bluuebunny/crossref_metadata_2025 huggingface dataset:
An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children
Authors: Green S. M. , Leroy P. L. , Roback M. G. , Irwin M. G. , Andolfatto G. , Babl F. E. , Barbi E. , Costa L. R. , Absalom A. , Carlson D. W. , Krauss B. S. , Roelofse J. , Yuen V. M. , Alcaino E. , Costa P. S. , Mason K. P. ,   the International Committee for the Advancement of Procedural Sedation
Published: December 2019

The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post‐1984 literature there are no published reports of aspiration‐associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus‐derived algorithm in which each patient is first risk‐stratified during their pre‐sedation assessment, using evidence‐based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.
Effects of tracheal intubation and tracheal tube position on regional lung ventilation: an observational study
Authors: Lumb A. B. , Savic L. , Horsford M. R. , Hodgson S. R.
Published: December 2019

Anaesthesia and positive pressure ventilation cause ventral redistribution of regional ventilation, potentially caused by the tracheal tube. We used electrical impedance tomography to map regional ventilation during anaesthesia in 10 patients with and without a tracheal tube. We recorded impedance data in subjects who were awake, during bag‐mask ventilation, with the tracheal tube positioned normally, rotated 90° to each side and advanced until in an endobronchial position. We recorded the following measurements: ventilation of the right lung (proportion, %); centre of ventilation (100% = entirely ventral); global inhomogeneity (0% = homogenous); and regional ventilation delay, an index of temporal heterogeneity. We compared the results using Student's t‐tests. Relative to subjects who were awake, anaesthesia with bag‐mask ventilation reduced right‐sided ventilation by 5.6% (p = 0.002), reduced regional ventilation delay by 1.6% (p = 0.025), and moved the centre of ventilation ventrally from 51.4% to 58.2% (p = 0.0001). Tracheal tube ventilation caused a further centre of ventilation increase of 1.3% (p = 0.009). With the tube near the carina, right‐sided ventilation increased by 3.2% (p = 0.031) and regional ventilation delay by 2.8% (p = 0.049). Tube rotation caused a 1.6% increase in right‐sided ventilation compared with normal position (p = 0.043 left and p = 0.031 right). Global inhomogeneity remained mostly unchanged. Ventral ventilation with positive pressure ventilation occurred with bag‐mask ventilation, but was exacerbated by a tracheal tube. Tube position influenced ventilation of the right and left lungs, while ventilation overall remained homogenous. Tube rotation in either direction resulted in ventilation patterns being closer to when awake than either bag‐mask ventilation or a normally positioned tube. These results suggest that even ideal tube positioning cannot avoid the ventral shift in ventilation.
Early lexical development of children raised in institutional care in Russia
Authors: Zhukova Marina A. , Kornilov Sergey A. , Tseitlin Stella N. , Eliseeva Marina B. , Vershinina Elena A. , Muhamedrahimov Rifkat J. , Grigorenko Elena L.
Published: December 2019

Children abandoned to institutions display a host of developmental delays, including those involving general cognition and language. The majority of published studies focus on children over 3 years of age; little is known about whether these delays may be detected earlier when children undergo rapid lexical development. To investigate the early language development of children raised in institutional settings in the Russian Federation, we compared a group of children in institutional care (n = 36; 8–35 months) to their age‐matched peers raised in biological families, who have never been institutionalized (n = 72) using the Russian version of the CDI. The results suggest that institutionalization is associated with pronounced delays in children's early language development with large and robust effect sizes. Among children with a history of institutionalization, these delays are also associated with difficulties in Daily Living skills, communication, and socialization.
Broad‐Based Employee Ownership and Labour Productivity During the 2008 Recession: Evidence from Public Firms in Europe
Authors: Kim Kyoung Yong , Patel Pankaj C.
Published: December 2019

Did publicly traded European firms with employee ownership (EO) realize higher firm performance during or after the Great Recession? Contributing to the growing interest in exploring the association between EO and firm performance during and after the 2008 economic crisis, we draw on a longitudinal sample of 4,259 firm‐years representing 892 publicly traded firms from 28 European countries. The results show that compared to firms without EO, those with EO experienced higher firm performance during or after the recession, albeit with small effect size. Consistent with past findings, we found that firms with EO were less likely to lower their employee count during or after the recession. Findings are robust to controlling for contemporaneous endogeneity and alternate specifications. Our results indicate that publicly traded European firms with EO, on average, realized higher firm performance in the face of the Great Recession.
Predicting indirect effects of transportation network expansion on Asian elephants: Implications for environmental impact assessments
Authors: Huang Cheng , Li Xueyou , Hu Wenqiang , Jiang Xuelong
Published: December 2019

The rapid proliferation of transportation networks (TNs) threatens the viability of species with wide geographic ranges via habitat fragmentation, road kill, and indirect socio‐ecological interactions. Environmental impact assessments of TNs are mostly descriptive and focus on the direct impacts of the linear features of TNs, while the indirect and cumulative impacts are largely neglected. Using spatially explicit data of elephant‐caused damage from 2012 to 2015 in southwest China, we quantified the barrier effects of TNs on Asian elephant populations and predicted future patterns of damage under a TN expansion scenario using maximum entropy algorithms. The TNs acted as a strong barrier for the elephants, even in herds that have inhabited highly fragmented landscapes for years. Overall damage patterns were highly asymmetric around roads, with only 18% of events occurring on the far side of roads (relative to the core home range). Models predicted that TN expansion would reduce elephant habitats, exacerbating herd isolation and human–elephant conflict locally. Thus, we suggest that future environmental impact assessments should integrate mitigation of indirect conflicts.

Abstract in Chinese is available with online material.
Implementing participation‐focused services: A study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi)
Authors: Kolehmainen Niina , Marshall Joanne , Hislop Jenni , Fayed Nora , Kay Diane , Ternent Laura , Pennington Lindsay
Published: December 2019

Background

It is widely agreed that children's services should use participation‐focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence‐based knowledge translation strategy, to support implementation of participation‐focused practice in front‐line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers.

Method

Best‐practice guidelines for using audit and feedback were followed. For audit, participation‐focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning.

Results

A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians’ skills in participation‐focused behaviours (median = 3.00–5.00, interquartile range [IQR] = 2.25‐6.00), social processes (median = 4.00, IQR = 3.00–5.00), and behavioural regulation (median = 4.00–5.00, IQR = 3.00–6.00).

Conclusions

MAPi provides a practical, off‐the‐shelf method for front‐line services to investigate and support their implementation of participation‐focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across‐services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.
Deep learning‐based quantification of PET/CT prostate gland uptake: association with overall survival
Authors: Polymeri Eirini , Sadik May , Kaboteh Reza , Borrelli Pablo , Enqvist Olof , Ulén Johannes , Ohlsson Mattias , Trägårdh Elin , Poulsen Mads H. , Simonsen Jane A. , Hoilund‐Carlsen Poul Flemming , Johnsson Åse A. , Edenbrandt Lars
Published: December 2019

Aim

To validate a deep‐learning (DL) algorithm for automated quantification of prostate cancer on positron emission tomography/computed tomography (PET/CT) and explore the potential of PET/CT measurements as prognostic biomarkers.

Material and methods

Training of the DL‐algorithm regarding prostate volume was performed on manually segmented CT images in 100 patients. Validation of the DL‐algorithm was carried out in 45 patients with biopsy‐proven hormone‐naïve prostate cancer. The automated measurements of prostate volume were compared with manual measurements made independently by two observers. PET/CT measurements of tumour burden based on volume and SUV of abnormal voxels were calculated automatically. Voxels in the co‐registered 18F‐choline PET images above a standardized uptake value (SUV) of 2·65, and corresponding to the prostate as defined by the automated segmentation in the CT images, were defined as abnormal. Validation of abnormal voxels was performed by manual segmentation of radiotracer uptake. Agreement between algorithm and observers regarding prostate volume was analysed by Sørensen‐Dice index (SDI). Associations between automatically based PET/CT biomarkers and age, prostate‐specific antigen (PSA), Gleason score as well as overall survival were evaluated by a univariate Cox regression model.

Results

The SDI between the automated and the manual volume segmentations was 0·78 and 0·79, respectively. Automated PET/CT measures reflecting total lesion uptake and the relation between volume of abnormal voxels and total prostate volume were significantly associated with overall survival (P = 0·02), whereas age, PSA, and Gleason score were not.

Conclusion

Automated PET/CT biomarkers showed good agreement to manual measurements and were significantly associated with overall survival.
Comparison of silicon and metallic bifurcated stents in patients with malignant airway lesions
Authors: Sökücü Sinem Nedime , Özdemir Cengiz , Tural Önür Seda , Dalar Levent , Altın Sedat
Published: December 2019

Introduction and objective

Silicon and metallic are two types of stents in use. In this study, we compared complications and long‐term survival among patients who received silicon or fully covered, bifurcated self‐expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas.

Methods

Patients in whom Y‐shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files.

Results

Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30‐, 90‐ or 180‐day mortality between the two groups (P = .966, .846 and .534, respectively).

Conclusions

No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.
Fifty years of digestive endoscopy: Successes, setbacks, solutions and the future
Authors: Axon Anthony Thomas Roger
Published: December 2019

Flexible endoscopes became generally available 50 years ago and created a revolution in the practice of gastroenterology. They improved diagnosis enormously, enabled quicker, less invasive, and more cost‐effective surgical treatment, while endoscopic screening has prevented many cancer deaths. The new technology stimulated research leading to a better understanding of gastrointestinal pathology, identifying new diseases and clarifying the etiology of others. Better‐controlled clinical trials accelerated the use of newer and more effective drugs. National and international endoscopy societies supported nursing input, encouraged research, stimulated specialist journals, and devised guidelines that encouraged audit and quality assurance. Advances in instrument design and the manufacture of new accessories enhanced endoscopic technique, diagnostic ability, patient comfort, and safety. The risk of cross‐infection inherent in the use of complex labile equipment that cannot be autoclaved remains a challenge. Endoscopy societies working closely with industry have established rigid protocols for high‐level disinfection that minimize the risks, but strict adherence to guidelines and continued vigilance is essential, especially with the increasing prevalence of antibiotic‐resistant commensals that can give rise to opportunistic infection. Government health departments have a responsibility to encourage and support research in this area by endoscopists, instrument manufacturers, and the pharmaceutical industry. Current trends suggest that in the future, artificial intelligence will greatly improve endoscopic diagnosis, and that therapeutic endoscopy will expand, encouraging endoscopists to subspecialize.
Neurocognitive and behavioural profile in Panayiotopoulos syndrome
Authors: Fonseca Wald Eric L A , Debeij‐Van Hall Mariette H J A , De Jong Eline , Aldenkamp Albert P , Vermeulen R Jeroen , Vles Johan S H , Klinkenberg Sylvia , Hendriksen Jos G M
Published: December 2019

Aim

To determine neurocognitive performance and behavioural problems in children with Panayiotopoulos syndrome.

Method

All 18 children (10 females, 8 males; mean age 4y 7mo; SD 1y 10mo) diagnosed with Panayiotopoulos syndrome at the Kempenhaeghe Epilepsy Center in the Netherlands between 2010 and 2017 were analysed retrospectively. All underwent a neuropsychological/behavioural assessment, an academic assessment, and a 24‐hour electroencephalogram.

Results

Mean full‐scale IQ (93.5; range 76–123; p=0.04) and performance IQ (93.2; range 76–126; p=0.04) were within the normal range, although significantly lower compared to the normative mean. Verbal IQ (96.3; range 76–118) and processing speed (96.1; range 74–114) were not significantly lower. Simple auditory/visual reaction times, visual attention, visual‐motor integration, and verbal memory were significantly lower compared to normative values. On average, patients with Panayiotopoulos syndrome were 8 months behind in arithmetic speed and 11 months behind in reading speed for the number of months in school. Behavioural questionnaires revealed significantly higher scores on reported internalizing behavioural problems.

Interpretation

Children with Panayiotopoulos syndrome demonstrated diffuse cognitive dysfunction in full‐scale IQ, performance IQ, visual attention, visual‐motor integration, and verbal memory. A high incidence of internalizing behavioural problems was reported. This strongly suggests neuropsychological and behavioural comorbidity in children with Panayiotopoulos syndrome.

What this paper adds

Children with Panayiotopoulos syndrome are at risk for cognitive deficits in various cognitive domains.

Children with Panayiotopoulos syndrome are also prone to internalizing behavioural problems.

Mild‐to‐severe academic underachievement was present in more than half of the children with Panayiotopoulos syndrome.
Doubly Disadvantaged: Gender, Spatially Concentrated Deprivation and Nascent Entrepreneurial Activity
Authors: Murzacheva Ekaterina , Sahasranamam Sreevas , Levie Jonathan
Published: December 2019

Drawing on human capital, intersectionality and mixed embeddedness theory, we test hypotheses on the relationship between gender differences in human capital and gender differences in nascent entrepreneurial activity across geographical space, and the moderating effect of spatially concentrated deprivation on this relationship. Using UK data from Global Entrepreneurship Monitor, we find that the disadvantaged position of female nascent entrepreneurs arises from social exclusion, and specifically that the gender differences in nascent entrepreneurial activity are directly related to differences in general and specific human capital across locales. Moreover, in deprived locations, women as a group do not gain from any human capital advantage they might have over men, causing a double disadvantage for women. Our results make a novel contribution to the literature on disadvantage entrepreneurship, and we discuss policy options to tackle double disadvantage in deprived locales.
Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis
Authors: Kwon Churl‐Su , Agarwal Parul , Subramaniam Varsha , Dhamoon Mandip , Mazumdar Madhu , Yeshokumar Anusha , Panov Fedor , Ghatan Saadi , Jetté Nathalie
Published: December 2019

Objective

Hospital readmissions result in increased health care costs and are associated with worse outcomes after neurosurgical intervention. Understanding factors associated with readmissions will inform future studies aimed at improving quality of care in those with epilepsy.

Methods

Patients of all ages with epilepsy who underwent a neurosurgical intervention were identified in the 2014 Nationwide Readmissions Database, a nationally representative dataset containing data from roughly 17 million US hospital discharges. Diagnosis of epilepsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM)–based case definitions. Neurosurgical interventions for epilepsy: resective/disconnective surgery, responsive neurostimulation/deep brain stimulation, vagus nerve stimulation, radiosurgery, and intracranial electroencephalography were identified using ICD‐9‐CM procedure codes. Primary outcome was all‐cause 30‐day readmission following discharge from the index hospitalization.

Results

There were a total of 2284 index surgical admissions. Overall, 10.83% (n = 251) of patients following an index epilepsy surgery admission were readmitted within 30 days. Factors independently associated with 30‐day readmission for all epilepsy surgery admissions were: Medicare insurance (P < .01), discharge disposition that was not home (P < .01), higher Elixhauser comorbidity indexes (P < .01), longer length of stay (P < .01), and adverse events of surgical and medical care during index stay (P = .04). In the multivariate model, Medicare insurance (hazard ratio [HR] 1.81 [1.29‐2.53], P < .01) and length of stay (HR 1.02 [1.01‐1.04], P < .01) remained significant independent predictors for 30‐day readmission. The most common primary reason for readmissions was epilepsy/convulsions accounting for 22.85%.

Significance

Our results suggest that careful management of postoperative seizures and discharge planning after epilepsy surgery may be important to optimize outcomes and reduce the risk of readmission, particularly for patients on Medicare.
External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients
Authors: Lin Jiahe , Ding Siqi , Li Xueying , Hua Yingjie , Wang Xinshi , He Ruqian , Du Yanru , Xia Niange , Chen Yanyan , Zhu Zhenguo , Zheng Rongyuan , Xu Huiqin
Published: December 2019

Objective

The models currently available for predicting the risk of seizure recurrence after antiepileptic drug (AED) withdrawal in adult epilepsy patients include the prediction model developed by Lamberink et al (Lamberink model, 2017) and the Medical Research Council prediction model (MRC model, 1993). However, there was no external validation for the two models. The purpose of this study was to perform an independent external validation and a comparison of the Lamberink model and the MRC model in adult patients.

Methods

The study population was recruited from the Wenzhou Epilepsy Follow‐up Registry Database (WEFURD). All the predictors of the Lamberink and MRC models and the occurrence of seizure recurrence in the participants were collected based on the WEFURD. Participants' predicted probabilities of seizure recurrence were obtained by a Web‐based tool and the prognostic index formula. The external validation of the Lamberink model and the MRC model were quantified by discrimination, calibration, and decision curve analysis (DCA).

Results

Of 212 patients, 126 (59.4%) had seizure recurrence after AED withdrawal. The Lamberink 2‐year model, the Lamberink 5‐year model, the MRC 1‐year model, and the MRC 2‐year model had areas under the curve of 0.71 (95% confidence interval [CI] = 0.64‐0.78), 0.68 (95% CI = 0.60‐0.76), 0.60 (95% CI = 0.50‐0.69), and 0.58 (95% CI = 0.50‐0.66), respectively. Additionally, the Lamberink 2‐year model had a significantly better integrated discrimination improvement than the MRC 2‐year model (P < .001). Regarding calibration, the Lamberink 2‐year model (P = .121) and the MRC 1‐year model (P = .264) were well calibrated, but the Lamberink 5‐year model (P = .022) and the MRC 2‐year model (P = .008) were not. In the DCA, the Lamberink 2‐year model performed well at threshold probabilities of 30%‐65%.

Significance

This external validation shows that the Lamberink 2‐year model might be more accurate and has greater clinical benefit than others for guiding drug withdrawal in adult epilepsy clinics.
Temporal development of biodiversity of macrophytes in newly established lakes
Authors: Stage Sø Jonas , Sand‐Jensen Kaj , Baastrup‐Spohr Lars
Published: December 2019

Every year, a vast number of wetlands are constructed to restore ecosystem function and biodiversity, thus counteracting massive historical losses by reclamation to farmland. However, our knowledge of the long‐term effects on biodiversity, particularly of large systems such as lakes, is very limited.

Our objective was to follow the development of macrophytes over 3–4 decades in 24 new, shallow, eutrophic lakes in order to test the hypotheses that: (1) species richness reaches a maximum after some years and then declines; and (2) species composition changes substantially from small early colonisers to taller, competitive later colonisers, which causes ongoing high β‐diversity.

A generalised linear mixed‐effect model showed that species richness was related to lake size, phosphorus concentration and spatial setting, which are known to influence natural lakes as well. Moreover, species composition and richness were affected by lake age. Species colonised rapidly and richness peaked at an intermediate age and then declined.

Temporal species turnover within lakes was high in three lake age groups of ≤10, 11–20 or >20 years since establishment, although lowest after 11–20 years. Species replacement tended to contribute most to β‐diversity in the youngest lakes, whereas richness fluctuated in older lakes and appeared to contribute most to temporal turnover there.

Early colonisers in ≤10‐year‐old lakes were commonly replaced by tall canopy‐forming species in 11–20‐year‐old lakes, probably as a result of increasing competition for light and space over time. After 20 years, rootless Ceratophyllum submersum as well as species with floating and emergent leaves became dominant, potentially due to the gradual accumulation of more organic sediment difficult to root and grow in, along with gradually reduced light penetration in the water.

Establishing new lakes for biodiversity remains a challenge because of the falling richness and continuous species turnover with lake age, but our results suggest that constructing large, nutrient‐poor lakes in species‐rich landscapes ensures the best prerequisites for obtaining diverse communities.
Biomass loss and change in species dominance shift stream community excretion stoichiometry during severe drought
Authors: Hopper Garrett W. , Gido Keith B. , Pennock Casey A. , Hedden Skyler C. , Guinnip James P. , Fisher Molly A. , Tobler Courtney M. , Hedden Crosby K. , Bruckerhoff Lindsey A.
Published: December 2019

Animals contribute significantly to nutrient cycling through excretion, but most studies consider their effects under relatively benign abiotic conditions. Disturbances such as drought may alter animals’ nutrient contributions through shifts in species composition and biomass. Headwater streams are particularly vulnerable to extreme climate events and thus might show rapid changes in stream biota and their ecosystem effects.

We tested how biomass and subsequent ecosystem effects (nutrient cycling) of an intermittent prairie stream community changed during a drought. We quantified the biomass and contributions to nutrient cycling for assemblages comprising fishes, crayfish, and tadpoles in 12 isolated pools over 3 months encompassing the harshest drought on record for Kings Creek, KS, U.S.A. We predicted that macroconsumer biomass would decline with pool surface area and that differences in macroconsumer biomass and taxonomic composition would lead to different contributions of pool assemblages to nutrient cycling.

The biomass of pool assemblages declined with decreasing pool size, a pattern apparently driven by mortality, emigration, or metamorphosis. We also observed a change in assemblage structure of drying pools during drought relative to pool size, shifting dominance toward species with more drought‐resistant traits. Accordingly, assemblage nitrogen (N) excretion rates declined as pool biomass was reduced, leading to a 58% reduction in N available to epilithic biofilms. Phosphorus (P) excretion rates declined from June to July, but increased in August, as species with high P excretion rates maintained similar proportional biomass and biomass of a non‐native fish increased. Molar N:P of pool assemblage excretion declined significantly throughout the drought and coincided with loss of southern redbelly dace (Chrosomus erythrogaster: Cyprinidae).

Animal‐mediated nutrient cycling was altered by the loss of biomass and stoichiometric traits of taxa that differed in their occurrences and ability to tolerate abiotic conditions during drought. Elevated availability of dissolved N in isolated pools may increase N uptake rates by biofilms during drought conditions, indicating the importance of N excreted by aggregated macroconsumers, especially those with unique stoichiometric traits. While the significance of shifts in the composition of freshwater communities to ecosystems is not entirely known, additional losses in ecosystem function and changes in community structure may follow episodes of severe drought.
Some challenges and opportunities for grazing dairy cows on temperate pastures
Authors: Wilkinson J. Michael , Lee Michael R. F. , Rivero M. Jordana , Chamberlain A. Thomas
Published: December 2019

Grazing plays an important role in milk production in most regions of the world. In this review, some challenges to the grazing cow are discussed together with opportunities for future improvement. We focus on daily feed intake, efficiency of pasture utilization, output of milk per head, environmental impact of grazing and the nutritional quality to humans of milk produced from dairy cows in contrasting production systems. Challenges are discussed in the context of a trend towards increased size of individual herds and include limited and variable levels of daily herbage consumption, lower levels of milk output per cow, excessive excretion of nitrogenous compounds and requirements for minimal periods of grazing regardless of production system. A major challenge is to engage more farmers in making appropriate adjustments to their grazing management. In relation to product quality, the main challenge is to demonstrate enhanced nutritional/processing benefits of milk from grazed cows. Opportunities include more accurate diet formulations, supplementation of grazed pasture to match macro‐ and micronutrient supply with animal requirement and plant breeding. The application of robotics and artificial intelligence to pasture management will assist in matching daily supply to animal requirement. Wider consumer recognition of the perceived enhanced nutritional value of milk from grazed cows, together with greater appreciation of the animal health, welfare and behavioural benefits of grazing should contribute to the future sustainability of demand for milk from dairy cows on pasture.
The impact of foreign influence on exporting through open innovation
Authors: Thompson Piers , Zang Wenyu
Published: December 2019

Foreign direct investment brings both increased competitive pressures and opportunities for domestic Small and Medium Sized Enterprises (SMEs). Competition may force them to seek new international markets, but also provide access to international customers. However, as economies become more knowledge‐based in order to access international markets, SMEs must seek to innovate. This study examines how foreign firm presence and innovation influence the exporting activities of SMEs. It contributes to the existing literature by dividing innovation into product/process innovation and in‐house/open innovation. With open innovation, products are more likely to be novel and productivity boosted to a larger degree. We interact different types of innovation with foreign influence to examine whether there is a moderating influence on the relationship. The individual firm level data and foreign influence data are from the Longitudinal Small Business Survey and Office for National Statistics. Whether firms are active exporters is explored using multilevel logit regressions. Both innovative activities and the foreign influence increase the likelihood of exporting. In‐house product innovation boosts export propensity to a lesser degree in areas with higher levels of foreign influence. The hypothesis that open innovation has more impact on exporting activities when foreign influence is greater is not supported for either type of innovation.
Chromic phosphate‐32 colloid radiosynovectomy for the treatment of haemophilic synovitis: A long‐term follow‐up study
Authors: Ebrahimpour Adel , Ebrahiminasab Mehdi , Kaseb Mohammadhasan , Asadollahi Saeed , Mortazavi SM Javad
Published: December 2019

Aim

We previously reported the outcome of chromic phosphate‐32(32P) colloid synoviorthesis in 53 haemophilic patients with an average follow‐up of 31 months. The purpose of the present study was the long‐term follow‐up of the same cohort on both clinical and radiographic features.

Materials

Nine patients failed to attend the recall appointment. The mean follow‐up for the remaining 44 patients (52 procedures) was 15 years (range, 14.6‐15.5). The mean age at the time of reassessment was 31 years (range, 18‐43).

Results

The haemarthrosis frequency was not statistically significant at the latest follow‐up years compared with 31 months (0.8 vs 0.4 per week, P = .3). There was no significant change in the clinical severity of haemophilic arthropathy (P = .5). Most of the treated joints still are in stage III of Fernandez‐Palazzi and Caviglia classification. There was a trend towards the radiologic deterioration of arthritis with nearly 50% of patients at Arnold‐Hilgartner Stage V. 13% of patients underwent a total knee arthroplasty (TKA). The age at which the initial radiosynovectomy was performed was significantly higher in patients who had a TKA than those who had not (22 vs 15 years, P < .002).

Conclusion

The bleeding control effect of 32P on the target joint remains over time; however, it did not appear to halt the progression of radiographic changes in haemophiliacs. It could delay the need for TKA if it performs at the right time.
The Influence of Migraine on Driving: Current Understanding, Future Directions, and Potential Implications of Findings
Authors: Tepper Stewart J. , Silberstein Stephen D. , Rosen Noah L. , Lipton Richard B. , Dennehy Ellen B. , Dowsett Sherie A. , Doty Erin
Published: December 2019

Objective

To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients.

Background

Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have the potential to negatively influence driving ability.

Methods

We reviewed the published findings related to migraine and driving performance. Study findings relevant to symptoms of migraine and their potential effect on driving were also reviewed. This required a more expansive exploration of the literature beyond migraine, for example, review of the literature relating to the effect of pain, sleepiness, visual disturbances, or vertigo on driving. Finally, the potential effects of treatment for migraine on driving were reviewed.

Results

Literature on the effect of migraine on driving performance is sparse and, in general published studies on the topic have a number of limitations. Based on review of the literature pertaining to other disorders, it seems feasible that some symptoms occurring as part of the migraine attack could impact driving performance, although formal study in this area is lacking. Many of the approved treatments for migraine have the potential to impact driving, yet this has not been specifically studied, and the extent to which these risks are communicated to patients is not clear.

Conclusion

The impact of migraine on driving performance has been largely neglected, with few studies specifically designed to address the topic, and relevant studies were generally small with limited control of confounders. This area requires more focus, given a potential for impact on road safety.
Impact of lifestyle behaviors in early childhood on obesity and cardiometabolic risk in children: Results from the Spanish INMA birth cohort study
Authors: Bawaked Rowaedh Ahmed , Fernández‐Barrés Sílvia , Navarrete‐Muñoz Eva Maria , González‐Palacios Sandra , Guxens Mònica , Irizar Amaia , Lertxundi Aitana , Sunyer Jordi , Vioque Jesus , Schröder Helmut , Vrijheid Martine , Romaguera Dora
Published: December 2019

Background

Identifying modifiable lifestyle behaviors linked to childhood obesity is necessary to develop preventive strategies.

Objective

To estimate the association of five lifestyle behaviors in children aged 4 years on obesity and cardiometabolic risk factors at age 4 years and on obesity and blood pressure at age 7 years.

Methods

We used child lifestyle data from the INMA project at age 4 years (n = 1480). We constructed a child lifestyle score by summing five behaviors (physical activity, sleep time, television time, plant based foods and intake of ultra‐processed foods) and we categorized it into tertiles. At ages 4 and 7 years, we calculated age‐ and sex‐specific z‐scores for BMI, waist circumference (WC), and blood pressure. At age 4, we also calculated age‐, and sex‐, specific z‐scores for triglycerides and HDL. We used linear and logistic regression analyses.

Results

The lifestyle score was not associated with the outcomes at 4 years, but it was negatively associated with BMI and WC z‐scores at age 7 years. Children at age 4 years in the highest tertile of the score had lower risk of overweight or obesity at age 7 years (OR = 0.61; 95% CI 0.39; 0.96) and abdominal obesity (OR = 0.48; 95% CI 0.24; 0.96).

Conclusions

Higher adherence to a healthy lifestyle at age 4 years decreased risk of overweight, obesity and abdominal obesity at 7 years.
Ultraslow full‐power shock wave lithotripsy versus slow power‐ramping shock wave lithotripsy in stones with high attenuation value: A randomized comparative study
Authors: Al‐Dessoukey Ahmad A , Abdallah Mahmoud , Moussa Ayman S , Sayed Osama , Abdelbary Ahmed M , Abdallah Rabie , Massoud Amr M , Abdelhamid Mohamed H , Elmarakbi Akram A , Ragheb Ahmed M , ElSheemy Mohammed S , Ghoneima Waleed
Published: December 2019

Objectives

To compare the efficacy and safety of ultraslow full‐power versus slow rate, power‐ramping shock wave lithotripsy in the management of stones with a high attenuation value.

Methods

This was a randomized comparative study enrolling patients with single high attenuation value (≥1000 Hounsfield unit) stones (≤3 cm) between September 2015 and May 2018. Patients with skin‐to‐stone distance >11 cm or body mass index >30 kg/m2 were excluded. Electrohydraulic shock wave lithotripsy was carried out at rate of 30 shock waves/min for group A versus 60 shock waves/min for group B. In group A, power ramping was from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18–22 kV for 100 shock waves, then a safety pause for 2 min. This full power (22 kV) was maintained until the end of the session. In group B, power ramping was carried out with an increase of 4 kV each 500 shock waves, then maintained on 22 kV in the last 1000–1500 shock waves. Follow up was carried out up to 3 months after the last session. Perioperative data were compared, including the stone free rate (as a primary outcome) and complications (secondary outcome). Predicting factors for success were analyzed using logistic regression.

Results

A total of 100 patients in group A and 96 patients in group B were included. The stone‐free rate was significantly higher in group A (76% vs 38.5%; P < 0.001). Both groups were comparable in complication rates (20% vs 19.8%; P = 0.971). The stone‐free rate remained significantly higher in group A in logistic regression analysis (odds ratio 24.011, 95% confidence interval 8.29–69.54; P < 0.001).

Conclusions

Ultraslow full‐power shock wave lithotripsy for high attenuation value stones is associated with an improved stone‐free rate without affecting safety. Further validation studies are required using other shock wave lithotripsy machines.
EZH2 dysregulation: Potential biomarkers predicting prognosis and guiding treatment choice in acute myeloid leukaemia
Authors: Chu Ming‐qiang , Zhang Ting‐juan , Xu Zi‐jun , Gu Yu , Ma Ji‐chun , Zhang Wei , Wen Xiang‐mei , Lin Jiang , Qian Jun , Zhou Jing‐dong
Published: December 2019

Accumulating studies have proved EZH2 dysregulation mediated by mutation and expression in diverse human cancers including AML. However, the expression pattern of EZH2 remains controversial in acute myeloid leukaemia (AML). EZH1/2 expression and mutation were analysed in 200 patients with AML. EZH2 expression was significantly decreased in AML patients compared with normal controls but not for EZH1 expression. EZH2 mutation was identified three of the 200 AML patients (1.5%, 3/200), whereas none of the patients harboured EZH1 mutation (0%, 0/200). EZH2 expression and mutation were significantly associated with −7/del(7) karyotypes. Moreover, lower EZH2 expression was associated with older age, higher white blood cells, NPM1 mutation, CEBPA wild‐type and WT1 wild‐type. Patients with EZH2 mutation showed shorter overall survival (OS) and leukaemia‐free survival (LFS) than patients without EHZ2 mutation after receiving autologous or allogeneic haematopoietic stem cell transplantation (HSCT). However, EZH2 expression has no effect on OS and LFS of AML patients. Notably, in EZH2 low group, patients undergone HSCT had significantly better OS and LFS compared with patients only received chemotherapy, whereas no significant difference was found in OS and LFS between chemotherapy and HSCT patients in EZH2 high group. Collectively, EZH2 dysregulation caused by mutation and under‐expression identifies specific subtypes of AML EZH2 dysregulation may be acted as potential biomarkers predicting prognosis and guiding the treatment choice between transplantation and chemotherapy.
IL‐17C amplifies epithelial inflammation in human psoriasis and atopic eczema
Authors: Lauffer F. , Jargosch M. , Baghin V. , Krause L. , Kempf W. , Absmaier‐Kijak M. , Morelli M. , Madonna S. , Marsais F. , Lepescheux L. , Albanesi C. , Müller N.S. , Theis F.J. , Schmidt‐Weber C. , Eyerich S. , Biedermann T. , Vandeghinste N. , Steidl S. , Eyerich K.
Published: December 2019

Background

Key pathogenic events of psoriasis and atopic eczema (AE) are misguided immune reactions of the skin. IL‐17C is an epithelial‐derived cytokine, whose impact on skin inflammation is unclear.

Objective

We sought to characterize the role of IL‐17C in human ISD.

Methods

IL‐17C gene and protein expression was assessed by immunohistochemistry and transcriptome analysis. Primary human keratinocytes were stimulated and expression of cytokines chemokines was determined by qRT‐PCR and luminex assay. Neutrophil migration towards supernatant of stimulated keratinocytes was assessed. IL‐17C was depleted using a new IL‐17C‐specific antibody (MOR106) in murine models of psoriasis (IL‐23 injection model) and AE (MC903 model) as well as in human skin biopsies of psoriasis and AE. Effects on cell influx (mouse models) and gene expression (human explant cultures) were determined.

Results

Expression of IL‐17C mRNA and protein was elevated in various ISD. We demonstrate that IL‐17C potentiates the expression of innate cytokines, antimicrobial peptides (IL‐36G, S100A7 and HBD2) and chemokines (CXCL8, CXCL10, CCL5 and VEGF) and the autocrine induction of IL‐17C in keratinocytes. Cell‐free supernatant of keratinocytes stimulated with IL‐17C was strongly chemotactic for neutrophils, thus demonstrating a critical role for IL‐17C in immune cell recruitment. IL‐17C depletion significantly reduced cell numbers of T cells, neutrophils and eosinophils in murine models of psoriasis and AE and led to a significant downregulation of inflammatory mediators in human skin biopsies of psoriasis and AE ex vivo.

Conclusion

IL‐17C amplifies epithelial inflammation in Th2 and Th17 dominated skin inflammation and represents a promising target for the treatment of ISD.
Accuracy of SCORTEN to predict the prognosis of Stevens‐Johnson syndrome/toxic epidermal necrolysis: a systematic review and meta‐analysis
Authors: Torres‐Navarro I. , Briz‐Redón Á. , Botella‐Estrada R.
Published: December 2019

Background

The SCORTEN score is a specific predictor of the probability of death for patients diagnosed with Stevens‐Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).

Objectives

To evaluate the overall accuracy of SCORTEN and the influence of several moderators such as age, sex, geographical region and age of the study.

Methods

A systematic search was performed on MEDLINE, The Cochrane Library, EMBASE, SCOPUS and Web of Knowledge, with no restriction on language (last update 5 February 2019 for all databases). Original studies on the use of SCORTEN were eligible. The standardized mortality ratio (SMR), defined as the quotient between the number of deaths observed and the number expected following SCORTEN, was taken as the measurement of analysis.

Results

Sixty‐four papers were part of the main meta‐analysis carried out in the study. A pooled log(SMR) of −0.0889 (95% CI: −0.2023 to 0.0245) was obtained, suggesting a reasonable behaviour of SCORTEN as a predictor of mortality. The possible influence of several factors in the accuracy of SCORTEN was studied by means of meta‐regression models. Multivariate meta‐regression allowed finding that the mean age of the patients and the ending year of the study are the only factors that significantly influence SCORTEN predictions. The mean age of the group of patients was associated with a significant increase in the observed/expected ratio, whereas a progressive reduction in the observed/expected ratio can be appreciated over the years. Finally, an underestimation of mortality was found for SCORTEN values of 3 or less and the opposite for those above 3 (SCORTEN range: 0–7).

Conclusions

The rarity of the disease and the heterogeneity of the studies included are major limitations. Despite the overall remarkable accuracy displayed by SCORTEN, the influence of several factors, as comorbidities (e.g. renal impairment), involved body surface area and patient's age, seem of enough relevance to consider a redefinition of the scale.