bluuebunny/crossref_metadata_2025 huggingface dataset:
Physicochemical properties and emulsification properties of maize starch modified by hydrochloric, phosphoric and tartaric acid
Authors: Skendi Adriana , Papageorgiou Maria , Ritzoulis Christos
Published: June 2020

Native maize starch (NS) dispersions treated with hydrochloric (HA; 1M, 2M), phosphoric (PA; 1M, 2M) and tartaric acid (TA; 0.67M, 1.33M) were investigated in terms of their morphological, structural and physicochemical properties, including emulsification capacity. The molecular weight of starch was affected by both factors (acid type and concentration). The mean molecular weight (Mw) was decreased by 89% and 11% after treatment with HA (1M) and PA (1M), respectively. TA‐treated starch resulted into three distinct size distributions, one of which showed larger Mw as compared to the NS. Dynamic light scattering measurements revealed that the modified starches in aqueous environment were spread in at least two distributions, one of them showing particle sizes higher than 200 nm, whereas the other lower than 200 nm. Clarity of treated starch pastes decreased in the following order: HA > TA > PA > NS. Generally, O/W emulsification and stability properties deteriorated with starch modification. ΤΑ yielded the most stable emulsion among the modified starches.
Effect of encapsulated Lactobacillus plantarum as probiotic on dry‐sausages during chilled storage
Authors: Cavalheiro Carlos Pasqualin , Ruiz‐Capillas Claudia , Herrero Ana Maria , Jiménez‐Colmenero Francisco , Pintado Tatiana , de Menezes Cristiano Ragagnin , Fries Leadir Lucy Martins
Published: June 2020

The impact of free and encapsulated Lactobacillus plantarum addition on the physicochemical and microbiological properties during chilled storage (60 days) of dry‐fermented sausages have been studied. Control (C) treatment was performed without probiotic incorporation, and the reformulation was comprised of L. plantarum as free cells (F) in alginate spheres (EA), in water‐in‐oil simple emulsion (ESM) and in water‐in‐oil‐in‐water double emulsion (EDM). After 60 days of storage, lower (P < 0.05) lipid oxidation was observed in F and EA (0.602–0.625 mg MDA kg−1) while it was higher (P < 0.05) in EDM (1.949 mg MDA kg−1). Treatments C and ESM presented intermediate TBARS levels compared to other treatments at the end of storage. All dry‐fermented sausages presented high levels of lactic acid bacteria during the whole chilled storage (8.06–9.29 log CFU g−1 at day 0 and 8.02–9.35 log CFU g−1); however, EA treatment presented the highest L. plantarum viability even at 60 days of storage (8.34 log CFU g−1). Therefore, the strategy of L. plantarum inoculation in alginate spheres seems to be the best strategy for the delivery of probiotics during chilled storage of dry‐fermented sausages.
Risque d'entreprise et part du travail: théorie et faits observés dans l'industrie en Chine
Authors: ZOU Jingxian , SHEN Guangjun , JIA Shen
Published: June 2020

Les auteurs examinent la relation entre risque d'entreprise et déclin de la part du travail en Chine. Partant du modèle d'Holmström et Milgrom (1987), ils montrent qu'un risque d'entreprise moindre motiverait les travailleurs à travailler plus intensément, ce qui augmenterait le produit par tête et le salaire moyen. Toutefois l'augmentation du produit peut faire baisser la part du travail. Une étude empirique, fondée sur la CIED, base de données des entreprises industrielles chinoises, (1998‐2007), et sur l'enquête de la Banque mondiale sur le climat de l'investissement (2005), confirme cette hypothèse d'une corrélation positive entre part du travail et risque d'entreprise.
Participación del trabajo y riesgo empresarial. Teoría y evidencia de las manufacturas chinas
Authors: ZOU Jingxian , SHEN Guangjun , JIA Shen
Published: June 2020

Este estudio analiza el papel del riesgo empresarial en la disminución de la participación del trabajo en China. A partir del modelo desarrollado por Holmström y Milgrom (1987), los autores muestran que un menor riesgo empresarial puede motivar a los trabajadores a trabajar más, aumentando el producto por trabajador y el salario medio, pero el incremento de la producción reducirá la participación del trabajo. Utilizando la base de datos sobre empresas industriales chinas para el periodo 1998‐2007 y la encuesta sobre clima de inversión del Banco Mundial de 2005, obtienen evidencia robusta de una correlación positiva entre la participación del trabajo y el riesgo empresarial.
Bayesian Model Selection of Gaussian Directed Acyclic Graph Structures
Authors: Castelletti Federico
Published: June 2020

During the last years, graphical models have become a popular tool to represent dependencies among variables in many scientific areas. Typically, the objective is todiscoverdependence relationships that can be represented through a directed acyclic graph (DAG). The set of all conditional independencies encoded by a DAG determines its Markov property. In general, DAGs encoding the same conditional independencies are not distinguishable from observational data and can be collected into equivalence classes, each one represented by a chain graph called essential graph (EG). However, both the DAG and EG space grow super exponentially in the number of variables, and so, graph structural learning requires the adoption of Markov chain Monte Carlo (MCMC) techniques. In this paper, we review some recent results on Bayesian model selection of Gaussian DAG models under a unified framework. These results are based on closed‐form expressions for the marginal likelihood of a DAG and EG structure, which is obtained from a few suitable assumptions on the prior for model parameters. We then introduce a general MCMC scheme that can be adopted both for model selection of DAGs and EGs together with a couple of applications on real data sets.
Supranational grievance mechanisms and firm‐level employment relations
Authors: Ford Michele , Gillan Michael , Thein Htwe Htwe
Published: June 2020

The dynamics of regulation of employment relations in the global supply chains of multinational enterprises (MNEs), including the growth of various forms of private regulation, has attracted significant scholarly attention. However, the role of international organisations in supporting supranational institutional pathways for social contestation of business practices has been neglected. This study addresses this gap by analysing cases lodged by national and global unions through the specific instances mechanism of the OECD Guidelines for MNEs. It reveals the design and operational deficiencies of this mechanism but also points to the current and future opportunities for firm‐level labour grievances and justice claims to be addressed at the supranational scale.
Synthesis of rare earth containing single‐phase multicomponent metal carbides via liquid polymer precursor route
Authors: Sun Yanan , Chen Fenghua , Qiu Wenfeng , Ye Li , Han Weijian , Zhao Wenying , Zhou Heng , Zhao Tong
Published: June 2020

Novel high‐entropy carbide ceramics (HEC) containing rare earth metals, namely (Ti, Zr, Hf, Ta, La, Y)C, (Ti, Zr, Hf, Ta, Nb, La, Y)C, and (Ti, Zr, Hf, Ta, Nb, Mo, W, La)C were prepared with single‐phase structure by polymer precursor method. Controlled co‐hydrolysis and polycondensation of equiatomic metal‐containing monomers were conducted successively, followed by blending allyl‐functional novolac resin as carbon source, and the polymer precursors were obtained as clear viscous liquid solutions. The single‐phase formation possibility was theoretically analyzed from the aspects of size‐effect parameter δ of the designed compositions. All as‐obtained ceramics possessed single face‐centered‐cubic structure of metal carbides and high‐compositional uniformity from nanoscale to microscale. The (Ti, Zr, Hf, Ta, Nb, Mo, W, La)C ceramic powder pyrolyzed at 1800°C exhibited low‐oxygen impurity content of 1.2 wt%. Thus, multicomponent high‐entropy carbide nanoceramics with over five metal elements containing even rare earth element were firstly synthesized and characterized.
Coupling TiO2 nanorods with g‐CN using modified physical vapor deposition for efficient photoelectrochemical water oxidation
Authors: Wang Lingling , Wang Ruyi , Feng Leyu , Liu Yi
Published: June 2020

The core‐shell TiO2@g‐CN nanorods arrays were constructed directly on fluorine‐doped tin oxide grass using vacuum magnetic filtered arc ion plating. The unique structure combines both advantages from TiO2 as an effective electron‐transfer layer and graphic carbon nitride (g‐CN) with a proper band gap serving as visible light absorption layer. Under 100 mW/cm2 (AM 1.5G) light illumination, the optimal TiO2@g‐CN produces a photocurrent density of 0.91 mA/cm2 at 1.23 V vs reversible hydrogen electrode, which is 2.1 times of the bare TiO2 (0.43 mA/cm2) obtained at the same potential. The improved photoelectrochemical performance is mainly attributed from the improved charge separation and transport within the heterojunction as well as the enhanced light absorption.
Highly efficient preparation of Li2O breeder materials with core‐shell structure by oil‐based granulation route
Authors: Chen Ruichong , Qi Jianqi , Shi Qiwu , Shi Yanli , Wang Hailiang , Guo Hao , Zeng Yuanyuan , Yang Mao , Liao Zhijun , Lu Tiecheng
Published: June 2020

This paper gives an oil‐based granulation approach to realize the efficient preparation of Li2O breeder materials, which solve the problems of long preparation cycle, high manufacturing cost and difficult to be homogenization and densification in the past. Li2O precursor spheres with narrow size distribution and uniform spherical shape can be obtained using paraffin oil as binders. The Li2O feed powder with bimodal size distribution will self‐organize to form a core‐shell structured sphere during granulation, in which the core and shell are composed of small particles and large particles, respectively. Notably, the Li2O ceramic spheres sintered at 900°C can achieve a crush load of 40.69 ± 4.01 N and a theoretical density of 79.66% TD, which was not achievable by the methods reported in the previous literature. The strategy proposed in this work not only can be easily extended to other material systems but also opens up a new avenue for the design and preparation of tritium breeder materials with uniform size distribution and satisfactory mechanical properties.
Audit committee quality indices, reporting quality and firm value
Authors: Almaqoushi Wael , Powell Ronan
Published: June 2020

We investigate the relation between audit committee (AC) quality indices, financial reporting, internal control quality and firm value using a US dataset for the period 2002–12. The indices are developed by linking firm value with principal component analysis (PCA) factors based on a broad set of 82 AC variables, some of which influence the quality of the AC, but are not addressed in prior literature. Significant AC factors include ‘overlapping directors’, ‘busyness’ and ‘foreign director’, and we use these factors to develop ‘high’ and ‘low’ AC quality indices. We show that low AC quality firms are more likely to manage earnings, be external auditor dependent with respect to non‐audit tax services, and switch to a lower quality auditor. Low AC quality firms are also more likely to have internal control concerns disclosed by predecessor auditors, including accounting issues, financial restatements, audit opinion concerns and deficiencies that undermine internal control effectiveness. Further, they are more likely to receive an audit report containing additional explanatory notes. Conversely, high AC quality firms are significantly less likely to have these concerns. Our findings highlight the value of using AC quality indices in delivering greater oversight of the financial reporting process.
Involvement of a novel circularRNA, hsa_circ_0000520, attenuates tumorigenesis of cervical cancer cell through competitively binding with miR‐146b‐3p
Authors: Zhang Jinling , Cai Ruyu , Zhang Yifan , Wang Xiaoyu
Published: June 2020

The implication of circular RNAs (circRNAs) in the pathogenesis of human cervical cancer (CC) has been demonstrated by numerous of researches, nevertheless, the whole regulatory network of circRNAs in CC remains unclear. In the present study, two GSE data sets (GSE113696 and GSE102686) were enrolled to analysed different expressed circRNA. We found that hsa_circ_0000520(circ_0000520) was decreased in CC tissues and cell lines. Functional studies indicated circ_0000520 overexpression in vitro repressed CC cell proliferation, invasion and migration, while promoted CC cell apoptosis. Moreover, circ_0000520 overexpression in vivo repressed CC tumour growth. Mechanismly, circ_0000520 and PAX5 were revealed to directly bind to miR‐146b‐3p, and circ_0000520 could indirectly regulate PAX5 by sponging miR‐146b‐3p. In conclusion, circ_0000520 repressed CC progression in vitro and in vivo by sponging miR‐146b‐3p to release PAX5.
Dose‐dependent effect of smoking and smoking cessation on periodontitis‐related tooth loss during 10 ‐ 47 years periodontal maintenance—A retrospective study in compliant cohort
Authors: Ravidà Andrea , Troiano Giuseppe , Qazi Musa , Saleh Muhammad H. A. , Saleh Islam , Borgnakke Wenche S. , Wang Hom‐Lay
Published: June 2020

Aim

We retrospectively explored effects of smoking on tooth loss due to periodontitis (TLP) in long‐term compliant patients.

Materials and Methods

Chart data were collected from 258 patients undergoing post‐non‐surgical periodontal treatment (mean 2.24 visits/year) for 10–47.5 (mean 24.2) years. Patients were categorized as: (1) never smokers, (2) former smokers, (3) current light smokers (<10 cigarettes/day) and (4) current heavy smokers (≥10 cigarettes/day).

Results

Of 6,590 teeth present at baseline (mean 25.6 teeth/patient), 264 teeth were lost due to periodontitis, corresponding to 0.03, 0.05, 0.08 and 0.11 TLP annually among never smokers, former smokers, current light smokers and current heavy smokers, respectively. A tooth from a current heavy smoker had 4.4‐fold, 2.7‐fold and 2.6‐fold greater risk of TLP than a tooth from a never smoker, a current light smoker and a former smoker, respectively. Both heavy and light former smokers needed washout periods of approximately 15 years to reach the TLP risk level of never smokers. The TLP risk decreased by 6%/year of smoking cessation.

Conclusions

It took almost 15 years of smoking cessation for the risk of TLP among former smokers to reach the level of never smokers. Hence, the 2018 periodontitis grading system should consider the impact of the “washout” period on former smokers.
Systematic review and sequential network meta‐analysis on the efficacy of periodontal regenerative therapies
Authors: Tsai Shang‐Jie , Ding Yu‐Wei , Shih Ming‐Chieh , Tu Yu‐Kang
Published: June 2020

Aims

We aimed to update a previous network meta‐analysis comparing the efficacy of periodontal regenerative therapies on the treatment of infrabony lesions.

Materials and Methods

Seven clinical trials were added after literature research for studies published between January 2011 and September 2019. We conducted network meta‐analysis (NMA) to compare the effects of guided tissue regeneration (GTR), enamel matrix derivatives (EMD) and their combination therapies on probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. Sequential network meta‐analysis (SNMA) was also used to control the type‐I error rate due to multiple testing.

Results

A total of 60 studies were included. For both PPD reduction and CAL gain, the flap operation (FO) was the least effective treatment. Although the differences between periodontal regenerative therapies were small, GTR attained the greatest reduction in PPD, and EMD with bone graft the greatest CAL gain compared to other therapies. SNMA used stricter efficacy criteria, yielding slightly different results from NMA.

Conclusions

EMD, GTR, and their combined therapies were more effective than flap operation, although the differences between regenerative therapies remain small in this updated study. SNMA reduces the risk of false‐positive findings, thereby providing more robust evidence on the superiority of treatments.
First records of the seven‐gilled Notorynchus cepedianus and six‐gilled Hexanchus griseus sharks (Chondrichthyes: Hexanchiformes: Hexanchidae) found in the Galápagos Marine Reserve
Authors: Buglass Salome , Nagy Shannon , Ebert David , Sepa Paulina , Turchik Alan , Bell Katherine L. C. , Rivera Fernando , Giddens Jonatha
Published: June 2020

This study reports the first records of cowsharks (Hexanchidae) in the Galápagos Islands, in particular Notorynchus cepedianus and Hexanchus griseus, observed between depths of 210 and 418 m on footage from free‐falling autonomous deep‐ocean cameras. These sightings provide new information on the habitat preferences and range distribution for N. cepedianus and the first records of H. griseus in Ecuadorian waters. The findings support the formulation of regional conservation strategies for these large apex predator species and highlight the limited biological knowledge of Galápagos' deep‐water ecosystems.
Experimental study on collision acceleration and damage characteristics of potato
Authors: Xie Shengshi , Wang Chunguang , Deng Weigang
Published: June 2020

To reveal the mechanism of potato mechanical damage, this article investigated the relationships between the collision characteristics of potato and various impact parameters using potato impact test rig and acceleration acquisition system. It was noted that the potato impact test rig and acceleration acquisition system allowed simultaneously analysis of the three indexes: maximum acceleration, minimum acceleration, and damaged area. In the experiments, the collision damaged area of potato increased with the enlarged tuber mass but decreased with the elevated temperature of potato tuber. In addition, the damaged area was the smallest during potato colliding with 65Mn‐Rubber (10 mm diameter 65Mn steel rod wrapped in 2 mm rubber) compared with other two materials. With the increment of collision initial height, the maximum acceleration and damaged area increased, but the minimum acceleration changed on the basis of opposite trend. Under the experimental factor of collision initial height, the indexes of maximum acceleration and minimum acceleration were strongly correlated with damaged area of potato. That could be used to predict collision effects. Finally, the predicted mathematical model between the average value of maximum acceleration, minimum acceleration and damaged area were established as follows: S = 0.9622amax‐433.25 (R2 = 0.9601), S = −3.9587amin + 58.658 (R2 = 0.8152).

Practical application

Currently, there are few studies for the collision between fresh potato and rod. Therefore, this study investigated the effect of collision parameters on collision acceleration and damaged area during fresh potato colliding rod. That becomes very important for the design and development of potato processing machinery, especially harvesting machinery. To accurately predict the damage in the phase of harvesting and postharvest processes, the correlation analysis between initial height, tuber mass, tuber temperature, impact material, maximum and minimum acceleration, and damaged area are, respectively, discussed. Meantime, the corresponding mathematical models of significant parameters and damaged area are well established.
The release rate and antimicrobial activity of calcium‐alginate films containing self‐microemulsifying Thymus vulgaris essential oil against Escherichia coli and Staphylococcus aureus
Authors: Almasi Laleh , Radi Mohsen , Amiri Sedigheh
Published: June 2020

The aim of this study was to fabricate antimicrobial calcium‐alginate‐based films containing the self‐microemulsifying thyme essential oil (TEO) formulations using Tween 80 as the surfactant, and acetic (AA) or propionic (PA) acids as the cosurfactants. A Ca‐alginate film containing nano‐emulsified TEO as well as a neat Ca‐alginate film were considered as the controls. The scanning electron microscopy micrographs showed a highly porous texture for SME films, which resulted in an increase in water vapor permeability and water absorption capacity of these films. The SME films released the TEO completely within 155 min and inhibited the growth of S. aureus and E. coli in in vitro antimicrobial tests. The population of S. aureus and E. coli reduced significantly in ground beef covered with SME films. The results of this study showed that self‐microemulsifying TEO films could effectively increase the shelf life of ground beef by controlling its microbial population.
Zero COVID‐19 infection in inflammatory bowel disease patients: Findings from population‐based inflammatory bowel disease registries in Hong Kong and Taiwan
Authors: Mak Joyce Wing Yan , Weng Meng‐Tzu , Wei Shu Chen , Ng Siew Chien
Published: June 2020

Background and Aim

It is unsure whether inflammatory bowel disease (IBD) is a risk factor for novel coronavirus infection (COVID‐19).

Methods

IBD patients were identified from population‐based databases in Hong Kong and Taiwan from January 21, 2020, until April 15, 2020.

Results

Total 2954 and 2554 IBD patients were identified in Hong Kong and Taiwan, respectively. None had COVID‐19. Pooled analysis showed that 65.3%, 39.1%, 4.3%, and 12.8% IBD patients in Hong Kong and 75.8 %, 51.4 %, 26.1%, and 52.3 % in Taiwan were on 5‐aminosalicylates, immunomodulators, corticosteroids, and biologics, respectively.

Conclusion

There were no reported cases of COVID‐19 infection amongst IBD patients in Hong Kong and Taiwan. IBD patients should continue their usual medications during the COVID‐19 pandemic.
Statistical Considerations for Embedded Pragmatic Clinical Trials in People Living with Dementia
Authors: Allore Heather G. , Goldfeld Keith S. , Gutman Roee , Li Fan , Monin Joan K. , Taljaard Monica , Travison Thomas G.
Published: June 2020

There is overwhelming need for nonpharmacological interventions to improve the health and well‐being of people living with dementia (PLWD). The National Institute on Aging Imbedded Pragmatic Alzheimer's Disease (AD) and AD‐Related Dementias Clinical Trials (IMPACT) Collaboratory supports clinical trials of such interventions embedded in healthcare systems. The embedded pragmatic clinical trial (ePCT) is ideally suited to testing the effectiveness of complex interventions in vulnerable populations at the point of care. These trials, however, are complex to conduct and interpret, and face challenges in efficiency (i.e., statistical power) and reproducibility. In addition, trials conducted among PLWD present specific statistical challenges, including difficulty in outcomes ascertainment from PLWD, necessitating reliance on reports by caregivers, and heterogeneity in measurements across different settings or populations. These and other challenges undercut the reliability of measurement, the feasibility of capturing outcomes using pragmatic designs, and the ability to validly estimate interventions' effectiveness in real‐world settings. To address these challenges, the IMPACT Collaboratory has convened a Design and Statistics Core, the goals of which are: to support the design and conduct of ePCTs directed toward PLWD and their caregivers; to develop guidance for conducting embedded trials in this population; and to educate quantitative and clinical scientists in the design, conduct, and analysis of these trials. In this article, we discuss some of the contemporary methodological challenges in this area and develop a set of research priorities the Design and Statistics Core will undertake to meet these goals. J Am Geriatr Soc 68:S68–S73, 2020.
Selecting Outcomes to Ensure Pragmatic Trials Are Relevant to People Living with Dementia
Authors: Hanson Laura C. , Bennett Antonia V. , Jonsson Mattias , Kelley Amy , Ritchie Christine , Saliba Debra , Teno Joan , Zimmerman Sheryl
Published: June 2020

Outcome measures for embedded pragmatic clinical trials (ePCTs) should reflect the lived experience of people living with dementia (PLWD) and their caregivers, yet patient‐ and caregiver‐reported outcomes (PCROs) are rarely available in large clinical and administrative data sources. Although pragmatic methods may lead to use of existing administrative data rather than new data collected directly from PLWD, interventions are truly impactful only when they change outcomes prioritized by PLWD and their caregivers. The Patient‐ and Caregiver‐Reported Outcomes Core (PCRO Core) of the IMbedded Pragmatic Alzheimer's Disease (AD) and AD‐Related Dementias Clinical Trials (IMPACT) Collaboratory aims to promote optimal use of outcomes relevant to PLWD and their caregivers in pragmatic trials. The PCRO Core will address key scientific challenges limiting outcome measurement, such as gaps in existing measures, methodologic constraints, and burdensome data capture. PCRO Core investigators will create a searchable library of AD/AD‐related dementias (ADRD) clinical outcome measures, including measures in existing data sources with potential for AD/ADRD ePCTs, and will support best practices in measure development, including pragmatic adaptation of PCROs. Working together with other Cores and Teams within the IMPACT Collaboratory, the PCRO Core will support investigators to select from existing outcome measures, and to innovate in methods for measurement and data capture. In the future, the work of the IMPACT Collaboratory may galvanize broader embedded use of outcomes that matter to PLWD and their care partners in large health systems. J Am Geriatr Soc 68:S55–S61, 2020.
Ethical and Regulatory Issues for Embedded Pragmatic Trials Involving People Living with Dementia
Authors: Largent Emily A. , Hey Spencer Phillips , Harkins Kristin , Hoffman Allison K. , Joffe Steven , Lima Julie C. , London Alex John , Karlawish Jason
Published: June 2020

Embedded pragmatic clinical trials (ePCTs) present an opportunity to improve care for people living with dementia (PLWD) and their care partners, but they also generate a complex constellation of ethical and regulatory challenges. These challenges begin with participant identification. Interventions may be delivered in ways that make it difficult to identify who is a human subject and therefore who needs ethical and regulatory protections. The need for informed consent, a core human subjects protection, must be considered but can be in tension with the goals of pragmatic research design. Thus it is essential to consider whether a waiver or alteration of informed consent is justifiable. If informed consent is needed, the question arises of how it should be obtained because researchers must acknowledge the vulnerability of PLWD due in part to diminished capacity and also to increased dependence on others. Further, researchers should recognize that many sites where ePCTs are conducted will be unfamiliar with human subjects research regulations and ethics. In this report, the Regulation and Ethics Core of the National Institute on Aging Imbedded Pragmatic Alzheimer’s disease (AD) and AD‐related dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory discusses key ethical and regulatory challenges for ePCTs in PLWD. A central thesis is that researchers should strive to anticipate and address these challenges early in the design of their ePCTs as a means of both ensuring compliance and advancing science. J Am Geriatr Soc 68:S37–S42, 2020.
Outcomes of Intensive Care Patients Older Than 90 Years: An 11‐Year National Observational Study
Authors: Haas Lenneke E. M. , Bakhshi‐Raiez Ferishta , van Dijk Diederik , de Lange Dylan W. , de Keizer Nicolette F.
Published: June 2020

BACKGROUND/OBJECTIVES

Many intensive care unit (ICU) physicians are reluctant to admit patients aged 90 years and older, although evidence to support these decisions is scarce. Although the body of evidence on outcomes of patients aged 80 years and older is growing, it does not include patients aged 90 years and older. The aim of this study was to compare the short‐ and long‐term mortality of ICU patients aged 90 years and older in the Netherlands with ICU patients aged 80 to 90 years, that is, octogenarians.

DESIGN

Multicenter national cohort study over an 11‐year period (2008‐2018), using data of the National Intensive Care Evaluation (NICE) registry and the Dutch insurance claims registry.

SETTING

All 82 ICUs in the Netherlands.

PARTICIPANTS

All patients aged 80 years and older at the time of ICU admission.

MEASUREMENTS

A total of 104,754 patients aged 80 years and older, of whom 9,495 (9%) were 90 years and older, were admitted to Dutch ICUs during the study period.

RESULTS

ICU mortality of the patients aged 90 years and older was lower (13.8% vs 16.1%; P < .001) and hospital mortality was similar (26.1% vs 25.7%; P = .41) compared with octogenarians. After 3 months, mortality was higher for the patients aged 90 years and older (43.1% vs 33.7%; P < .001) and after 1‐year mortality was 55.0% vs 42.7%; P < .001.

CONCLUSION

In the Netherlands, mortality rates of patients aged 90 years and older admitted to the ICU are not as disappointing as often assumed. They have a lower ICU mortality and a similar hospital mortality compared with octogenarians. Nevertheless, their longer term mortality is higher compared with octogenarians. However, almost 3 of 4 patients leave the hospital alive, and almost half of the patients aged 90 years and older are still alive 1 year after their ICU admission. J Am Geriatr Soc 68:1842‐1846, 2020.
Transforming Dementia Care Through Pragmatic Clinical Trials Embedded in Learning Healthcare Systems
Authors: Tuzzio Leah , Hanson Leah R. , Reuben David B. , Baier Rosa R. , Gurwitz Jerry H. , Bayliss Elizabeth A. , Williamson Jeff , Fraser James R. , Sherman Samantha J. , Larson Eric B.
Published: June 2020

The current evidence base for testing nonpharmacological interventions for people living with dementia (PLWD) and their caregivers is limited, especially within care settings such as ambulatory care, assisted living communities, nursing homes, hospitals, and hospices. There has been even less attention to translation of effective interventions for PLWD into delivery of care. Thus, there is an urgent need for researchers to partner with these care settings, especially those that follow a learning healthcare systems (LHSs) model, and vice versa to conduct embedded pragmatic clinical trials (ePCTs). These trials are conducted within sites that offer routine care and are designed to answer important, relevant clinical questions and leverage existing electronic health and administrative data. ePCTs set in LHSs create a unique opportunity for researchers, healthcare providers, and PLWD and their families to work and learn together as potentially effective interventions are studied and stress tested in real‐world situations. Healthcare settings that embrace research or quality improvement as part of a culture of continuous learning are ideal settings for ePCTs. In this article, we summarize what we have learned from the National Institutes of Health's Health Care Systems Research Collaboratory–funded ePCTs, discuss challenges of ePCTs within settings that serve PLWD, and describe the work of the Health Care Systems Core within the National Institute on Aging's IMbedded Alzheimer's Disease and Related Dementias Clinical Trials Collaboratory that will occur over the next 5 years. J Am Geriatr Soc 68:S43–S48, 2020.
The Relationship Between Pregnancy Intentions and Diet or Physical Activity Behaviors in the Preconception and Antenatal Periods: A Systematic Review and Meta‐Analysis
Authors: Nkrumah Isaac , North Madelon , Kothe Emily , Chai Tze Lin , Pirotta Stephanie , Lim Siew , Hill Briony
Published: June 2020

Introduction

Healthy preconception and antenatal diet and physical activity behaviors may optimize maternal and offspring outcomes. These behaviors are thought to be linked to pregnancy intentions. The aim of this study was to conduct a systematic review and meta‐analysis to determine the association between women's pregnancy intentions and diet or physical activity behaviors in the preconception and antenatal periods.

Methods

MEDLINE Complete, PsycINFO, CINAHL Complete, Global Health, Embase, and INFORMIT: Health Subset were searched in September 2018 for studies that evaluated relationships between pregnancy intentions and dietary and physical activity behaviors. Risk of bias was assessed, and random effects meta‐analyses were conducted for dietary (food groups; energy and macronutrients; diet quality; and caffeine, iodine, and folate intake) and physical activity outcomes.

Results

Of 2623 screened records, 19 eligible studies were identified. The overall risk of bias was moderate to high. Twelve studies measured diet and physical activity behaviors during preconception, 5 during pregnancy, and 2 across both periods. Eleven studies measured pregnancy intention retrospectively, and 8 prospectively measured pregnancy intention. The number of studies available for meta‐analyses of individual dietary and physical activity outcomes ranged from 2 to 5. Pregnancy intentions were not associated with preconception fruit, vegetable, or caffeine intake or physical activity. Antenatally, women with intended pregnancies were more likely to report healthier diets, lower caffeine intake, and higher physical activity. Insufficient studies were available to conduct subgroup comparisons for prospective or retrospective assessment.

Discussion

Pregnancy intentions were not associated with preconception diet or physical activity behaviors. In contrast, antenatally, women with intended pregnancies demonstrated better diet and physical activity behaviors. Given the small number of studies available for meta‐analyses, further research is needed to consolidate our findings. Meanwhile, health professionals can assess women's pregnancy intentions during preconception and pregnancy and encourage a healthy lifestyle.
A Maturity Matrix for Nurse Leaders to Facilitate and Benchmark Progress in Genomic Healthcare Policy, Infrastructure, Education, and Delivery
Authors: Tonkin Emma , Calzone Kathleen A. , Badzek Laurie , Benjamin Caroline , Middleton Anna , Patch Christine , Kirk Maggie
Published: June 2020

Purpose

Nurse leaders driving strategic integration of genomics across nursing need tools and resources to evaluate their environment, guide strategies to address deficits, and benchmark progress. We describe the development and pilot testing of a self‐assessment maturity matrix (MM) that enables users to benchmark the current state of nursing genomic competency and integration for their country or nursing group; guides the development of a strategic course for improvement and implementation; and assesses change over time.

Design

Mixed‐methods participatory research and self‐assessment.

Methods

During a 3‐day workshop involving nursing experts in health care and genomics, a genomic integration MM grid was built by consensus using iterative participatory methods. Data were analyzed using descriptive techniques. This work built on an online survey involving the same participants to identify the critical elements needed for “effective nursing which promotes health outcomes globally through genomics.”

Findings

Experts from 19 countries across six continents and seven organizations participated in item development. The Assessment of Strategic Integration of Genomics across Nursing (ASIGN) MM incorporates 55 outcome‐focused items serving as subscales for six critical success factors (CSFs): education and workforce; effective nursing practice; infrastructure and resources; collaboration and communication; public/patient involvement; policy and leadership. Users select their current circumstances for each item against a 5‐point ordinal scale (precontemplation to leading). Nurses representing 17 countries undertook matrix pilot testing. Results demonstrate variation across CSFs, with many countries at the earliest stages of implementation.

Conclusions

The MM has the potential to guide the strategic integration of genomics across nursing and enables additional assessments within and between countries to be made.

Clinical Relevance

Nurse leadership and direction are essential to accelerate integration of genomics across nursing practice and education. The MM helps nurse leaders to benchmark progress and guide strategic planning to build global genomic nursing capacity.
Extrinsic innervation of the pelvic organs in the lesser pelvis of human embryos
Authors: Kruepunga Nutmethee , Hikspoors Jill P. J. M. , Hülsman Cindy J. M. , Mommen Greet M. C. , Köhler S. Eleonore , Lamers Wouter H.
Published: June 2020

Realistic models to understand the developmental appearance of the pelvic nervous system in mammals are scarce. We visualized the development of the inferior hypogastric plexus and its preganglionic connections in human embryos at 4–8 weeks post‐fertilization, using Amira 3D reconstruction and Cinema 4D‐remodelling software. We defined the embryonic lesser pelvis as the pelvic area caudal to both umbilical arteries and containing the hindgut. Neural crest cells (NCCs) appeared dorsolateral to the median sacral artery near vertebra S1 at ~5 weeks and had extended to vertebra S5 1 day later. Once para‐arterial, NCCs either formed sympathetic ganglia or continued to migrate ventrally to the pre‐arterial region, where they formed large bilateral inferior hypogastric ganglionic cell clusters (IHGCs). Unlike more cranial pre‐aortic plexuses, both IHGCs did not merge because the 'pelvic pouch', a temporary caudal extension of the peritoneal cavity, interposed. Although NCCs in the sacral area started to migrate later, they reached their pre‐arterial position simultaneously with the NCCs in the thoracolumbar regions. Accordingly, the superior hypogastric nerve, a caudal extension of the lumbar splanchnic nerves along the superior rectal artery, contacted the IHGCs only 1 day later than the lumbar splanchnic nerves contacted the inferior mesenteric ganglion. The superior hypogastric nerve subsequently splits to become the superior hypogastric plexus. The IHGCs had two additional sources of preganglionic innervation, of which the pelvic splanchnic nerves arrived at ~6.5 weeks and the sacral splanchnic nerves only at ~8 weeks. After all preganglionic connections had formed, separate parts of the inferior hypogastric plexus formed at the bladder neck and distal hindgut.
Mandibular osteomyelitis after hyaluronic acid injection
Authors: Wang Hayson Chenyu , Wang Yunting , Long Xiao , Wang Xiaojun
Published: June 2020

Background

Mandibular osteomyelitis after filler injection is extremely rare.

Aims

We reported a case of mandibular osteomyelitis after hyaluronic acid injection.

Patients

A 33‐year‐old woman received 1 mL hyaluronic acid injection on her chin 1 year ago, after which her chin kept swelling and painful, and gradually ulcerated with pus flowing out. She received antibiotics, debridement procedures, negative pressure wound therapy, and hyperbaric oxygen therapy without symptoms improved. Cone‐beam computed tomography scan showed local bone destruction, sequestrum formation, and tissue calcification on the right mandible body. The patient was diagnosed with mandibular osteomyelitis and received local curettage for the removal of necrotized bone.

Results

Literature search found no case reports on mandibular osteomyelitis after filler injection so far.

Conclusion

Minimizing the risk of contamination and infection is strictly required during the filler injection process. Once the patient shows signs of incurable mandibular infection postoperation, clinicians should consider the possibility of osteomyelitis.
Cardiovascular problems associated with IVF therapy
Authors: Henriksson P.
Published: June 2020

We are now in the beginning of the fifth decade of in vitro fertilization (IVF) with more than ten million children born and an annual growth rate of half a million. It was recently found that there is a sevenfold increase in the incidence of pulmonary embolism (PE) during the first trimester of an IVF pregnancy as compared to spontaneous pregnancy. PE is a major cause of maternal mortality, and it is thus of outmost importance to understand the pathophysiological mechanism. The oestrogen surge during the ovarian stimulation has been hypothesized to be the initiating pathophysiological event. A support of this is a current report showing that embryo transfer performed directly after ovarian stimulation increased the risk of PE more than eightfold, whereas no such increase was noted after delayed embryo transfer. This increased risk coincides with a persisting increased oestrogen level. Further reported cardiovascular problems are arterial thromboses, pre‐eclampsia and gestational hypertension. Global haemostasis tests change in the direction of increased coagulability, but mostly within normal limits. Cell‐bound haemostasis and in particular platelet activation are less studied. However, a major increase in the number of microvesicles (MVs) and markers indicating platelet activation was reported during ovarian stimulation. We now need longitudinal data concerning haemostatic variables that extends into the first trimester. A major research focus should be to identify biomarkers that could be used already before instigation of IVF. Another way to avoid risk could be to delay embryo transfer by adapting a freeze‐all strategy.
Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS
Authors: Snyder Thomas , Agarwal Shashank , Huang Jeffrey , Ishida Koto , Flusty Brent , Frontera Jennifer , Lord Aaron , Torres Jose , Zhang Cen , Rostanski Sara , Favate Albert , Lillemoe Kaitlyn , Sanger Matthew , Kim Sun , Humbert Kelley , Scher Erica , Dehkharghani Seena , Raz Eytan , Shapiro Maksim , K Nelson Peter , Gordon David , Tanweer Omar , Nossek Erez , Farkas Jeffrey , Liff Jeremy , Turkel‐Parrella David , Tiwari Ambooj , Riina Howard , Yaghi Shadi
Published: June 2020

BACKGROUND AND PURPOSE

Mechanical thrombectomy (MT) has helped many patients achieve functional independence. The effect of time‐to‐treatment based in specific epochs and as related to Alberta Stroke Program Early CT Score (ASPECTS) has not been established. The goal of the study was to evaluate the association between last known normal (LKN)‐to‐puncture time and good functional outcome.

METHODS

We conducted a retrospective cohort study of prospectively collected acute ischemic stroke patients undergoing MT for large vessel occlusion. We used binary logistic regression models adjusted for age, Modified Treatment in Cerebral Ischemia score, initial National Institutes of Health Stroke Scale, and noncontrast CT ASPECTS to assess the association between LKN‐to‐puncture time and favorable outcome defined as Modified Rankin Score 0‐2 on discharge.

RESULTS

Among 421 patients, 328 were included in analysis. Increased LKN‐to‐puncture time was associated with decreased probability of good functional outcome (adjusted odds ratio [aOR] ratio per 15‐minute delay = .98; 95% confidence interval [CI], .97‐.99; P = .001). This was especially true when LKN‐puncture time was 0‐6 hours (aOR per 15‐minute delay = .94; 95% CI, .89‐.99; P = .05) or ASPECTS 8‐10 (aOR = .98; 95% CI, .97‐.99; P = .002) as opposed to when LKN‐puncture time was 6‐24 hours (aOR per 15‐minute delay = .99; 95% CI, .97‐1.00; P = .16) and ASPECTS <8 (aOR = .98; 95% CI, .93‐1.03; P = .37).

CONCLUSION

Decreased LKN‐groin puncture time improves outcome particularly in those with good ASPECTS presenting within 6 hours. Strategies to decrease reperfusion times should be investigated, particularly in those in the early time window and with good ASPECTS.
COVID‐19 Screening with Chest CT in Acute Stroke Imaging: A Clinical Decision Model
Authors: Qureshi Adnan I. , French Brandi R. , Siddiq Farhan , Arora Niraj A. , Nattanmai Premkumar , Gomez Camilo R.
Published: June 2020

BACKGROUND AND PURPOSE

Acute stroke patients may have undiagnosed coronavirus disease 2019 (COVID‐19) infection, transmissible to medical professionals involved in their care. Our aim was to determine the value of incorporating a chest computed tomography (CT) scan during acute stroke imaging, and the factors that influence this decision.

METHODS

We constructed a probabilistic decision tree of the value of acquiring a chest CT scan or not, expressed in quality‐adjusted life months (QALM) of patients and medical professionals. The model was based on the chance of detecting infection by chest CT scan, the case fatality rates of COVID‐19 infection, the risk of COVID‐19 infection after exposure, the expected proportion of medical professionals exposed, and the exposure reduction derived from early disease detection.

RESULTS

The decision to incorporate the chest CT scan was superior to not doing so (12.00 QALM vs 11.99 QALM, respectively), when the probability of patients having undetected COVID‐19 infection is 3.5%, potentially exposing 100% of medical professionals, and if early detection reduces exposure by 50%. The risk of developing symptomatic COVID‐19 infection following exposure casts uncertainty on the results, but this is offset by the potential for reducing exposure.

CONCLUSIONS

We identified a measurable benefit of incorporating a chest CT into the urgent imaging protocol of acute stroke patients in reducing exposure of medical professionals without appropriate precautions. The clinical impact of this benefit, however, may not be materially significant.
Vagus Nerve Ultrasound in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Charcot‐Marie‐Tooth Disease Type 1A
Authors: Niu Jingwen , Zhang Lei , Ding Qingyun , Liu Jingwen , Zhang Zhe , Cui Liying , Liu Mingsheng
Published: June 2020

BACKGROUND AND PURPOSE

Both clinical autonomic dysfunction and involvement of autonomic nerves have been reported in a range of peripheral nerve disorders. We employed nerve ultrasound to assess the size of the vagus nerve in a serial study of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and Charcot‐Marie‐Tooth type 1B (CMT1B) as compared to healthy controls (HCs). We correlated these findings with involvement of the median and ulnar nerves.

METHODS

Forty‐three patients with CIDP, 8 with CMT1A, and 105 HC were prospectively recruited. The cross‐sectional areas (CSAs) of the vagus, median, and ulnar nerves were measured bilaterally. The alteration of CSA of those nerves was followed longitudinally in CIDP.

RESULTS

The median (range) CSA of the vagus nerve was 2 (1‐28) mm2 in CIDP, 3 (2‐6) mm2 in CMT1A, and 1 (1‐2) mm2 in HC. The vagus nerve CSA was positively correlated with the maximum CSA of median/ulnar nerve in CIDP and CMT1A. The alteration in vagus nerve CSA was positively correlated with the alteration in mean median/ulnar nerve CSA in CIDP during follow‐up.

CONCLUSIONS

The vagus nerve was involved to a similar extent as the median and ulnar nerves in CIDP and CMT1A, although no symptoms or signs of vagus nerve involvement were found. Further study should be performed to explore the clinical relevance of vagus nerve enlargement in these disorders.