bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of obesity on outcomes in patients undergoing emergency cholecystectomy for acute cholecystitis
Authors: Wong Alixandra , Naidu Sanjeev , Lancashire Raymond P. , Chua Terence C.
Published: February 2022

Background

Obesity is a perceived risk factor for poorer surgical outcomes, including increased complication rates and mortality. As obesity rates rise annually, evaluating surgical outcomes in the obese population has become increasingly important. This study examines the impact of obesity on outcomes following emergency laparoscopic cholecystectomy (LC) for acute cholecystitis.

Methods

A retrospective review of patients who underwent emergency LC for acute cholecystitis between March 2018 and March 2021 was performed. A total of 326 patients were included and stratified by body mass index (BMI) into two groups: obese (BMI ≥30 kg/m2, n = 156) and non‐obese (BMI <30 kg/m2, n = 170). Primary outcomes included length of stay, time to definitive surgery, and postoperative complications. Secondary outcomes included total operative time and intraoperative findings.

Results

Obese patients were younger than non‐obese patients (median, 45 [34.3–56.8] and 48.5 [34.0–66.3] years; p < 0.001) and had a higher prevalence of diabetes (13.5% versus 6.5%; p = 0.034). Higher American Society of Anesthesiologists (ASA) classification (p < 0.001) and operative grading scores were observed in the obese group (76.3% versus 40.6%, p < 0.001), who were more likely to have a distended gallbladder (19.9% versus 11.2%, p = 0.030) and gallstone impaction (23.1% versus 11.8%, p = 0.007) in comparison to the non‐obese group. Length of hospital stay, time to definitive surgery, and postoperative complication rates were similar between groups.

Conclusion

Although obesity is associated with greater technical difficulty during surgery than non‐obese patients, similar postoperative outcomes were achieved. Obesity should not be a contraindication for LC and can be safely performed in the emergency setting.
Racism without racists and consequentialist life‐maximizing approaches to triaging
Authors: Cordeiro‐Rodrigues Luis , Ewuoso Cornelius
Published: February 2022

Consequentialist life‐maximizing approaches to triaging prescribe that everyone ought to have an equal chance of living a typical lifespan, through the saving more life‐years (or saving most lives) principle, which emphasizes the youngest‐first principle and in some cases a lottery approach, often at the expense of the old and the sick. Although this approach has already been criticized by several bioethicists, this article provides a different kind of criticism to the life‐cycle viewpoint, one that has not yet been explored at length; namely, we contend that the life‐maximizing approach entails a form of racism without racists in its attitude towards Black people. More specifically, we contend that by neglecting the idea that current societies are not post‐racial, it privileges White individuals and disadvantages Black people in the triaging process, curtails equal opportunities for Black people, reinforces white normativity, and neglects African culture. We end the article by pointing towards an Afro‐communitarian relational triaging approach that does not face the same difficulties as consequentialist life‐maximizing approaches do.
Clinical outcomes of second relapsed and refractory first relapsed paediatric AML: A retrospective study within the NOPHO‐DB SHIP consortium
Authors: White Tara , Kaspers Gertjan , Abrahamsson Jonas , Arad‐Cohen Nira , Cianci Daniela , Fernandez Jose , Ha Shau‐Yin , Hasle Henrik , De Moerloose Barbara , Zwaan C. Michel , Goemans Bianca F.
Published: February 2022

As treatments for second relapsed and refractory first relapsed paediatric AML transition from purely palliative to more commonly curative in nature, comparative data is necessary for evaluating the effectiveness of emerging treatment options. Furthermore, little is known about predictors of prognosis following third‐line therapy. From 2004 until 2019, 277 of the 869 patients enrolled in NOPHO‐DB SHIP consortium trials experienced a first relapse and, of these patients, 98 experienced refractory first relapse and 59 a second relapse. Data on patient and disease characteristics within this cohort of 157 patients was analysed to determine probability of overall survival (pOS) and to identify factors influencing survival. Data on early treatment response and complete remission were not available. One and 5‐year pOS were 22 ± 3% and 14 ± 3%, respectively. There was no statistically significant difference in survival between refractory first relapsed and second relapsed AML. Factors influencing prognosis included: late relapse, type of third‐line treatment, FLT3 mutational status, and original treatment protocol. These data provide a baseline for evaluating the effectiveness of emerging therapies for the treatment of children with refractory first relapsed and second relapsed paediatric AML and evidence that select patients receiving third‐line therapy can be cured.
The importance of prototype similarity for physical activity: Cross‐sectional and longitudinal associations in a large sample of young adolescents
Authors: Wheatley Catherine , Wassenaar Thomas M. , Beale Nick , Salvan Piergiorgio , Dawes Helen , Davies Emma , Johansen‐Berg Heidi
Published: February 2022

Objectives

Physical activity declines during adolescence. The Theory of Planned Behaviour (TPB) is a useful framework for investigating activity but leaves variance unexplained. We explored the utility of a dual‐process approach using the TPB and the Prototype Willingness Model (PWM) to investigate correlates of physical activity, and 1‐year change in physical activity, among a large sample of adolescents.

Design

A cross‐sectional and longitudinal analysis of baseline and follow‐up data from the Fit to Study cluster‐randomized trial.

Methods

A total of 9,699 secondary school pupils at baseline and 4,632 at follow‐up (mean age = 12.5 years) completed measures of past week physical activity and constructs from both behaviour‐change models, at time‐points 1 year apart. Cross‐sectional analyses used multilevel, stepwise regression models to measure the strength of associations between model constructs and physical activity, and variance in behaviour explained by PWM over and above TPB. In longitudinal analyses, change scores were calculated by subtracting follow‐up from baseline scores. Models controlling for trial treatment status measured the strength of associations between change scores, and variance explained.

Results

At baseline, after controlling for past behaviour, physically active prototype similarity had the strongest relationship with activity after the intention to be active. Change in prototype similarity had the strongest relationship with change in activity after the change in intention and attitudes. Prototype perceptions and willingness explained additional variance in behaviour.

Conclusion

A dual‐process model incorporating prototype perceptions could more usefully predict physical activity than models based on rational expectations alone. Behaviour‐change interventions promoting an active self‐image could be tested for effects on physical activity.
A pilot study of intralesional methotrexate injections versus triamcinolone acetonide in patients affected by nail matrix psoriasis
Authors: Starace Michela , Alessandrini Aurora , Iorizzo Matilde , D'Altobrando Ambra , Ferrari Tiziano , Bruni Francesca , Piraccini Bianca Maria
Published: February 2022

Nail disorders in general are difficult to treat and often frustrating, and this is also the case with nail psoriasis, especially when it is limited to the nails, and not affecting joints. The quality of life of patients with nail psoriasis is negatively affected, owing to the chronic course of the disease and frequent relapses. The purpose of this study was to compare treatment response and maintenance of response during follow-up of 12 patients with nail matrix psoriasis limited to a few nails, who were treated with intralesional injections of either methotrexate (MTX) 25 mg/mL or triamcinolone acetonide 10 mg/mL. Patients were treated every 6 weeks for 24 weeks and followed up for 6 months. Photographic documentation and assessment by Nail Psoriasis Severity Index were performed during each treatment session and at each follow-up visit. At the end of the four treatment sessions, all patients had improvement of their disease, which continued during follow-up, especially for the MTX-treated group.
Cytomorphological and immunophenotypic characteristics of blastic plasmacytoid dendritic cell neoplasm involving central nervous system: a case report and review of literature
Authors: Prasad Tanya , Pushpam Deepam , Chopra Anita
Published: February 2022

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematopoietic neoplasm derived from precursors of plasmacytoid dendritic cells. We describe cytomorphological and immunophenotypic features of BPDCN in cerebrospinal fluid (CSF) in a 66‐year‐old patient who presented with delayed central nervous system relapse. Morphological examination showed dense infiltration by monotonous population of intermediate‐sized cells, resembling blasts. Nuclei had irregular contour with fine chromatin and prominent nucleoli. The cells had scant, pale blue, agranular cytoplasm. In some cells, intracytoplasmic vacuoles were also seen. No lymphoglandular bodies were seen. No mitosis or karyorrhexis were observed. On immunophenotyping, these cells were positive for CD45dim, CD123dim, HLA‐DR, CD56, CD36bright, TCL1, CD4, CD117, CD38dim and negative for CD13, CD33, CD34, CD14, CD64 and CD16. The relevance of clinical suspicion, cytological recognition, and inclusion of BPDCN specific immunophenotypic markers is emphasized.
When nasal cytology detects acute lymphoblastic leukaemia: New diagnostical implications
Authors: Gelardi Matteo , Giancaspro Rossana , Pecoraro Pietro , Cassano Michele
Published: February 2022

Nasal cytology is a diagnostic tool that evaluates the normal and pathological aspects of the nasal mucosa, by identifying and counting the cell types and their morphology. Since the cytological characteristics of the infiltrating inflammatory cells could reflect any cytopathological alterations of the blood circulating cells, it is not surprising that pathological findings of patients affected by oncohaematological diseases could also be found in nasal cytology. Therefore, this diagnostic tool could be applied to other branches of medicine including haematology.
A rare case of giant left circumflex coronary artery fistula to coronary sinus in patient with persistent left superior vena cava and bicuspid aortic valve
Authors: Abazid Rami M. , Goela Aashish , Islam Ali , Blissett Sarah
Published: February 2022

A 61‐year‐old male presented with symptoms of decompensated heart failure and cardiogenic shock. Transthoracic and transesophageal echocardiography showed severely impaired left ventricular (LV) systolic function (LVEF of 20–25%), bicuspid aortic valve with moderate aortic insufficiency and no significant stenosis, dilated coronary sinus and a tortuous vascular structure in the left‐sided atrioventricular groove. Cardiac computed tomography confirmed the diagnosis of persistent left superior vena cava and a giant coronary artery fistula to the coronary sinus. Cardiac magnetic resonance illustrated non‐specific late gadolinium enhancement in the mid‐wall of the septum. The patient was treated medically and with cardiac re‐synchronization therapy.
Cardiac adaptation to high altitudes after short‐ and long‐term exposure among Chinese Han lowlanders
Authors: Liu Guyue , Zhao Liming , Xu Qing , Lang Mingjian , Xiao Rong
Published: February 2022

Background

Short‐term, high altitude (HA) exposure raises pulmonary artery systolic pressure (PASP) and decreases left ventricular volumes. However, relatively little is known of the long‐term cardiac consequences of prolonged exposure in Chinese Han lowlanders, a highly adapted HA population.

Aims

We studied cardiac structure and function by echocardiography to investigate short‐term adaptation and potential long‐term cardiac remodeling.

Methods

This study included 301 healthy subjects of short‐term exposure (STE), acclimatized Chinese Han lowlanders (AL) at HA, native Tibetans (NT), and sea level residents (SLR) with 75, 77, 69, and 80 participants, respectively. All groups underwent standard echocardiography.

Results

Compared with SLR, systolic blood pressure (SBP) and heart rate of STE and AL did not significantly increase following HA exposure, but SBP in STE was lower than AL. In lowlanders, HA exposure enlarged right heart and pulmonary artery (PA), reduced left ventricular (LV) diastolic function. This decrease in LV diastolic function increased with exposure time. Compared with SLR, ejection fraction did not change significantly in STE, but decreased in AL. Interventricular septal end‐diastolic thickness (IVSd) increased both in STE and AL compared with SLR. Compared with NT, AL population had higher SBP and the greater diameter of PA.

Conclusions

In Chinese Han lowlanders, exposure to HA enlarged right ventricle and decreased the diastolic function of LV. LV systolic function was preserved after short‐term HA exposure but decreased after long‐term HA exposure. It was possible to speculate that ethnicity contributed to the observed difference in heart.
The relationship between career commitment and career success among university staff: The mediating role of employability
Authors: Van der Heijden Beatrice I. J. M. , Davies Eleanor M. M. , van der Linden Dimitri , Bozionelos Nikos , De Vos Ans
Published: February 2022

Across Europe, ongoing changes in higher education, such as the stagnating (even decreasing) percentage of permanent or tenure‐track jobs, and the reduced government budgets impress on us the need to conduct empirical research on the dynamics of the careers in this sector. In this study, we focussed on career success in higher education, and specifically examined the relationship of career commitment with objective and subjective career success, and the mediating role of employability in this relationship. Participants were drawn from across occupational roles including academic and support staff (N = 354) in a large Dutch university. Process macro's for SPSS were used to test our hypothesized model. We found that career commitment was particularly related to three out of the five dimensions of employability (i.e., anticipation and optimisation, personal flexibility, and corporate sense). There also was positive association between employability and objective and subjective career success. Furthermore, personal flexibility and corporate sense fully mediated the relationship between career commitment and objective career success. Corporate sense partially mediated the relationship between career commitment and subjective career success. Unexpectedly, staff status was not a moderator. Different explanatory mechanisms seem to operate between career commitment and forms of career success. Our study implies that for university staff, it is important to actively invest in their employability, with a special focus on one's corporate sense, and to be supported in this by their surrounding stakeholders (i.e., their family, friends, peers, direct supervisor, and employer). In this way, they will be able to increase their career success and add to the sustained competitive advantage of their employers.
Antemortem basal forebrain atrophy in pure limbic TAR DNA‐binding protein 43 pathology compared with pure Alzheimer pathology
Authors: Teipel Stefan J. , Grothe Michel J. ,   for the Alzheimer's Disease Neuroimaging Initiative
Published: February 2022

Background and purpose

Currently, the extent of cholinergic basal forebrain atrophy in relatively pure limbic TAR DNA‐binding protein 43 (TDP‐43) pathology compared with relatively pure Alzheimer disease (AD) is unclear.

Methods

We compared antemortem magnetic resonance imaging (MRI)‐based atrophy of the basal forebrain and medial and lateral temporal lobe volumes between 10 autopsy cases with limbic TDP‐43 pathology and 33 cases with AD pathology on postmortem neuropathologic examination from the Alzheimer's Disease Neuroimaging Initiative cohort. For reference, we studied MRI volumes from cognitively healthy, amyloid positron emission tomography‐negative subjects (n = 145). Group differences were assessed using Bayesian analysis of covariance. In addition, we assessed brain‐wide regional volume changes using partial least squares regression (PLSR).

Results

We found extreme evidence (Bayes factor [BF]01 > 600) for a smaller basal forebrain volume in both TDP‐43 and AD cases compared with amyloid‐negative controls, and moderate evidence (BF01 = 4.9) that basal forebrain volume was not larger in TDP‐43 than in AD cases. The ratio of hippocampus to lateral temporal lobe volumes discriminated between TDP‐43 and AD cases with an accuracy of 0.78. PLSR showed higher gray matter in lateral temporal lobes and cingulate and precuneus, and reduced gray matter in precentral and postcentral gyri and hippocampus in TDP‐43 compared with AD cases.

Conclusions

Atrophy of the cholinergic basal forebrain appears to be similarly pronounced in cases with limbic TDP‐43 pathology as in AD. This suggests that a clinical trial of the efficacy of cholinesterase inhibitors in amyloid‐negative cases with amnestic dementia and an imaging signature of TDP‐43 pathology may be warranted.
pH variability at volcanic CO2 seeps regulates coral calcifying fluid chemistry
Authors: Comeau Steeve , Cornwall Christopher E. , Shlesinger Tom , Hoogenboom Mia , Mana Ralph , McCulloch Malcolm T. , Rodolfo‐Metalpa Riccardo
Published: February 2022

Coral reefs are iconic ecosystems with immense ecological, economic and cultural value, but globally their carbonate‐based skeletal construction is threatened by ocean acidification (OA). Identifying coral species that have specialised mechanisms to maintain high rates of calcification in the face of declining seawater pH is of paramount importance in predicting future species composition, and growth of coral reefs. Here, we studied multiple coral species from two distinct volcanic CO2 seeps in Papua New Guinea to assess their capacity to control their calcifying fluid (CF) chemistry. Several coral species living under conditions of low mean seawater pH, but with either low or high variability in seawater pH, were examined and compared with those living in ‘normal’ (non‐seep) ambient seawater pH. We show that when mean seawater pH is low but highly variable, corals have a greater ability to maintain constant pHcf in their CF, but this characteristic was not linked with changes in abundance. Within less variable low pH seawater, corals with limited reductions in pHcf at the seep sites compared with controls tended to be more abundant at the seep site than at the control site. However, this finding was strongly influenced by a single species (Montipora foliosa), which was able to maintain complete pHcf homeostasis. Overall, although our findings indicate that there might be an association between ecological success and greater pHcf homeostasis, further research with additional species and at more sites with differing seawater pH regimes is required to solidify inferences regarding coral ecological success under future OA.
Intertwined like a double helix: A meta‐synthesis of the qualitative literature examining the experiences of living with someone with multiple sclerosis
Authors: Parkinson Anne , Brunoro Crystal , Leayr Jack , Fanning Vanessa , Chisholm Katrina , Drew Janet , Desborough Jane , Phillips Christine
Published: February 2022

Background

Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS.

Methods

Using the theoretical lens of personhood, we undertook a scoping review and meta‐synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring.

Results

Of 330 articles, 49 were included in the review. We identified five themes. One of these—seeking information and support—reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes—changing identities and adapting to life with a person with MS—point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with.

Conclusion

People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are ‘co‐constituents of the patient's identity’ assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient‐centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network.

Patient and Public Involvement

Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper.
Who are Canada’s temporary foreign workers? Policy evolution and a pandemic reality
Authors: Akbar Marshia
Published: February 2022

Since the late‐2000s, Canada has admitted an increasing number of foreign workers with a wide range of temporary work permits to meet local labour shortages and growing labour market demands. Unlike permanent residents, temporary residents are subjected to restricted work authorizations and social citizenship rights. Besides, Canadian policies distinguish different groups of temporary foreign workers based on their skill level and work permit type to determine their eligibility for employment, social rights and permanent residency. Reviewing secondary sources, this paper contributes to analyzing the key policies that have shaped the diverse streams within the Canadian temporary migration program. The analysis also highlights the inequalities experienced by various categories of temporary foreign workers in Canada and assesses these inequalities within the context of the COVID‐19 pandemic.
The going gets rougher: Exploring the labour market outcomes of international graduates in Australia
Authors: Tang Angelina , Perales Francisco , Rowe Francisco , Baxter Janeen
Published: February 2022

Given emerging evidence on their troubled transition to work, this study examines patterns, trends and changes in the labour market outcomes of international graduates remaining in Australia at 4 months following course completion between 1998 and 2015. Using the Australian Graduate Survey, this study shows that the share of international graduates who stayed on with the intention to work doubled during this period. The recent cohorts tended to come from non‐English‐speaking backgrounds, hold temporary visas and lack local work experience, all of which have been linked to disadvantageous labour market outcomes. This study further reveals a clear trend of rising economic inactivity, unemployment, part‐time employment and qualification mismatch among international graduates over time, reflecting their vulnerability against a backdrop of socio‐political and economic changes in the country. These findings indicate a need to review and strengthen existing policies and interventions to better help international graduates integrate into the labour market.
Managing the rising tide of Nigerian migrants to the West—A policy vacuum or a structural challenge?
Authors: Okeke‐Ihejirika Philomina , Odimegwu Ike
Published: February 2022

This analysis explores the growing attraction of migrants to destinations perceived as better pastures as well as the roots and consequences of international migration, especially for irregular migrants. The findings of two focus group discussions with Nigerian scholars, policymakers, service providers, and members of society suggest: (1) public policy on international migration should consider the social, political, and economic challenges that render many Africans desperate to leave the continent regardless of the harsh realities awaiting them along the way or in a new homeland; (2) given the fundamental rights of individuals to migrate, it is crucial that relevant information about the realities of life in Western host societies (especially newer destinations such as Canada) be made available in immigrant‐sending regions, such as Africa; and (3) efforts to engage the new African diaspora should also prioritize their active participation in building equitable societies in their countries of origin.
Impact of obesity on acute complications of catheter ablation for cardiac arrhythmia
Authors: Schenker Niklas , von Blumenthal Flurina , Hakmi Samer , Lemes Christine , Mathew Shibu , Rottner Laura , Wohlmuth Peter , Reißmann Bruno , Rillig Andreas , Metzner Andreas , Willems Stephan , Ouyang Feifan , Kuck Karl‐Heinz , Maurer Tilman
Published: February 2022

Introduction

The prevalence of obesity is increasing. However, data on the periprocedural complication rate of catheter ablation for arrhythmia in patients stratified by body mass index (BMI) are scarce.

Methods

This study included 1000 consecutive patients (age 62.0 ± 14.4 years) undergoing catheter ablation for cardiac arrhythmia. The primary study endpoint was any periprocedural major complication (cardiac tamponade, pseudoaneurysm, arteriovenous fistula, transient ischemic attack, stroke, valve damage, myocardial infarction, or death).

Results

The mean BMI was 27.6 ± 5.1 kg/m2 and the majority of patients were overweight (BMI 25.0–29.9 kg/m2, 43.4%). A BMI of 30.0–34.9 kg/m2 (Class I obesity) was present in 177 (17.7%) of patients, a BMI of 35.0–39.9 kg/m2 (Class II obesity) in 67 (6.7%), and a BMI ≥ 40 kg/m2 (Class III obesity) in 16 (1.6%). There were 31 major complications (3.1%) and one fatality (0.1%) due to terminal heart failure in a patient undergoing palliative ventricular tachycardia ablation. There was no significant impact of the BMI on the rate of major complications (p = .495). Compared to normal weight patients, odds ratios for complications in overweight patients, as well as Class I, II, and III obesity were 1.1 (95% confidence interval (CI): 0.8, 1.7), 1.3 (CI: 0.6, 2.6), 1.4 (CI: 0.5, 4.1), and 1.6 (CI: 0.4, 6.3), respectively. Radiation exposure and procedure duration were significantly increased in obese patients (p < .001 and p = .001, respectively).

Conclusion

In this study, obesity did not have a significant impact on the incidence of periprocedural complications after CA for cardiac arrhythmia.
Time point of nocturnal trough systolic blood pressure as an independent predictor of cardiovascular events
Authors: Zhu Jing , Hao Xiwa , Tang Hefei , Xu Jie , Wang Anxin , Zhang Xiaoli , Wang Yongjun
Published: February 2022

Nocturnal trough systolic blood pressure (NTSBP) and Time Point of Nocturnal Trough Systolic Blood Pressure (T‐NTSBP) were important parameters of nocturnal blood pressure, the predictive values of which are unclear for stroke outcome. This study aimed to examine the relationship between NTSBP/T‐NTSBP and stroke outcome. The authors used data from a nationwide ambulatory blood pressure monitoring cohort study conducted in China, which recruited 2348 ischemic stroke and transient ischemic attack (TIA) patients. NTSBP was defined as the lowest SBP during nighttime (22:00–6:00), and T‐NTSBP was defined as the corresponding time point of NTSBP. The associations between NTSBP/T‐NTSBP and stroke outcome (stroke recurrence and combined vascular event [CVE]) at 90 days or 1 year were analyzed using cox regression models. According to NTSBP classified by quartile, hazard ratio (HR) with 95% confidence interval (CI) for NTSBP quartile 4 (>129 mm Hg) was 2.727 (1.148–6.478) for CVE at 90‐day, compared with quartile 1 (≤102 mm Hg). However, an attenuated association between NTSBP and CVE was observed at 1 year. In addition, we observed the group of T‐NTSBP at 4:00–6:00 had a lowest CVE incidence at 90 days among four groups (22:00–23:59, 00:00–1:59 2:00–3:59, 4:00–6:00). After multivariable adjustment, T‐NTSBP was significantly associated with CVE incidence at 90 days (T‐NTSBP at the 4:00–6:00 versus the 22:00–23:59 group: HR, 0.433; 95%CI, 0.190–0.986), independent of NTSBP and average nocturnal SBP. Both of NTSBP and T‐NTSBP were important predictors for short‐term cardiovascular risk in ischemic stroke and TIA patients.
CEO overconfidence and debt covenant violations
Authors: Lartey Theophilus , Danso Albert
Published: February 2022

We examine how the level of chief executive officer (CEO) overconfidence might affect a borrowing firm's ex ante covenant intensity and ex post covenant violations. We find that overconfident CEOs are less effective in steering the firm away from unfavorable opportunistic behavior, and hence creditors include more stringent covenant restrictions in the loan contracts of their firms. The interpretational bias and other positive illusions of overconfident CEOs coupled with the more stringent and/or greater number of stringent ex ante covenants lead to a greater likelihood of covenant violation. These results remain robust after accounting for potential endogeneity issues through various techniques. Ex post tests reveal that firms with more confident CEOs are more likely to violate loan covenants after controlling for covenant intensity. We also find that overconfident CEOs can mitigate the incidence of covenant violations, but only among loans to lower rated (non‐investment‐grade) borrowers and revolving lines of credit where benefits of effective monitoring are most pronounced.
American College of Nurse‐Midwives Clinical Bulletin Number 18: Induction of Labor
Authors:   American College of Nurse‐Midwives, Carlson Nicole Smith , Dunn Amore Alexis , Ellis Jessica Ann , Page Katie , Schafer Robyn
Published: February 2022

Induction of labor is an increasingly common component of intrapartum care in the United States. This rise is fueled by a nationwide escalation in both medically indicated and elective inductions at or beyond term, supported by recent research showing some benefits of induction over expectant management. However, induction of labor medicalizes the birth experience and may lead to a complex cascade of interventions. The purpose of this Clinical Bulletin is twofold: (1) to guide clinicians on the use of person‐centered decision‐making when discussing induction of labor and (2) to review evidence‐based practice recommendations for intrapartum midwifery care during labor induction.
A Comparison of the Surface and Mechanical Properties of 3D Printable Denture‐Base Resin Material and Conventional Polymethylmethacrylate (PMMA)
Authors: Al‐Dwairi Ziad N. , Al Haj Ebrahim Abdulkareem A. , Baba Nadim Z.
Published: February 2022

Purpose

To study the surface and mechanical properties of 3D printed denture‐base resin materials and compare them with conventional heat‐cured polymethylmethacrylate (PMMA).

Materials and methods

Three brands of 3D printed denture‐base resin materials and one conventional heat‐cured PMMA were tested in this study: NextDent 3D printed resin, Dentona 3D printed resin, ASIGA 3D printed resin, and Meliodent conventional PMMA. Sixty specimens (25 × 25 × 3 mm) were fabricated (n=15 per group) to perform the following tests: wettability, surface roughness, and microhardness. One hundred twenty specimens (65 × 10 × 3 mm) were fabricated (n=30 per group) and stored in distilled water at (37 ±1°C) for 7 days. Specimens (N = 15) in each group were subjected to the three‐point bending test and impact strength test, employing the Charpy configuration on un‐notched specimens. The morphology of the fractured specimens was studied under scanning electron microscope (SEM). Statistical analysis was performed using one‐way ANOVA and Tukey‐pairwise multiple comparisons with 95% confidence interval. P‐values of ≤0.05 were considered significant.

Results

The conventional heat‐cured specimens demonstrated the highest means of surface roughness (0.23 ± 0.07 μm), Vickers hardness number (18.11 ±0.65) and flexural strength (92.44 ±7.91 MPa), and the lowest mean of contact angle (66.71° ±3.38°). ASIGA group showed the highest mean of contact angle (73.44° ±2.74°) and the lowest mean of surface roughness (0.19 ±0.03 μm). The highest mean of impact strength was recorded in the Dentona group (17.98 ±1.76 kg/m2). NextDent specimens showed the lowest means of Vickers hardness number (16.20 ±0.93), flexural strength (74.89 ±8.44 MPa), impact strength (15.20 ±0.69 kg/m2), and recorded the highest mean of bending modulus (2,115.80 ±178.95 MPa).

Conclusions

3D printed resin exhibited noticeable differences in surface and mechanical properties between different brands and with conventional heat‐polymerized PMMA.
The use of haemodialysis plastic cannula in prevalent patients with kidney failure: A feasibility crossover randomised trial study
Authors: Smith Vicki , Schoch Monica , (Andie) Xu Qunyan , Bennett Paul N.
Published: February 2022

Background

Haemodialysis plastic cannulae have been limited to incident arterio‐venous fistulae cannulation or in those who require a more flexible in situ access device. The feasibility of plastic cannulae in prevalent patients on haemodialysis has not been reported.

Objective

To determine the feasibility of plastic cannulae in prevalent haemodialysis patients.

Design

Prospective feasibility crossover randomised control trial.

Participants

Adults diagnosed with chronic kidney disease G5 requiring haemodialysis three or more times per week via a native arteriovenous fistula previously cannulated for at least 6 weeks.

Measurements

Cannulation success rate, cannulation manipulation type, arterial and venous needle pressure. Patient needle‐related anxiety as measured by the 4‐item Patient Health Questionnaire and Meditation in Dialysis Questionnaire and nurse satisfaction.

Results

Eight patients completed 12 weeks plastic canulae and metal needles. Plastic cannulae were less likely to be successful in cannulation compared to metal needles (odds ratio = 0.15; 95% confidence interval [CI]: 0.05–0.48; p = 0.001). There was no effect of type of needle on the change in arterial needle pressure or change in venous needle pressure and no effect of plastic needle on repositioning (relative risk [RR] = 1.09; 95% CI: 0.385, 3.089; p = .871) or gauze pillow application (RR = 0.936; 95% CI: 0.467, 1.874; p = .851) than metal needles, relative to no manipulation. There were low rates of psychological distress or needle‐related anxiety towards plastic or metal needles.

Conclusions

Plastic cannulae are feasible in prevalent haemodialysis patients, however, metal needles are still preferred in a haemodialysis center that has historically used metal needles.
Using texture analyzer to characterize pecan and olive oil tactile properties, compare to viscometer analysis, and link to fatty acid profile and total polyphenols
Authors: Davila Mindy , Liu Xuejun , Yusufali Zahra , Du Xiaofen
Published: February 2022

This study aimed to characterize mechanical properties of five pecan oils and one olive oil using a texture analyzer compared to a rotational viscometer; the results were linked to fatty acid profile and total polyphenol content. The seven texture parameters (firmness, consistency, cohesiveness, viscosity index, and stickiness at 5 s, stickiness at 30 s, and delta stickiness) showed significant difference (p ≤.05) among the six oils. Overall, olive oil had higher texture analysis values and significantly higher rotational viscosity than pecan oils. Chemically, C18 fatty acids accounted for approximately 90% of the total fatty acids in the five pecan oils. Olive oil had a higher amount of long‐chain, unsaturated fatty acids. Total polyphenols in pecan oils were 8–15 mg gallic acid equivalent (GAE)/100 g, while olive oil contained 27.2 mg GAE/100 g. Correlation analysis demonstrated a significant, positive relationship between “consistency” texture and rotational viscosity measurement. Mechanical properties (seven texture parameters and rotational viscosity) were partially correlated to fatty acid profile, though no universal pattern was identified.
The roles of recombination and selection in shaping genomic divergence in an incipient ecological species complex
Authors: Wersebe Matthew J. , Sherman Ryan E. , Jeyasingh Punidan D. , Weider Lawrence J.
Published: February 2022

Speciation genomic studies have revealed that genomes of diverging lineages are shaped jointly by the actions of gene flow and selection. These evolutionary forces acting in concert with processes such as recombination and genome features such as gene density shape a mosaic landscape of divergence. We investigated the roles of recombination and gene density in shaping the patterns of differentiation and divergence between the cyclically parthenogenetic ecological sister‐taxa, Daphnia pulicaria and Daphnia pulex. First, we assembled a phased chromosome‐scale genome assembly using trio‐binning for D. pulicaria and constructed a genetic map using an F2‐intercross panel to understand sex‐specific recombination rate heterogeneity. Finally, we used a ddRADseq data set with broad geographic sampling of D. pulicaria, D. pulex, and their hybrids to understand the patterns of genome‐scale divergence and demographic parameters. Our study provides the first sex‐specific estimates of recombination rates for a cyclical parthenogen, and unlike other eukaryotic species, we observed male‐biased heterochiasmy in D. pulicaria, which may be related to this somewhat unique breeding mode. Additionally, regions of high gene density and recombination are generally more divergent than regions of suppressed recombination. Outlier analysis indicated that divergent genomic regions are probably driven by selection on D. pulicaria, the derived lineage colonizing a novel lake habitat. Together, our study supports a scenario of selection acting on genes related to local adaptation shaping genome‐wide patterns of differentiation despite high local recombination rates in this species complex. Finally, we discuss the limitations of our data in light of demographic uncertainty.
Deep learning‐based diagnosis models for onychomycosis in dermoscopy
Authors: Zhu Xianzhong , Zheng Bowen , Cai Wenying , Zhang Jing , Lu Sha , Li Xiqing , Xi Liyan , Kong Yinying
Published: February 2022

Background

Onychomycosis is a common disease. Emerging noninvasive, real‐time techniques such as dermoscopy and deep convolutional neural networks have been proposed for the diagnosis of onychomycosis. However, deep learning application in dermoscopic images has not been reported.

Objectives

To explore the establishment of deep learning‐based diagnostic models for onychomycosis in dermoscopy to improve the diagnostic efficiency and accuracy.

Methods

We evaluated the dermoscopic patterns of onychomycosis diagnosed at Sun Yat‐sen Memorial Hospital, Guangzhou, China, from May 2019 to February 2021 and included nail psoriasis and traumatic onychodystrophy as control groups. Based on the dermoscopic images and the characteristic dermoscopic patterns of onychomycosis, we gain the faster region‐based convolutional neural networks to distinguish between nail disorder and normal nail, onychomycosis and non‐mycological nail disorder (nail psoriasis and traumatic onychodystrophy). The diagnostic performance is compared between deep learning‐based diagnosis models and dermatologists.

Results

All of 1,155 dermoscopic images were collected, including onychomycosis (603 images), nail psoriasis (221 images), traumatic onychodystrophy (104 images) and normal cases (227 images). Statistical analyses revealed subungual keratosis, distal irregular termination, longitudinal striae, jagged edge, and marble‐like turbid area, and cone‐shaped keratosis were of high specificity (>82%) for onychomycosis diagnosis. The deep learning‐based diagnosis models (ensemble model) showed test accuracy /specificity/ sensitivity /Youden index of (95.7%/98.8%/82.1%/0.809) and (87.5%/93.0%/78.5%/0.715) for nail disorder and onychomycosis. The diagnostic performance for onychomycosis using ensemble model was superior to 54 dermatologists.

Conclusions

Our study demonstrated that onychomycosis had distinctive dermoscopic patterns, compared with nail psoriasis and traumatic onychodystrophy. The deep learning‐based diagnosis models showed a diagnostic accuracy of onychomycosis, superior to dermatologists.
Prevention of central line‐associated bloodstream infections: ICU nurses' knowledge and barriers
Authors: Badparva Bita , Ghanbari Atefeh , Karkhah Samad , Osuji Joseph , Kazemnejad leyli Ehsan , Jafaraghaee Fateme
Published: February 2022

Background

Central line‐associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality.

Aim

The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence‐based guidelines in practice.

Design

A cross‐sectional study.

Methods

Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020.

Results

A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence‐based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.

Conclusions

Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU.

Relevance to Clinical Practice

The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence‐based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.
Plant–microbiome interactions under a changing world: responses, consequences and perspectives
Authors: Trivedi Pankaj , Batista Bruna D. , Bazany Kathryn E. , Singh Brajesh K.
Published: February 2022

Climate change is increasing global temperatures and the frequency and severity of droughts in many regions. These anthropogenic stresses pose a significant threat to plant performance and crop production. The plant‐associated microbiome modulates the impacts of biotic and abiotic stresses on plant fitness. However, climate change‐induced alteration in composition and activities of plant microbiomes can affect host functions. Here, we highlight recent advancements in our understanding of the impact of climate change (warming and drought) on plant–microbiome interactions and on their ecological functions from genome to ecosystem scales. We identify knowledge gaps, propose new concepts and make recommendations for future research directions. It is proposed that in the short term (years to decades), the adaptation of plants to climate change is mainly driven by the plant microbiome, whereas in the long term (century to millennia), the adaptation of plants will be driven equally by eco‐evolutionary interactions between the plant microbiome and its host. A better understanding of the response of the plant and its microbiome interactions to climate change and the ways in which microbiomes can mitigate the negative impacts will better inform predictions of climate change impacts on primary productivity and aid in developing management and policy tools to improve the resilience of plant systems.
Profiling of plasma‐derived exosomal RNA expression in patients with periodontitis: A pilot study
Authors: Kwon Eun Jung , Kim Hyun‐Joo , Woo Bok Hee , Joo Ji‐Young , Kim Yun Hak , Park Hae Ryoun
Published: February 2022

Objective

This study aimed to profile differentially expressed (DE) exosomal RNAs in healthy subjects and periodontitis patients and compare their levels before and after treatment.

Materials and methods

Plasma samples from healthy subjects and patients with periodontitis (pre‐/post‐periodontal treatment) were collected for this case–control study. After isolation of exosomes from the plasma, the RNA was extracted and small RNA sequencing was performed (3 healthy samples, 4 pre‐treatment samples, and 5 post‐treatment samples). Two‐way analyses were conducted according to the treatment status in the periodontitis group, unpaired analysis (grouping as pre‐/post‐treatment) and paired analysis (matching pre‐ and post‐treatment in the same subject). The DE exosomal RNAs were screened by sequencing and visualized using the R software. Gene Ontology analysis was performed, and target genes were identified.

Results

In both paired and unpaired analyses, two DE microRNAs (DEmiRs; miR‐1304‐3p and miR‐200c‐3p) and two DE small nucleolar RNAs (DEsnoRs; SNORD57 and SNODB1771) were common, and they were found to be downregulated during periodontitis and recovered to healthy levels after treatment. The top three target genes (NR3C1, GPR158, and CNN3) commonly regulated by DEmiRs were identified.

Conclusions

Plasma‐derived exosomal miRs (miR‐1304‐3p and miR‐200c‐3p) and snoRs (SNORD57 and SNODB1771) could be valuable biomarkers for periodontitis.
How to describe and measure phenology? An investigation on the diversity of metrics using phenology of births in large herbivores
Authors: Thel Lucie , Chamaillé‐Jammes Simon , Bonenfant Christophe
Published: February 2022

Proposed in 1849 by Charles Morren to depict periodical phenomena governed by seasons, the term ‘phenology' has spread in many fields of biology. With the wide adoption of the concept of phenology flourished a large number of metrics with different meaning and interpretation. Here, we first a priori classified 52 previously published metrics used to characterise the phenology of births in large herbivores according to four biological characteristics of interest: timing, synchrony, rhythmicity and regularity of births. We then applied each metric retrieved on simulation data, considering normal and non‐normal distributions of births, and varying distributions of births in time. We then evaluated the ability of each metric to capture the variation of the four phenology characteristics via a sensitivity analysis. Finally, we scored each metric according to eight criteria we considered important to describe phenology correctly. The high correlation we found among the many metrics we retrieved suggests that such diversity of metrics is unnecessary. We further show that the best metrics are not the most commonly used, and that simpler is often better. Circular statistics with the mean vector orientation and mean vector length seems, respectively, particularly suitable to describe the timing and synchrony of births in a wide range of phenology patterns. Tests designed to compare statistical distributions, like Mood and Kolmogorov–Smirnov tests, allow a first and easy quantification of rhythmicity and regularity of birth phenology respectively. By identifying the most relevant metrics our study should facilitate comparative studies of phenology of births or of any other life‐history event. For instance, comparative studies of the phenology of mating or migration dates are particularly important in the context of climate change.