bluuebunny/crossref_metadata_2025 huggingface dataset:
SPONTANEOUS RUPTURE OF A NORMAL SPLEEN
Authors: Paulvannan S , Pye JK
Published: April 2023

A 45‐year‐old woman was admitted with a gangrenous toe. She had a pancreatico‐renal transplant for end‐stage renal disease due to type I insulin dependent diabetes three years previously and had been taking immunosuppressive agents. An epidural catheter was placed to relieve the rest pain. Next day she was found to be hypotensive and tachycardic along with other features of shock. She did not have any clinical symptoms and signs initially. Urgent blood investigations were normal except for Hb of 5.0 g/dl; an ultrasound scan showed free fluid in the peritoneal cavity. Emergency laparotomy after resuscitation confirmed a massive haemoperitoneum secondary to a ruptured spleen. Histology showed loss of areas of the capsule and other areas showing subcapsular haemorrhage with no underlying pathology in the spleen.
OMEGA‐3 FATTY ACIDS: THEIR ROLE IN THE PREVENTION AND TREATMENT OF ATHEROSCLEROSIS RELATED RISK FACTORS AND COMPLICATIONS
Authors: Bhatnagar D , Durrington PN
Published: April 2023

Fatty acids are an important source of energy which can have an influence on serum lipids. Omega‐3 and omega‐6 fatty acids, both polyunsaturated fatty acids, have been advocated as replacement for saturated fat. Omega‐3 fatty acids, derived from fish and certain green plants, lower serum triglycerides, but they have also been shown to have a direct effect on myocardial contractility, blood pressure, platelet function, coagulation factors, cell‐mediated immunity and markers of inflammation. Recently available clinical trial data, including those using the concentrated omega‐3 fatty acid preparation Omacor®, indicate that omega‐3 fatty acids are valuable in preventing sudden death following myocardial infarction. Studies indicate that omega‐3 fatty acids are just as effective as, or have a benefit superior to, statins in secondary prevention. Omacor is also useful in the treatment of hypertriglyceridaemia, both as monotherapy and in combination with statins.
PIMECROLIMUS: A REVIEW OF PRE‐CLINICAL AND CLINICAL DATA
Authors: Graham‐Brown RAC , Grassberger M
Published: April 2023

Pimecrolimus (Elidel®) is a novel cell‐selective inhibitor of inflammatory cytokines that has specifically been developed for the treatment of inflammatory skin diseases due to its favourable skin selective pharmacological profile. Therapeutic efficacy and safety of pimecrolimus cream 1 % has been established in the short‐term treatment and the long‐term management of atopic eczema in clinical studies in adults, children and infants. It rapidly relieves pruritus, and redness and swelling disappear or are only mild in up to 70% of pimecrolimus treated patients during the first three weeks. When applied at the first signs and symptoms of atopic eczema, pimecrolimus has proven to prevent flare progression and to provide superior long‐term disease control compared with a conventional treatment, based on reactive use of corticosteroids. Pimecrolimus cream 1% is well tolerated, even on sensitive areas such as the face and neck. Blood concentrations remain low, even when extensive body areas are treated and no clinically significant systemic effects have been observed during short‐ or long‐term clinical studies with pimecrolimus.
SONOGRAPHIC REPRODUCIBILITY OF A NOVEL APPROACH IN THE ASSESSMENT OF CENTRALISED ACCESS IN END‐STAGE RENAL DISEASE
Authors: Barth JD , Pahl M , Zhang L , Zonjee M , Vazeri N
Published: April 2023

A reliable and accurate non‐invasive test is needed to help determine grafts and/or fistulae in end‐stage renal disease (ESRD) patients. Sonographic scanning to assess the state of the fistula and AV shunt seems underused. To find out what role B‐mode and Doppler play in the assessment of fistula and shunt, we scanned nine patients with a fistula as central access and nine patients with a graft several times over a period of a month. Diameters were measured before and after the AV shunt and Doppler measurements were made pre, inter and post shunt. We established that B‐mode measurements are reliable in predicting the future and integrity of both fistulae and grafts. Doppler measurements were less consistent and therefore less reliable. The average initial measurement showed a screen of 5.766 mm and a second measurement of 5.890 mm; The coefficient of variation (CV)/reproducibility was 1.58% for first measurement. The average first and second measurements post graft were 6.317 mm and 6.365 mm, respectively. The CV/reproducibility was 0.48%. First and second peak flow measurements averaged 149 m/s and 112 m/s, respectively, resulting in a CV of 14.0%. We conclude that morphological changes may be more reliable than Doppler values, indicating a potentially greater use for B‐mode ultrasound in predicting an open shunt and/or fistula.
EVALUATION OF THE EFFICACY, SAFETY, AND TOLERABILITY OF EZETIMIBE IN PRIMARY HYPERCHOLESTEROLAEMIA: A POOLED ANALYSIS FROM TWO CONTROLLED PHASE III CLINICAL STUDIES
Authors: Knopp RH , Dujovne CA , Le Beaut A , Lipka LJ , Suresh R , Veltri EP
Published: April 2023

Ezetimibe is a novel cholesterol absorption inhibitor that blocks intestinal absorption of dietary and biliary cholesterol. Data from 1719 patients who participated in two multicentre, double‐blind studies of ezetimibe were pooled to evaluate the drug's efficacy and safety in patients with primary hypercholesterolaemia. Following dietary stabilisation, a two‐ to 12‐week washout period, and a four‐week, single‐blind, placebo lead‐in period, patients were randomised to ezetimibe 10 mg or placebo once daily in the morning for 12 consecutive weeks. The primary efficacy endpoint was percent reduction in plasma low‐density lipoprotein (LDL)‐cholesterol from baseline at endpoint. Ezetimibe reduced LDL‐cholesterol by a mean of 18.2% compared with an increase of 0.9% with placebo (p<0.01) and resulted in favourable, statistically significant changes in HDL‐cholesterol, triglycerides and apo B. The response to ezetimibe was consistent across all subgroups analysed. Ezetimibe was well tolerated, with a safety profile similar to placebo. (Int J Clin Pract 2003; 57(5): 363–368)
RESULTS FROM A CARDIOVASCULAR PREVENTION CAMPAIGN IN PERSONS AGED 45–64 YEARS
Authors: Devroey D , De Swaef N , Coigniez P , Vandevoorde J , Kartounian J , Betz W
Published: April 2023

The aim of this study was to screen a target population for modifiable cardiovascular risk factors and to find out how treatment goals were achieved in the treated population. All inhabitants aged between 45 and 64 years in the town of Lede in Belgium were invited by the local authorities for a free health check‐up. In total, 629 subjects were screened. Total cholesterol ≥250 mg/dl or triglycerides ≥200 mg/dl was found in 38%, increased fasting glucose (≥110 mg/dl) in 8.6%, diabetes in 2.8%, increased systolic blood pressure (SBP) (≥=140 mmHg) in 22% and increased diastolic blood pressure (DBP) (≥90 mmHg) in 8%. The low‐density lipoprotein cholesterol (LDL‐C) target level of 115 mg/dl was attained in 13% of treated women and 34% of treated men. Target levels for SBP and DBP were attained in 40% and 75% respectively of those treated. Fasting glucose <120 mg/dl was found in 33% of the diabetic participants. (Int J Clin Pract 2003; 57(5): 430–434)
PLATELET AGGREGATION RESPONSE AND ADENOSINE TRIPHOSPHATE SECRETION AFTER ABDOMINAL TOTAL HYSTERECTOMY
Authors: Hayashi M , Kiumi F , Hoshimoto K , Ohkura T
Published: April 2023

This study was designed to clarify the quantitative relationship between platelet aggregation and the secretion of adenosine triphosphate (ATP) after surgery. Peripheral blood was collected from 41 patients who underwent abdominal total hysterectomy. Platelet count, volume, aggregation and the amount of secreted ATP were determined using live platelets before, one day after and two weeks after surgery. Platelet aggregation and ATP secretion were investigated using a lumi‐aggregometer. The aggregating reagents used were 5 μM of adenosine diphosphate (ADP) (final concentration) and 5 μg/ml of collagen. Structural alterations of platelets at these time points were also investigated by electron microscopy. Platelet aggregation induced by collagen was significantly lower (p<0.05) one day after surgery. ADP‐induced aggregation two weeks after surgery was more intense than before (p<0.05) and one day after (p<0.05) surgery. The amount of secreted ATP induced by each of ADP and collagen was significantly lower (p<0.05–0.01) one day after surgery and correlation coefficients between platelet aggregation and secretion of ATP showed lower values in both ADP‐ and collagen‐induced aggregation. One day after surgery electron microscopy showed that granule concentrations were markedly reduced in platelets. In conclusion, after consumption of circulating platelets at the site of operation, in addition to being lost by bleeding, the remaining platelets in circulation consist of platelet subpopulations different from those present before surgery, exhibiting low values of correlation coefficients between platelet aggregation and secretion of ATP and low concentrations of granules.
COMPARISON OF FINASTERIDE AND ALPHA‐BLOCKERS AS INDEPENDENT RISK FACTORS FOR ERECTILE DYSFUNCTION
Authors: Sadeghi‐Nejad H , Sherman N , Lue J
Published: April 2023

There are insufficient data on the effects of alpha‐blockers and finasteride on erectile function in men who have other risk factors for erectile dysfunction (ED). This study was conducted to compare the relative effects of these medications on ED in men who may be on other medications or have other risk factors for ED. Patients attending urology and primary care clinics were asked to complete an IRB‐approved questionnaire that combined the validated Sexual Health Inventory for Men (SHIM) and a detailed medical history. A total of 123 patients completed the questionnaire. The age range was 28–88 years (mean: 68 years). Eighty‐one per cent of patients had SHIM scores <21, indicating some degree of ED. The average SHIM scores in a population of patients with similar age and risk factors who had been on finasteride or alpha‐blockers indicated the presence of ED but did not reveal a significant difference between the two groups. The scores were no different from an age‐matched group of patients who were not on either medication, demonstrating the relatively greater importance of various other risk factors for ED. There was an inverse linear relationship between the number of ED risk factors and SHIM scores. There does not appear to be a significant difference between alpha‐blockers and finasteride as independent risk factors for ED. Age and other risk factors (heart disease, diabetes, hypertension, smoking, and hypercholesterolaemia) tend to have a much stronger influence on the severity of ED as assessed by SHIM scores.
PHAEOCHROMOCYTOMA PRESENTING AS DILATED CARDIOMYOPATHY
Authors: Attar MN , Moulik PK , Salem GD , Rose EL , Khaleeli AA
Published: April 2023

Phaeochromocytomas are rare endocrine tumours that secrete excessive amounts of catecholamines and can lead to myocarditis and cardiomyopathy. We report a 63‐year‐old man with long‐standing hypertension and diabetes who presented with dilated cardiomyopathy, which was initially thought to be secondary to ischaemic heart disease. Subsequent coronary angiography was normal. Carvedilol therapy unmasked the characteristic features of phaeochromocytoma. Surgical resection of a right adrenal tumour cured his symptoms, hypertension and diabetes, as well as causing a substantial improvement in cardiac function. Phaeochromocytoma should be considered as a rare cause of dilated cardiomyopathy of uncertain aetiology.
REUSABLE VERSUS DISPOSABLE INSTRUMENTS IN TONSILLECTOMY: A COMPARATIVE STUDY OF OUTCOMES
Authors: Maheshwar A , De M , Browning ST
Published: April 2023

Tonsillectomy, traditionally performed using reusable instruments (RIs), has recently been performed using disposable instruments (DIs), to prevent the theoretical risk of spreading new variant Creutzfeldt‐Jakob disease. Following this, there have been concerns of increased risk of complications, especially haemorrhage. We audited our hospital's complication rates of 100 tonsillectomies performed using R| and 100 using DIs. We analysed the overall complication rates and the postoperative haemorrhage rates. and compared them with the broader groups of RIs versus DIs. We also compared patients who did not have diathermy with those who did have diathermy. The overall complication rate was 6% with RIs and 33% with DIs and the haemorrhage rate was 1% and 12%, respectively. With DIs, these rates were significantly higher in the diathermy subgroup. We believe this is the first study to look at the complications due to DIs.
KOUNIS SYNDROME SECONDARY TO ALLERGIC REACTION FOLLOWING SHELLFISH INGESTION
Authors: Zavras GM , Papadaki PJ , Kokkinis CE , Kalokairinov K , Kouni SN , Batsolaki M , Gouvelou‐Deligianni GV , Koutsojannis CM
Published: April 2023

Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre‐existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.
GLUTEAL COMPARTMENT SYNDROME MISDIAGNOSED AS DEEP VEIN THROMBOSIS
Authors: Chua HC , Lim T , Lee HC , Lee SW
Published: April 2023

Gluteal compartment syndrome usually occurs secondary to prolonged immobility and recumbency following alcohol and drug abuse. The resultant pain and swelling in the lower limb may be misdiagnosed as deep vein thrombosis. Once compartment syndrome is diagnosed, urgent decompression fasciotomy is required. The outcome is poor if the diagnosis is missed or delayed. We report such a case.
TREATMENT OF TOXIC EPIDERMAL NECROLYSIS WITH INTRAVENOUS IMMUNOGLOBULIN
Authors: Sidwell RU , Swift S , Yan C‐L , Porter W , Thompson EM , Clark JA , Bunker CB
Published: April 2023

Toxic epidermal necrolysis (TEN) is a rare severe reaction of the skin resulting in full thickness damage to the epidermis. The condition has significant morbidity as a result of dehydration, protein loss, thermoregulatory difficulties, and renal, lung, liver and heart failure. The mortality rate approaches 30%, most commonly from bacterial sepsis. Management of this condition is cessation of the suspected causative agent and supportive care on a burns or intensive care unit. There have been recent reports of treatment using intravenous immunoglobulin (IVIG) therapy, though its efficacy is yet to be established. It has been proposed that IVIG inhibits the Fas‐FasL mediated apoptosis of keratinocytes affected by TEN. We describe a case of extensive drug‐induced TEN in a 33‐year‐old woman who showed rapid improvement with IVIG therapy at a dose of 0.75 g/kg/day given for four consecutive days.
PRIONS AND DISPOSABLE SURGICAL INSTRUMENTS
Authors: Nix P
Published: April 2023

Single‐use surgical instruments have been used in the UK's ENT departments. This is in response to guidelines issued by the Department of Health and the British Association of Otolaryngologists and Head and Neck Surgeons, in order to prevent the spread of new variant Creutzfeldt‐Jakob disease (vCJD) in a young population of patients undergoing routine adenotonsillectomy. In one institution we found that the new single‐use instruments were inferior to previous standard kits and that postoperative haemorrhage rates had increased following children's tonsillectomy from 1.7% to 7.8% (p<0.01). Because of the increased reporting of complications following the use of single‐use surgical instruments for adenotonsillectomies, ENT departments in the UK are no longer obliged to use these disposable instruments. This is due to the theoretical risk of prion infection being outweighed by the actual risk to the patient from increased postoperative haemorrhage. (Int J Clin Pract 2003; 57(8): 678–680)
NASOPHARYNGEAL CARRIAGE RATE OF HAEMOPHILUS INFLUENZAE IN CHILDREN AGED 7–12 YEARS IN TURKEY
Authors: Ayyildiz A , Aktas AE , Yazgi H
Published: April 2023

This study was undertaken to determine the nasopharyngeal carriage prevalence of Haemophilus spp. in children aged 7–12 years in Erzurum, Turkey. Three hundred randomly selected students from three regions with different socioeconomic properties were included in the study. Nasopharyngeal swabs taken from the students were streaked into selective media for Haemophilus spp. Isolated colonies were identified by macroscopic and microscopic examination and their X and V factor needs determined. Those identified as H. influenzae were serotyped by specific capsule antisera. Haemophilus spp. were recovered from 51 (17.0%), nine (3.0%) of which were H. influenzae type b (Hib), 30 (10.0%) H. influenzae non‐type b, and 12 (4.0%) H. parainfluenzae. Results were evaluated by several risk factors such as age, gender, number of siblings, siblings attending a nursery, family smoking habits and family economic status.
AN EVALUATION OF PHARMACEUTICAL TREATMENT OF DYSLIPIDAEMIA AMONG PATIENTS WITHOUT DIAGNOSED ATHEROSCLEROTIC DISEASE IN BELGIUM
Authors: Devroey D , Betz W , Kartounian J
Published: April 2023

The aim of this study was to assess the lipoprotein levels in patients without diagnosed atherosclerotic disease but treated with lipid‐lowering drugs. During February and March 2002 all demands for continuation of reimbursement of lipid‐lowering drugs were recorded at two regional offices of health insurance associations. A total of 1973 patients without diagnosed atherosclerotic disease were included (mean age 66 years). Mean total cholesterol (TC) was 5.39 mmol/l, high‐density lipoprotein cholesterol (HDL‐C) 1.50 mmol/l, low‐density lipoprotein cholesterol (LDL‐C) 3.16 mmol/l and triglycerides (TG) 1.59 mmol/l. Thirty‐four per cent of the treated patients reached the TC target of 5.0 mmol/l or less. The LDL‐C target level of 3.0 mmol/l or less was reached by 45% of the patients. Of the patients receiving a statin, 61% were not treated with the optimal doses. The treatment was adjusted in 15% of the patients who did not reach the combined endpoint.
A CASE OF SEPTICAEMIA, MENINGITIS AND PNEUMONIA CAUSED BY STREPTOCOCCUS BOVIS TYPE II
Authors: Namiduru M , Karaoglan I , Aktaran S , Dikensoy O , Baydar I
Published: April 2023

We present a case of septicaemia, pneumonia and meningitis due to Streptococcus bovis type‐ll in a patient who had undergone a total hip prosthesis under general anaesthesia three weeks earlier. This organism is an uncommon human pathogen that sometimes causes bacteraemia and endocarditis and is usually connected with colon pathology and dental procedures. In the reported case, there were no risk factors for S. bovis infection except for the hip operation. S. cow's type II sensitive to penicillin was isolated from all blood and pleural fluid cultures. The patient recovered and was discharged from hospital two weeks after presentation. (Int J Clin Pract 2003; 57(8): 735–736)
LANGERHANS CELL HISTIOCYTOSIS PRESENTING AS ADULT ONSET EPILEPSY
Authors: Jain RS
Published: April 2023

A 37‐year‐old man presented with recurrent secondary generalised seizures from right focal onset. An MRI scan of the brain revealed multiple contrast enhancing lesions mainly involving the frontal, parietal and temporal regions. The left frontotemporal lesion was biopsied and histopathology confirmed it to be a rare case of adult Langerhans cell histiocytosis. He was given a short course of oral corticosteroids. Two years later his clinical condition was much improved on antiepileptic therapy alone, and repeat MRI brain and MR spectroscopy showed significant resolution of the lesions.
PERSISTENT OTORRHOEA AFTER VENTILATION TUBE INSERTION: A TREATMENT PROTOCOL
Authors: Siddiq MA , Narula AA
Published: April 2023

Otorrhoea is the commonest complication of ventilation tube (grommet) insertion. In some cases it may be unresponsive to short courses of topical antibiotic/steroid drops and/or systemic antibiotics. This study investigated whether a five‐day course of inpatient treatment with intravenous antibiotics, topical medication and daily microsuction was effective in treating persistent otorrhoea. Eleven subjects were included, of whom nine responded to the proposed treatment regimen. We recommend that patients with persistent otorrhoea after ventilation tube insertion should be managed according to these guidelines before considering an examination under anaesthetic or a ventilation tube removal.
EXCITABILITY OF THE MOTOR CORTEX IN SCHIZOPHRENIA FOLLOWING TYPICAL AND ATYPICAL ANTIPSYCHOTICS: TWO SERIAL CASE REPORTS
Authors: Puri BK , Davey NJ , Zaman R
Published: April 2023

A previous electrophysiological investigation of schizophrenia using transcranial magnetic stimulation has shown altered corticospinal inhibition in medicated patients compared with drug‐naive patients. Based on this work, we have carried out the first serial electrophysiological case studies of the human corticospinal system in schizophrenia in which a typical antipsychotic was compared with an atypical antipsychotic. We used transcranial magnetic stimulation‐based techniques to study the time course of drug action in two antipsychotic drug‐naive patients with schizophrenia; one patient treated with a typical antipsychotic (haloperidol) and the other with an atypical antipsychotic (risperidone). The typical antipsychotic was associated with an increase in corticospinal excitability which we found to occur 4–5 weeks after beginning medication. In contrast, the atypical antipsychotic was associated with a decrease in corticospinal excitability, occurring 3–4 weeks after starting pharmacotherapy. We conclude that these opposite neurophysiological effects are related to the relative dopaminergic and serotonergic actions of the two classes of drug. (Int J Clin Pract 2003; 57(9): 831–833)
ADDISONIAN CRISIS DUE TO ADRENAL GLAND METASTASIS IN HODGKIN'S DISEASE
Authors: Akçay MN , Tekin SB , Akçay G
Published: April 2023

Adrenal insufficiency or Addison's disease is a rare illness associated with multiple pathology. We describe the case of a 61‐year‐old male with Hodgkin's disease and metastases in both adrenal glands who was diagnosed with adrenal insufficiency as a result of an acute addisonian crisis. (Int J Clin Pract 2003; 57(9): 840–841)
ANTIPLATELET DRUGS IN CARDIOVASCULAR DISEASES
Authors: Weston C , Rao U
Published: April 2023

Platelets play a key role in the pathogenesis of atherothrombotic conditions, e.g. acute coronary syndromes, cerebrovascular and peripheral vascular events. Antiplatelet agents interfere with platelet activation and aggregation and, as such, would be expected to modify the natural history of cardiovascular disease. In this review we explore the evidence to support the use of such drugs, singly or in combination, in a variety of situations characterised by thrombosis and summarise some of the concerns inherent in their use.
Assessing the Farm–Nonfarm Households' Income Gap along the Income Distribution in the European Union
Authors: Marino Maria , Rocchi Benedetto , Severini Simone
Published: April 2023

This article investigates the presence of a farm–nonfarm income gap along the income distribution in the European Union. Our findings show that the income disparity between farm and nonfarm households varies at the opposite poles of the distribution within and between countries. On average, farm households in the lowest quartile are worse off than nonfarm households in the same quartile, whilst farm households in the highest quartile are better off than their nonfarm counterpart. We also provide some evidence on the time dynamics of the farm–nonfarm households' income gap by looking at its evolution after the Great Recession. Finally, the policy implications stemming from the results are presented. In particular, the importance of re‐directing the Common Agricultural Policy public support in two main directions: from the richest farm households to the poorest farm households, to reduce within countries' inequality, and from the richest countries to the poorest countries, to reduce between countries' inequality.
Toward an adequate level of detail in flood risk assessments
Authors: Sieg Tobias , Kienzler Sarah , Rözer Viktor , Vogel Kristin , Rust Henning , Bronstert Axel , Kreibich Heidi , Merz Bruno , Thieken Annegret H.
Published: April 2023

Flood risk assessments require different disciplines to understand and model the underlying components hazard, exposure, and vulnerability. Many methods and data sets have been refined considerably to cover more details of spatial, temporal, or process information. We compile case studies indicating that refined methods and data have a considerable effect on the overall assessment of flood risk. But are these improvements worth the effort? The adequate level of detail is typically unknown and prioritization of improvements in a specific component is hampered by the lack of an overarching view on flood risk. Consequently, creating the dilemma of potentially being too greedy or too wasteful with the resources available for a risk assessment. A “sweet spot” between those two would use methods and data sets that cover all relevant known processes without using resources inefficiently. We provide three key questions as a qualitative guidance toward this “sweet spot.” For quantitative decision support, more overarching case studies in various contexts are needed to reveal the sensitivity of the overall flood risk to individual components. This could also support the anticipation of unforeseen events like the flood event in Germany and Belgium in 2021 and increase the reliability of flood risk assessments.
Industry influence on firms' R&D and innovation
Authors: Rind Asad A. , Abbassi Wajih , Bigelli Marco , Rouatbi Wael
Published: April 2023

This paper examines the effect of peers on a firm's research and development (R&D) policy. We show that firms do not make R&D decisions in isolation, and that industry dynamics play an important role in defining a firm's R&D intensity. Using a large sample of 54,393 firm‐year observations from 1991 to 2015 in the United States, we find that firms' R&D decisions are mainly driven by their industry peers' R&D policies. Moreover, we find that R&D mimicking is significant only in the presence of strong product market competition, whereas we do not find any evidence of information‐based herding in R&D investments. Our additional analysis shows that our main conclusions remain valid even in the presence of financial constraints, and regardless of the firms' market positions. Finally, we provide evidence that R&D mimicking increases firms' future values, future patent outputs, and estimated patent dollar values. Our findings are robust to endogeneity concerns, and to using alternative sample compositions, R&D intensity proxies, and different industry classifications.
Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation
Authors: Baayd Jami , Lloyd Mikelle , Garcia Gabriela , Smith Suzanne , Sylvester Heidi , Clark Erin , Cross Brett , Gero Alexandra , Cohen Susanna
Published: April 2023

Introduction

Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training.

Methods

We engaged community stakeholders to identify learning objectives and co‐design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post‐training form asking participants to evaluate the quality of the training and a 9‐question pre‐ and post‐training survey measuring changes in participants’ self‐efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test.

Results

A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self‐efficacy regarding their ability to manage birth transfers.

Discussion

Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.
Tetrasporophytic bias coupled with heterozygote deficiency in Antarctic Plocamium sp. (Florideophyceae, Rhodophyta)
Authors: Heiser Sabrina , Amsler Charles D. , Stoeckel Solenn , McClintock James B. , Baker Bill J. , Krueger‐Hadfield Stacy A.
Published: April 2023

Meiosis and syngamy generate an alternation between two ploidy stages, but the timing of these two processes varies widely across taxa, thereby generating life cycle diversity. One hypothesis suggests that life cycles with long‐lived haploid stages are correlated with selfing, asexual reproduction, or both. Though mostly studied in angiosperms, selfing and asexual reproduction are often associated with marginal habitats. Yet, in haploid‐diploid macroalgae, these two reproductive modes have subtle but unique consequences whereby predictions from angiosperms may not apply. Along the western Antarctic Peninsula, there is a thriving macroalgal community, providing an opportunity to explore reproductive system variation in haploid‐diploid macroalgae at high latitudes where endemism is common. Plocamium sp. is a widespread and abundant red macroalga observed within this ecosystem. We sampled 12 sites during the 2017 and 2018 field seasons and used 10 microsatellite loci to describe the reproductive system. Overall genotypic richness and evenness were high, suggesting sexual reproduction. Eight sites were dominated by tetrasporophytes, but there was strong heterozygote deficiency, suggesting intergametophytic selfing. We observed slight differences in the prevailing reproductive mode among sites, possibly due to local conditions (e.g., disturbance) that may contribute to site‐specific variation. It remains to be determined whether high levels of selfing are characteristic of macroalgae more generally at high latitudes, due to the haploid‐diploid life cycle, or both. Further investigations of algal life cycles will likely reveal the processes underlying the maintenance of sexual reproduction more broadly across eukaryotes, but more studies of natural populations are required.
Economic assessment of investment in automatic feeding systems for sea bass grow‐out farms of different sizes
Authors: Fernández Sánchez José L. , Basurco Bernardo , Aguilera Cristóbal
Published: April 2023

The aim of this work was to run an economic assessment of investment in automatic feeding systems for grow‐out farms of different sizes producing European sea bass in the Mediterranean Sea. For this, we have used an economic model to simulate the annual income statement of a typical farm with different production volumes: a small‐sized farm with a production of 413 tons/year, a medium‐sized farm of 1122 tons/year, and a large‐sized farm of 2539 tons/year. With the values obtained in the simulation, we have carried out partial budget and investment analyses to estimate the economic value of this investment decision. To complement our economic assessment, a sensitivity analysis has also been run to include risk in the investment decision. Our findings show that the implementation of automatic feeding systems in sea bass grow‐out farms would be a good economic decision, regardless of the farm size, since there are technological options suitable for different farm sizes and capital investment capacities. Consequently, innovation and investment in feeding management should not be impeded or limited by the farm size.
Evolution‐guided multiomics provide insights into the strengthening of bioactive flavone biosynthesis in medicinal pummelo
Authors: Zheng Weikang , Zhang Wang , Liu Dahui , Yin Minqiang , Wang Xia , Wang Shouchuang , Shen Shuangqian , Liu Shengjun , Huang Yue , Li Xinxin , Zhao Qian , Yan Lu , Xu Yuantao , Yu Shiqi , Hu Bin , Yuan Tao , Mei Zhinan , Guo Lanping , Luo Jie , Deng Xiuxin , Xu Qiang , Huang Luqi , Ma Zhaocheng
Published: April 2023

Pummelo (Citrus maxima or Citrus grandis) is a basic species and an important type for breeding in Citrus. Pummelo is used not only for fresh consumption but also for medicinal purposes. However, the molecular basis of medicinal traits is unclear. Here, compared with wild citrus species/Citrus‐related genera, the content of 43 bioactive metabolites and their derivatives increased in the pummelo. Furthermore, we assembled the genome sequence of a variety for medicinal purposes with a long history, Citrus maxima ‘Huazhouyou‐tomentosa’ (HZY‐T), at the chromosome level with a genome size of 349.07 Mb. Comparative genomics showed that the expanded gene family in the pummelo genome was enriched in flavonoids‐, terpenoid‐, and phenylpropanoid biosynthesis. Using the metabolome and transcriptome of six developmental stages of HZY‐T and Citrus maxima ‘Huazhouyou‐smooth’ (HZY‐S) fruit peel, we generated the regulatory networks of bioactive metabolites and their derivatives. We identified a novel MYB transcription factor, CmtMYB108, as an important regulator of flavone pathways. Both mutations and expression of CmtMYB108, which targets the genes PAL (phenylalanine ammonia‐lyase) and FNS (flavone synthase), displayed differential expression between Citrus‐related genera, wild citrus species and pummelo species. This study provides insights into the evolution‐associated changes in bioactive metabolism during the origin process of pummelo.
Frequency of child restraint system use and parental knowledge of such systems in western China
Authors: Wan Li , Wen Dan , Wan Xingli , Ren Yinghong , Jia Chao , Yang Xiuru , He Mei
Published: April 2023

Objectives

This study investigated the frequency of child restraint system (CRS) use in cars and assessed parental knowledge and attitudes toward such restraint systems in western China.

Study Design

Cross‐sectional survey.

Methods

This cross‐sectional survey was conducted between December 2021 and January 2022. Hospitals and kindergartens were convenience sampling selected, and parents with cars were asked whether they owned and used CRS. Parents’ knowledge and attitudes toward such systems were also determined. Factors associated with CRS were explored using binary logistic regression.

Results

A total of 4764 questionnaires were distributed to parents with children 0–6 years old. Among the 4455 responses received, 50.8% of the respondents owned CRS, and most of which were front‐facing child seats (42.0%). Less than half (44.4%) reported using a CRS sometimes, but only 19.6% used it all the time. The possession and use of a CRS varied significantly with the parental education level, age of the child, place of residence, number of children, family income, travel frequency, and travel distance. Logistic regression analysis showed that the frequency of car travel with a child and monthly family income significantly affected CRS use. Most parents (85.2%) perceived that adult seat belt in cars are effective at protecting their children in the event of a crash. The most frequent reason for not using a CRS was the tendency for children to travel in the car less often.

Conclusions

Although approximately half of the respondents owned a CRS, most of them used it rarely, if at all. Educating parents about safe ways for children to ride in a car and use of safety belts may promote CRS use.
Deciphering the role of alternative splicing as modulators of defense response in the MYMIV–Vigna mungo pathosystem
Authors: Laskar Parbej , Hazra Anjan , Pal Amita , Kundu Anirban
Published: April 2023

Alternative splicing (AS) is a crucial regulatory mechanism that impacts transcriptome and proteome complexity under stressful situations. Although its role in abiotic stresses is somewhat understood, our understanding of the mechanistic regulation of pre‐messenger RNA splicing in plant‐pathogen interaction is meager. To comprehend this unexplored immune reprogramming mechanism, transcriptome profiles of Mungbean Yellow Mosaic India Virus (MYMIV)‐resistant and susceptible Vigna mungo genotypes were analyzed for AS genes that may underlie the resistance mechanism. Results revealed a repertoire of AS‐isoforms accumulated during pathogenic infestation, with intron retention being the most common AS mechanism. Identification of 688 differential alternatively spliced (DAS) genes in the resistant host elucidates its robust antiviral response, whereas 322 DAS genes were identified in the susceptible host. Enrichment analyses confirmed DAS transcripts pertaining to stress, signaling, and immune system pathways have undergone maximal perturbations. Additionally, a strong regulation of the splicing factors has been observed both at the transcriptional and post‐transcriptional levels. qPCR validation of candidate DAS transcripts with induced expression upon MYMIV infection demonstrated a competent immune response in the resistant background. The AS‐impacted genes resulted either in partial/complete loss of functional domains or altered sensitivity to micro‐RNA‐mediated gene silencing. A complex regulatory module, miR7517‐ATAF2, has been identified in an aberrantly spliced ATAF2 isoform that exposes an intronic miR7517 binding site, thereby suppressing the negative regulator to enhance the defense reaction. The present study establishes AS as a noncanonical immune reprogramming mechanism that operates in parallel, thereby offering an alternative strategy for developing yellow mosaic‐resistant V. mungo cultivars.
Assessing the economic impacts of a perfect storm of extreme weather, pandemic control, and export restrictions: A methodological construct
Authors: Hu Yixin , Wang Daoping , Huo Jingwen , Chemutai Vicky , Brenton Paul , Yang Lili , Guan Dabo
Published: April 2023

This article investigates the economic impacts of a multi‐disaster mix comprising extreme weather, such as flooding, pandemic control, and export restrictions, dubbed a “perfect storm.” We develop a compound‐hazard impact model that improves on the ARIO model by considering the economic interplay between different types of hazardous events. The model considers simultaneously cross‐regional substitution and production specialization, which can influence the resilience of the economy to multiple shocks. We build scenarios to investigate economic impacts when a flood and a pandemic lockdown collide and how these are affected by the timing, duration, and intensity/strictness of each shock. In addition, we examine how export restrictions during a pandemic impact the economic losses and recovery, especially when there is the specialization of production of key sectors. The results suggest that an immediate, stricter but shorter pandemic control policy would help to reduce the economic costs inflicted by a perfect storm, and regional or global cooperation is needed to address the spillover effects of such compound events, especially in the context of the risks from deglobalization.
A copula‐based method of risk prediction for autonomous underwater gliders in dynamic environments
Authors: Chen Xi , Bose Neil , Brito Mario , Khan Faisal , Zou Ting
Published: April 2023

Autonomous underwater gliders (AUGs) are effective platforms for oceanic research and environmental monitoring. However, complex underwater environments with uncertainties could pose the risk of vehicle loss during their missions. It is therefore essential to conduct risk prediction to assist decision making for safer operations. The main limitation of current studies for AUGs is the lack of a tailored method for risk analysis considering both dynamic environments and potential functional failures of the vehicle. Hence, this study proposed a copula‐based approach for evaluating the risk of AUG loss in dynamic underwater environments. The developed copula Bayesian network (CBN) integrated copula functions into a traditional Bayesian belief network (BBN), aiming to handle nonlinear dependencies among environmental variables and inherent technical failures. Specifically, potential risk factors with causal effects were captured using the BBN. A Gaussian copula was then employed to measure correlated dependencies among identified risk factors. Furthermore, the dependence analysis and CBN inference were performed to assess the risk level of vehicle loss given various environmental observations. The effectiveness of the proposed method was demonstrated in a case study, which considered deploying a Slocum G1 Glider in a real water region. Risk mitigation measures were provided based on key findings. This study potentially contributes a tailored tool of risk prediction for AUGs in dynamic environments, which can enhance the safety performance of AUGs and assist in risk mitigation for decision makers.
A classification system for characterizing the integrity and quality of evidence in risk studies
Authors: Thekdi Shital , Aven Terje
Published: April 2023

Risk management requires a balance between knowledge and values. Knowledge consists of justified beliefs and evidence, with evidence including data, assumptions, and models. While quality and integrity of evidence are valued in the sciences, risk science involves uncertainty, which suggests that evidence can be incomplete or imperfect. The use of inappropriate evidence can invalidate risk studies and contribute to misinformation and poor risk management decisions. Additionally, the interpretation of quality and integrity of evidence may vary by the risk study mission, decision‐maker values, and stakeholder needs. While risk science has developed standards for risk studies, there remains a lack of clarity for how to demonstrate quality and integrity of evidence, recognizing that evidence can be presented in many formats (e.g., data, ideas, and theories), be leveraged at various stages of a risk study (e.g., hypotheses, analyses, and communication), and involve differing expectations across stakeholders. This study develops and presents a classification system to evaluate quality and integrity of evidence that is based on current risk science guidance, best practices from non‐risk disciplines, and lessons learned from recent risk events. The classification system is demonstrated on a cyber‐security application. This study will be of interest to risk researchers, risk professionals, and data analysts.
Hemoglobin mass and performance responses during 4 weeks of normobaric “live high–train low and high”
Authors: Kettunen Oona , Leppävuori Antti , Mikkonen Ritva , Peltonen Juha E. , Nummela Ari , Wikström Bettina , Linnamo Vesa
Published: April 2023

Purpose

To investigate whether 4 weeks of normobaric “live high–train low and high” (LHTLH) causes different hematological, cardiorespiratory, and sea‐level performance changes compared to living and training in normoxia during a preparation season.

Methods

Nineteen (13 women, 6 men) cross‐country skiers competing at the national or international level completed a 28‐day period (∼18 h day−1) of LHTLH in normobaric hypoxia of ∼2400 m (LHTLH group) including two 1 h low‐intensity training sessions per week in normobaric hypoxia of 2500 m while continuing their normal training program in normoxia. Hemoglobin mass (Hbmass) was assessed using a carbon monoxide rebreathing method. Time to exhaustion (TTE) and maximal oxygen uptake (VO2max) were measured using an incremental treadmill test. Measurements were completed at baseline and within 3 days after LHTLH. The control group skiers (CON) (seven women, eight men) performed the same tests while living and training in normoxia with ∼4 weeks between the tests.

Results

Hbmass in LHTLH increased 4.2 ± 1.7% from 772 ± 213 g (11.7 ± 1.4 g kg−1) to 805 ± 226 g (12.5 ± 1.6 g kg−1) (p < 0.001) while it was unchanged in CON (p = 0.21). TTE improved during the study regardless of the group (3.3 ± 3.4% in LHTLH; 4.3 ± 4.8% in CON, p < 0.001). VO2max did not increase in LHTLH (61.2 ± 8.7 mL kg−1 min−1 vs. 62.1 ± 7.6 mL kg−1 min−1, p = 0.36) while a significant increase was detected in CON (61.3 ± 8.0–64.0 ± 8.1 mL kg−1 min−1, p < 0.001).

Conclusions

Four‐week normobaric LHTLH was beneficial for increasing Hbmass but did not support the short‐term development of maximal endurance performance and VO2max when compared to the athletes who lived and trained in normoxia.
Basal NAD(H) redox state permits hydrogen peroxide‐induced mesenteric artery dilatation
Authors: Raph Sean M. , Dwenger Marc M. , Hu Xuemei , Nystoriak Matthew A.
Published: April 2023

Smooth muscle voltage‐gated K+ (Kv) channels in resistance arteries control vascular tone and contribute to the coupling of blood flow with local metabolic activity. Members of the Kv1 family are expressed in vascular smooth muscle and are modulated upon physiological elevation of local metabolites, including the glycolytic end‐product l‐lactate and superoxide‐derived hydrogen peroxide (H2O2). Here, we show that l‐lactate elicits vasodilatation of small‐diameter mesenteric arteries in a mechanism that requires lactate dehydrogenase (LDH). Using the inside‐out configuration of the patch clamp technique, we show that increases in NADH that reflect LDH‐mediated conversion of l‐lactate to pyruvate directly stimulate the activity of single Kv1 channels and significantly enhance the sensitivity of Kv1 activity to H2O2. Consistent with these findings, H2O2‐evoked vasodilatation was significantly greater in the presence of 10 mM l‐lactate relative to lactate‐free conditions, yet was abolished in the presence of 10 mM pyruvate, which shifts the LDH reaction towards the generation of NAD+. Moreover, the enhancement of H2O2‐induced vasodilatation was abolished in arteries from double transgenic mice with selective overexpression of the intracellular Kvβ1.1 subunit in smooth muscle cells. Together, our results indicate that the Kvβ complex of native vascular Kv1 channels serves as a nodal effector for multiple redox signals to precisely control channel activity and vascular tone in the face of dynamic tissue‐derived metabolic cues.

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Key points

Vasodilatation of mesenteric arteries by elevated external l‐lactate requires its conversion by lactate dehydrogenase.

Application of either NADH or H2O2 potentiates single Kv channel currents in excised membrane patches from mesenteric artery smooth muscle cells.

The binding of NADH enhances the stimulatory effects of H2O2 on single Kv channel activity.

The vasodilatory response to H2O2 is differentially modified upon elevation of external l‐lactate or pyruvate.

The presence of l‐lactate enhances the vasodilatory response to H2O2 via the Kvβ subunit complex in smooth muscle.
Morphological ontogeny of Pilogalumna ayildizi sp. nov. (Acari, Oribatida, Galumnidae), a new cryptic species from Turkey
Authors: Seniczak Stanisław , Seniczak Anna
Published: April 2023

The morphological ontogeny of Pilogalumna ayildizi sp. nov. is described and illustrated. This species is similar to P. tenuiclava (Berlese, 1908) as adult, but differs from it clearly by the morphology of juvenile stages and ecology. The larva of P. ayildizi has 12 pairs of gastronotal setae, most are short and smooth except for slightly longer dp and medium-sized c-series, h1 and h2, and minute h3, and the nymphs have 15 pairs of these setae, most are short and smooth except for medium-sized and barbed c-series. The gastronotal shield of juveniles is poorly developed with setae of d-, l-series and h1 in the larva, and d-, l-, h-series and p1 in the nymphs. In the juveniles setae of c-series, p2 and p3 have basal microsclerites, and a humeral organ is present.