blue catfish (Ictalurus furcatus). To date, the ultrastructure, virulence and immunogenicity of BCAHV have not been reported. Given the importance of blue catfish in producing channel ♀ (I. punctatus) × ♂ blue (I. furcatus) catfish hybrids and the increasing demand for hybrid catfish in the US catfish industry, the susceptibility of blue, channel and hybrid catfish to BCAHV was assessed. Further, the cross‐protective potential of BCAHV against Ictalurid herpesvirus 1 (IcHV1) was investigated in channel and hybrid catfish that survive BCAHV exposure. Neutralization assays revealed BCAHV is refractive (neutralization index [NI] = 0) to anti‐IcHV1 monoclonal antibody Mab 95, compared to IcHV1 (NI = 1.8). Exposure of blue catfish fingerling to 1.3 × 105 TCID50/L BCAHV produced cumulative mortality of 51.67 ± 0.70% and pathologic changes similar to those of channel catfish virus disease. No mortality was observed in channel or hybrid catfish. Twenty‐eight days post‐challenge, surviving channel and hybrid catfish were exposed to 9.4 × 104 TCID50/L IcHV1 (LC50 dose), resulting in 100% relative per cent survival compared to naïve cohorts. These data provide baseline information for BCAHV and lay the groundwork for future studies. Data also identify BCAHV as a potential vaccine candidate against IcHV1. Based on host range and immunogenicity evaluations, in addition to genome sequence data from previous studies, BCAHV should be given consideration as a new species of Ictalurivirus.
A computational‐experimental investigation of thermal vapor compressor as an energy saving tool for the crystallization of sugar in a sugar processing plant
Authors: Rezvanivand Fanaei Adel , Nikbakht Ali M. , Hassanpour Ali
Published: May 2021

Energy saving in the food industry is of a great deal of importance. Thermal vapor compressors (TVCs) do not have moving parts which offer advantages including simplicity, low construction capital, and low maintenance costs. In this study, a TVC is designed, and simulated to recover waste vapor streams and reuse the recovered streams in the crystallization of sugar. Computational fluid dynamics is employed to simulate the flows. The effect of motive steam pressure on the entrainment ratio and compressor ratio is simulated. Thermodynamics parameters such as static pressure, temperature, velocity, Mach number, and mass ratios of motive steam and suction are assessed. As the flow is of jet flow type, the realizable k‐e turbulent model is used to model the turbulence. The results show that by applying the motive steam at a pressure of 28 bars (boiler outlet), the pressure and temperature of discharge vapor reach the values of 0.65 bar and 511 K, respectively. The average mass ratios of motive and suction flow at the output of the designed TVC diffuser are 0.59 and 0.41, respectively. As the crystallization pressure demand is 0.6 bar, the findings reveal that the discharged vapor from TVC has sufficient enthalpy to be consumed in the crystallization section, hence making the whole process more efficient.

Practical application

Equipping the crystallization section of the sugar factory with a thermal vapor compressor, beside the recovery of low‐pressure vapor with motive steam, can reduce energy consumption and play a key role in decreasing fossil pollution. Computational Fluid Dynamics is a validated tool in the simulation of the food processing phenomenon. In terms of TVC optimization, the results obtained from this research serve to designers and process managers to get a detailed perception of energy reduction scenarios and recovery of low enthalpy streams.
Osteoporosis, bisphosphonate use, and risk of moderate or worse hearing loss in women
Authors: Curhan Sharon G. , Stankovic Konstantina , Halpin Christopher , Wang Molin , Eavey Roland D. , Paik Julie M. , Curhan Gary C.
Published: May 2021

Background

Osteoporosis and low bone density (LBD) may be associated with higher risk of hearing loss, but findings are inconsistent and longitudinal data are scarce. Bisphosphonates may influence risk, but the relation has not been studied in humans. We longitudinally investigated associations of osteoporosis and LBD, bisphosphonate use, vertebral fracture (VF), hip fracture (HF), and risk of self‐reported moderate or worse hearing loss.

Design

Longitudinal cohort study.

Setting

The Nurses' Health Study (NHS) (1982–2016) and Nurses' Health Study II (NHS II) (1995–2017).

Participants

Participants included 60,821 NHS women, aged 36–61 years at baseline, and 83,078 NHS II women, aged 31–48 years at baseline (total n = 143,899).

Measurements

Information on osteoporosis, LBD, bisphosphonate use, VF, HF, and hearing status was obtained from validated biennial questionnaires. In a subcohort (n = 3749), objective hearing thresholds were obtained by audiometry. Multivariable‐adjusted Cox proportional hazards models were used to examine independent associations between osteoporosis (NHS), osteoporosis/LBD (NHS II), and risk of hearing loss.

Results

The multivariable‐adjusted relative risk (MVRR, 95% confidence interval) of moderate or worse hearing loss was higher among women with osteoporosis or LBD in both cohorts. In NHS, compared with women without osteoporosis, the MVRR was 1.14 (1.09, 1.19) among women with osteoporosis; in NHS II, the MVRR was 1.30 (1.21, 1.40) among women with osteoporosis/LBD. The magnitude of the elevated risk was similar among women who did and did not use bisphosphonates. VF was associated with higher risk (NHS: 1.31 [1.16, 1.49]; NHS II: 1.39 [1.13, 1.71]), but HF was not (NHS: 1.00 [0.86, 1.16];NHS II: 1.15 [0.75,1.74]). Among participants with audiometric measurements, compared with women without osteoporosis/LBD, the mean multivariable‐adjusted hearing thresholds were higher (i.e., worse) among those with osteoporosis/LBD who used bisphosphonates.

Conclusion

Osteoporosis and LBD may be important contributors to aging‐related hearing loss. Among women with osteoporosis, the risk of hearing loss was not influenced by bisphosphonate use.
Closed‐loop sustainable product design for circular economy
Authors: Hapuwatte Buddhika M. , Jawahir I. S.
Published: May 2021

Intensifying global consumption stipulates the use of sustainable manufacturing and circular economy concepts to make products while managing available finite resources. Designers must be equipped to design products considering the economic, environmental, and social impacts of the product life cycle. This paper explores product design in relation to sustainability and circularity principles, presents fundamental concepts, sets definitions, and proposes a new methodology to incorporate these two principles. This new methodology synthesizes elements of design for sustainability and circularity. The primary stakeholder categories are updated to explicitly include “society‐at‐large”—a neglected category in typical manufacturer‐focused sustainability evaluations. Sustainability elements based on the total life cycle approach, including triple bottom line, life cycle perspective, 6Rs, and perpetual resource flow, are integrated with the circular design elements of resource conservation, product‐life extension, and circularity compliance to create the novel closed‐loop sustainable product design methodology. The metrics‐based product evaluation framework presented compels designers to integrate sustainability and circularity elements in the designed products. Sustainability concerns of the product life cycle are evaluated for both negative and positive impacts to identify the value created for all primary stakeholders (i.e., manufacturers, users, and society‐at‐large). This methodology promotes a holistic view of the product life cycle, including end‐of‐life activity planning, leading to a perpetual resource flow. Performance influencing parameters available for designers are also examined, including the overlooked “dedicated” and “incidental” process‐induced types, providing a strong basis for future research on product sustainability predictive models.
Role of shear wave elastography in predicting the metabolic and androgenic alterations in patients with polycystic ovary syndrome
Authors: Turan Özgür Deniz , Tuncyurek Ozum , Ertekin Ersen
Published: May 2021

Aim

To evaluate the variation in tissue stiffness caused by the changes in ovarian volume and stroma in polycystic ovary syndrome (PCOS) using a novel method of ultrasonography, that is shear wave elastography (SWE). The current study also aimed to evaluate the potential applications of this method in predicting the metabolic and androgenic alterations in patients with PCOS.

Methods

The present study included 33 patients with PCOS. The blood samples for the metabolic and androgenic parameters and SWE values pertaining to the patients were obtained on the same day during the early follicular phase. The predictive ability of SWE to reflect the metabolic and androgenic abnormalities was evaluated using the receiver operating characteristic curve (ROC) analysis.

Results

The mean SWE value pertaining to the group with higher total testosterone levels was significantly lower, compared to the group with normal testosterone levels (p = 0.041). The ROC analysis revealed that the predictive potential of SWE was statistically significant in regard to the serum testosterone levels alone (area under the curve [AUC] = 0.755, 95% confidence interval [CI]: 0.573–0.938, p = 0.041). There was no significant relationship between the SWE values and metabolic parameters.

Conclusions

Based on the results of the present study, decreased SWE values appear to be associated with increased serum testosterone levels. However, the present study did not observe any significant relationship between the SWE values and metabolic parameters. SWE can be used as a practical and non‐invasive method to predict the serum testosterone levels during the follow‐up evaluations of the patients with PCOS.
Effect of hard gummy candy chewing on masticatory function
Authors: Fujiwara Shigehiro , Hori Kazuhiro , Shitara Satoko , Okawa Jumpei , Kodama Shohei , Murakami Kazuhiro , Ono Takahiro
Published: May 2021

Background

Although various training methods have been reported for improving oral function such as occlusal force, there are few reports that show the training effect of eating hard food on the oral functions.

Objective

To examine the training effects of habitually ating hard gummy candies on oral functions.

Methods

Participants of this cohort study were recruited into a training (six women, eight men; mean age 27.6 ± 3.5 years) and control group (two women, seven men; mean age 28.3 ± 4.9 years). The training group ate nine custom‐developed hard gummy candies three times per week for 3 months. Training effects were evaluated by measuring the maximal occlusal force, masticatory performance, maximal tongue pressure, number of chewing cycles until swallowing the candy, duration of chewing and cycle time before training, after 1, 2 and 3 months of training, and 1 month after stopping training. The iEMG/force, which evaluates masseter muscle hypertrophy with electromyograms (EMG), was calculated.

Results

Masticatory performance after 1 month (p = 0.01), maximal occlusal force after 2 months (p < 0.01) and maximal tongue pressure after 3 months of training were significantly increased (p = 0.02), and the cycle time after 2 months of training (p = 0.02) was significantly decreased compared to before the intervention. Except for masticatory performance, the other effects were maintained for 1 month after stopping training. Changes in iEMG/force were not significant, but a tendency for muscle hypertrophy was observed in the training group.

Conclusion

Habitual eating of hard gummy candies is a task‐specific training that can improve overall masticatory function, including tongue pressure.
Religiosity and Immanent Justice Reasoning: A Replication Study in Japan and the U.S.
Authors: Murayama Aya , Miura Asako
Published: May 2021

Previous studies have investigated the importance of religiosity in enhancing peopleʼs justice reasoning, yet the findings have been limited to the Western culture, where a majority of people believe in Christianity. In order to investigate the effect of cultural difference and of religiosity on immanent justice reasoning, we compared and contrasted the degree of engagement in immanent justice reasoning regarding someoneʼs misfortune among American Christians, Japanese Buddhists, and nonreligious participants in the two cultures. The analysis found that among Americans, those who believed in Christianity engaged in stronger immanent justice reasoning toward an unfortunate person with lower moral values than did participants without a particular faith. The Japanese, on the other hand, showed stronger immanent justice reasoning for people with lower moral values, regardless of their faith. In addition, when the person had low moral value, the Japanese tended to engage in such reasoning more strongly than did Americans. Our results showed that religious beliefs may contribute to strengthening engagement in immanent justice reasoning in the Western culture, but such a generalization may not be accurate in other cultures.
Empowering our people: Predictors of retention in an STI risk reduction program among rural Native Americans with binge substance use
Authors: Tingey Lauren , Rosenstock Summer , Chambers Rachel , Patel Hima , Melgar Laura , Slimp Anna , Lee Angelita , Cwik Mary , Rompalo Anne , Gaydos Charlotte
Published: May 2021

Purpose

Substance use and sexual risk‐taking have been shown to co‐occur. Programs focused on sexually transmitted infections (STIs) reduction may benefit substance‐using, particularly binge substance‐using, adults. This is especially true for rural Native American communities who endure sexual and substance use disparities and have few STI risk reduction programs. This study explores factors predicting retention in an STI risk reduction program among rural Native adults engaged in binge substance use.

Methods

We analyzed data from 150 Native adults ages 18‐55 participating in an evaluation of “EMPWR,” a 2‐session STI risk reduction program in a rural, reservation‐based community. Multivariate logistic regression models were used to estimate associations between independent variables and program completion across demographics, sexual behaviors, substance use behaviors, mental health, recent health care utilization, and perceived enculturation and discrimination.

Findings

The sample was 49.2% (n = 59) female with a mean age of 33.61 years (SD = 8.25). Twenty‐six completed only the first EMPWR session, 94 completed both EMPWR sessions, and 30 were randomized but completed 0 sessions. Being married/cohabiting (adjusted odds ratio [AOR] = 6.40, P = .0063) and living with an older generation (AOR = 4.86, P = .0058) were significantly associated with higher odds of completing EMPWR.

Conclusions

Findings provide insight on factors driving retention of Natives with recent binge substance use in STI risk reduction programming. An important contribution to Native health literature is that living with an older generation positively predicted EMPWR program completion, suggesting that STI risk reduction programs should harness the strength of families to ensure program attendance and optimize impacts in rural reservation contexts.
Clinical efficacy of a benazepril and spironolactone combination in dogs with congestive heart failure due to myxomatous mitral valve disease: TheBEnazepril Spironolactone STudy(BESST)
Authors: Coffman Melissa , Guillot Emilie , Blondel Thomas , Garelli‐Paar Catherine , Feng Shuo , Heartsill Susanne , Atkins Clarke E.
Published: May 2021

Background

The renin‐angiotensin‐aldosterone system (RAAS), when chronically activated, is harmful and RAAS‐suppressive drugs are beneficial in the treatment of congestive heart failure (CHF). Mineralocorticoid receptor antagonists are widely used in the treatment of CHF in people.

Hypothesis/Objectives

To determine if a mineralocorticoid receptor antagonist (spironolactone) is beneficial and safe in CHF due to myxomatous mitral valve disease (MMVD) of varying severity, we hypothesized that, when combined with furosemide, a combination product (S+BNZ) containing the ACE inhibitor (ACE‐I), benazepril, and spironolactone, would be superior to benazepril alone.

Animals

Five hundred and sixty‐nine client‐owned dogs, with MMVD and CHF (ACVIM Stage C) of ≤10‐days' duration.

Methods

After initial stabilization, dogs were randomized into a positive‐controlled, double‐blind, multicenter trial, to receive furosemide plus S+BNZ or furosemide plus benazepril. The primary outcome variable was the percentage of dogs reaching cardiac endpoint before Day 360. Cardiac endpoint was defined as cardiac death or euthanasia, recurrence of pulmonary edema, necessity for nonauthorized cardiac drug(s) or a furosemide dosage >8 mg/kg/d.

Results

A significantly lower percentage of dogs treated with S+BNZ reached the primary outcome variable by Day 360 (OR = 0.56; 95% CI, 0.32‐0.98;P = .04) and risk of dying or worsening from cardiac causes, was significantly reduced (HR = 0.73; 95% CI = 0.59‐0.89,P = .002) vs benazepril alone. Adverse events, potentially associated with treatment, were rare and equal between groups.

Conclusion and Clinical Importance

The combination of S+BNZ is effective, safe, and superior to benazepril alone, when used with furosemide for the management of mild, moderate or severe CHF caused by MMVD in dogs.
Resistance, recuperation, or deviance? The meaning of personal internet use at work
Authors: Miltsov Alex
Published: May 2021

The use of internet‐based tools during work for personal purposes is a widespread phenomenon in both private and public organisations. By analysing 30 in‐depth interviews with cognitive workers in Canada, Sweden, the United Kingdom, and the United States, this study explores the ways in which contemporary workers engage in, experience, and rationalise personal Internet use at work. The results show that inter‐generational differences, organisational culture, and the patterns in the organisation of labour affect how workers experience and rationalise the phenomenon of PIUW. This study contributes to the organisational literature with an analysis of how contemporary cognitive workers experience navigating between working and non‐working activities in the workplace.
Long Term outcomes of percutaneous atrial fibrillation ablation in patients with continuous monitoring
Authors: Sulke Neil , Dulai Rajdip , Freemantle Nick , Sugihara Conn , Podd Steven , Eysenck William , Lewis Michael , Hyde Jonathan , Veasey Rick A , Furniss Stephen S
Published: May 2021

Introduction: There is limited data using continuous monitoring to assess outcomes of atrial fibrillation (AF) ablation. This study assessed long‐term outcomes of AF ablation in patients with implantable cardiac devices.

Methods: 207 patients (mean age 68.1 ± 9.5, 50.3% men) undergoing ablation for symptomatic AF were followed up for a mean period of 924.5 ± 636.7 days. Techniques included The Pulmonary Vein Ablation Catheter (PVAC) (59.4%), cryoablation (17.4%), point by point (14.0%) and The Novel Irrigated Multipolar Radiofrequency Ablation Catheter (nMARQ) (9.2%).

Results: 130 (62.8%) patients had paroxysmal AF (PAF) and 77 (37.2%) persistent AF. First ablation and repeat ablation reduced AF burden significantly (relative risk 0.91, [95% CI 0.89 to 0.94]; P <0.0001 and 0.90, [95% CI, 0.86–0.94]; P <0.0001).

Median AF burden in PAF patients reduced from 1.05% (interquartile range [IQR], 0.1%‐8.70%) to 0.10% ([IQR], 0%‐2.28%) at one year and this was maintained out to four‐years. Persistent AF burden reduced from 99.9% ([IQR], 51.53%‐100%) to 0.30% ([IQR], 0%‐77.25%) at one year increasing to 87.3% ([IQR], 4.25%‐100%) after four years. If a second ablation was required, point‐by‐point ablation achieved greater reduction in AF burden (relative risk, 0.77 [95% CI, 0.65–0.91]; P <0.01).

Conclusion: Ablation reduces AF burden both acutely and in the long‐term. If a second ablation was required the point‐by‐point technique achieved greater reductions in AF burden than “single‐shot” technologies. Persistent AF burden increased to near pre ablation levels by year 4 suggesting a different mechanism from PAF patients where this increase did not occur.
Dryopithecine palaeobiodiversity in the Iberian Miocene revisited on the basis of molar endostructural morphology
Authors: Fortuny Josep , Zanolli Clément , Bernardini Federico , Tuniz Claudio , Alba David M.
Published: May 2021

Extensive fieldwork at Abocador de Can Mata (north‐east Iberian Peninsula) has uncovered a previously unsuspected diversity of catarrhine primates in the middle Miocene (12.5–11.6 Ma) of Europe. However, the distinction of the great ape genera Pierolapithecus and Anoiapithecus from Dryopithecus (supported by craniodental differences) has been disputed by some authors. Here we revisit the diversity of great apes (dryopithecines) from the Iberian Miocene based on molar 3D endostructural morphology (relative enamel thickness, enamel distribution, and enamel–dentine junction (EDJ)). Using microtomography, we inspected an extensive sample of 49 hominoid molars representing at least five species from 12 localities. 2D and 3D relative enamel thickness values indicate that Dryopithecus and ‘Sivapithecus’ occidentalis (species inquirenda) display the thinnest and thickest enamel, respectively, while the remaining taxa (Hispanopithecus, Anoiapithecus, Pierolapithecus) show intermediate values. Upper molar enamel distribution maps exhibit a similar pattern in P. catalaunicus, A. brevirostris, D. fontani, H. laietanus and H. crusafonti whereas for the lower molars they reveal differences between H. laietanus and H. crusafonti. Lower molar enamel distribution and EDJ morphology of ‘S.’ occidentalis support the distinction of this species but do not resolve whether it is a junior synonym of Anoiapithecus brevirostris or Pierolapithecus catalaunicus. Overall our results support the distinction of middle Miocene dryopithecins from late Miocene hispanopithecins, the distinction of Pierolapithecus and Anoiapithecus from Dryopithecus among the former, and the distinct species status of H. crusafonti compared to H. laietanus among the latter. Our results highlight the potential of inner tooth morphology for hominoid alpha‐taxonomy.
Perceptual illusionism
Authors: Cutter Brian
Published: May 2021

Perceptual illusionism is the view that perceptual experience is, in general, radically illusory. That is, perceptual experience presents objects as having certain sensible properties and standing in certain sensible relations, but nothing in the subject’s environment has those properties or stands in those relations. This paper makes the case for perceptual illusionism by showing how a broad set of philosophical and scientific considerations converge to support illusionism about the full range of sensible properties and relations. After clarifying the illusionist thesis, I set out the argument in three parts. First, I briefly make the case for an illusionist view of color. I then argue for illusionism about the spatial/temporal properties presented in experience on the assumption that some “radical” view of space (and/or time) is correct—that is, some view according to which nothing like our ordinary three‐dimensional space (or four‐dimensional spacetime) exists at the fundamental level. Finally, I argue that there is a strong case for illusionism even if all radical views turn out to be false..
Perspectives in the study of the political economy of COVID‐19 vaccine regulation
Authors: Fonseca Elize M. da , Jarman Holly , King Elizabeth J. , Greer Scott L.
Published: May 2021

Vaccines against SARS‐CoV‐2 continue to be developed at an astonishingly quick speed and the early ones, like Pfizer and Moderna, have been shown to be more effective than many public health scientists had dared to hope. As COVID‐19 vaccine research continues to progress, the world's eyes are turning toward medicine regulators. COVID‐19 vaccines need to be authorized for use in each country in which the pharmaceutical industry intends to commercialize its product. This results in a patchwork of regulations that can influence the speed at which products are launched and the standards that govern them. In this research forum article, we discuss several key questions about COVID‐19 vaccine regulations that should shape research on the next stage of the pandemic response. We call for a research agenda that looks into the political economy of pharmaceutical regulation, particularly from a comparative perspective, including Global South countries.
Exclusion from Educational Opportunity in Diversifying Rural Contexts*
Authors: Aylward Alexandra , Barrio Brenda , Kramarczuk Voulgarides Catherine
Published: May 2021

Racial/ethnic disproportionality within special education refers to the over‐ or underrepresentation of a racial/ethnic group in an educational category, program, or service in comparison to the group's proportion in the overall population. The educational equity implications of disproportionality have been discussed in multiple studies, and schools may risk receiving federal citations and sanctions in significant instances of disproportionality. However, disproportionality in special education is rarely examined within rural settings, despite demographic change leading to more racially and ethnically diverse rural schools. This article uses event history methodology to understand how changing district‐level social contextual factors are associated with the issuance of federal citations for disproportionality in special education during 2004–2005 to 2011–2012 school years among rural districts within New York. We find that among majority‐white districts, the likelihood of citation is much greater when there is a substantial increase in the number of children of color enrolled. In contrast, racial/ethnic demographic changes within more diverse rural districts, whether enrollment increases or decreases, reduce the likelihood of a citation. Also, as teacher turnover and student enrollments increase, the likelihood of citation increases. As rural communities continue to become less racially and ethnically homogenous, scholars and educators must consider the ways in which Black, Indigenous, and students of color can be appropriately supported in schools and the important variation across rural spaces.
The complementary roles between clientelism and familism in social policy development
Authors: Yuda Tauchid Komara
Published: May 2021

What drives social policy development? Most of the literature addressing this issue focuses on the economic crisis and the increase in left power as its causation. On the basis of the Indonesian case, this paper engages in a debate about the clouts of clientelism and familial ethics in shaping social policy path development. This article claims that the quick replacement of productivist welfare regimes with the more inclusive system after Asian Financial Crisis is motivated by increased elites' interest in repositioning their clientelistic network within a public institution. This is occurring while familial precepts are being used as effective moral politics in encouraging kinship networks to internalize social risks during the regime replacement process. Overall, the case of Indonesia reflects the common characteristic of welfare regimes development in East Asian countries where efforts to modernize social policy are conditioned under a situation where democracy is not well‐established and the post‐modern family structure has not fully matured either. Consequently, the development of social policy to a large extent is still confined within a huge clientelistic influence and implemented under the familial ideology. This situation has ultimately retarded welfare state development.
Cooperation of chloroplast ascorbate peroxidases and proton gradient regulation 5 is critical for protecting Arabidopsis plants from photo‐oxidative stress
Authors: Kameoka Takashi , Okayasu Takaya , Kikuraku Kana , Ogawa Takahisa , Sawa Yoshihiro , Yamamoto Hiroshi , Ishikawa Takahiro , Maruta Takanori
Published: May 2021

High‐light (HL) stress enhances the production of H2O2 from the photosynthetic electron transport chain in chloroplasts, potentially causing photo‐oxidative damage. Although stromal and thylakoid membrane‐bound ascorbate peroxidases (sAPX and tAPX, respectively) are major H2O2‐scavenging enzymes in chloroplasts, their knockout mutants do not exhibit a visible phenotype under HL stress. Trans‐thylakoid proton gradient (∆pH)‐dependent mechanisms exist for controlling H2O2 production from photosynthesis, such as thermal dissipation of light energy and downregulation of electron transfer between photosystems II and I, and these may compensate for the lack of APXs. To test this hypothesis, we focused on a proton gradient regulation 5 (pgr5) mutant, wherein both ∆pH‐dependent mechanisms are impaired, and an Arabidopsis sapx tapx double mutant was crossed with the pgr5 single mutant. The sapx tapx pgr5 triple mutant exhibited extreme sensitivity to HL compared with its parental lines. This phenotype was consistent with cellular redox perturbations and enhanced expression of many oxidative stress‐responsive genes. These findings demonstrate that the PGR5‐dependent mechanisms compensate for chloroplast APXs, and vice versa. An intriguing finding was that the failure of induction of non‐photochemical quenching in pgr5 (because of the limitation in ∆pH formation) was partially recovered in sapx tapx pgr5. Further genetic studies suggested that this recovery was dependent on the NADH dehydrogenase‐like complex‐dependent pathway for cyclic electron flow around photosystem I. Together with data from the sapx tapx npq4 mutant, we discuss the interrelationship between APXs and ∆pH‐dependent mechanisms under HL stress.