bluuebunny/crossref_metadata_2025 huggingface dataset:
Trinidad and Tobago and money laundering control: a country committed to strengthening the link
Authors: Murray-Bailey Sherene Alicia
Published: June 2021

Purpose

In 2008, the author wrote on the Concept of “Money Laundering Control: The Missing Link in Trinidad and Tobago. Now, approximately two years after that seminal assessment, the author has re-assessed the domestic anti-money laundering (AML) framework, with particular reference to the controls in place to address money laundering (ML) and the confiscation of the proceeds of crime. This paper aims to assess the efficiency and effectiveness of the newly implemented regime and considers whether it meets international standards.

Design/methodology/approach

This analysis embraces a pluralist approach. Within this assessment, a case study method is used with contextual qualitative analysis. Empirical data is analyzed and causal connections are linked to the analysis.

Findings

This research highlights catalytic change and creativity in addressing deficiencies within the AML architecture in Trinidad and Tobago. Upon analysis, it is pellucid that a radically altered criminal justice landscape has emerged and a more aggressive and targeted approach to address ML and the confiscation of the proceeds of crime is apparent. The result is a shift in paradigm with tangible outcomes to suggest that the strategies have borne fruit and that the twin island Republic is indeed committed to strengthening the link.

Research limitations/implications

Findings are limited to Trinidad and Tobago and to the period ended April 2020.

Originality/value

As a country with a medium to high ML risk, the possible negative socio-economic effects of ML cannot be underscored. Disruption of ML and the confiscation of the proceeds of crime are, therefore, imperative. This paper considers the progress made in addressing these pertinent issues and assists in assessing the effects of the reformation efforts undertaken by Trinidad and Tobago.
Modular growth and functional heterophylly of the phreatophyte Ziziphus lotus: A trait‐based study
Authors: Torres‐García M. Trinidad , Salinas‐Bonillo Maria Jacoba , Pacheco‐Romero Manuel , Cabello Javier
Published: June 2021

The variation of plant functional traits, from the cell to the whole‐plant level, is a central question in trait‐based ecology with regard to understanding ecological strategies and adaptations that result from environmental drivers. Here, we analyzed whole‐plant and leaf traits of the phreatophyte Ziziphus lotus (L.) Lam., a long‐lived shrub that dominates one of the few terrestrial groundwater‐dependent ecosystems (GDEs) in Mediterranean Basin drylands. We (a) assessed architectural traits and growth patterns, (b) analyzed leaf morpho‐functional traits (specific leaf area [SLA] and stomata pore index [SPI]) and physiological traits (gas exchange rates), as well as their variations within individuals, and (c) evaluated temporal variations in modular growth (i.e., sequential iteration of structural units) between growing seasons and in leaf traits within seasons. Z. lotus' growth pattern was based on the repetition of modules composed of shoots (short and long) and branches (flowering and plagiotropic) that promoted a functional differentiation between vegetative and reproductive structures, respectively. We identified morpho‐functionally distinct leaves (i.e., heterophylly) borne on different types of branches. Leaves on flowering branches had higher SLA and water use efficiency (WUEi), but lower SPI and transpiration rates than leaves on vegetative ones. We also observed trade‐offs in the elongation of vegetative and flowering structures between growing seasons: the shorter the long shoots, the larger the flowering branches. The modular differentiation and heterophylly of Z. lotus might contribute to prioritizing the investment of resources of this phreatophyte, either for growth or reproduction, and could improve the efficiency in uptake and conservation of resources in drylands.
High‐frequency hospital users: The tail that wags the readmissions dog
Authors: Fouayzi Hassan , Ash Arlene S.
Published: June 2021

Objective

To describe the characteristics of high‐frequency hospital users (four or more hospitalizations in a year) and the consequences of including or excluding their data from a readmission‐based measure.

Data sources

2015 and 2016 Massachusetts Medicaid data.

Study design

We compare demographics, morbidity burden, and social risk factors for high‐ and low‐frequency hospital users, and membership in 17 accountable care organizations. We evaluate how excluding hospitalizations of high‐frequency users from a 30‐day readmission measure (with or without risk adjustment) changes its rate and variability and affects performance rankings of accountable care organizations. The outcome is readmission within 30 days; each live discharge from a hospital contributes one observation.

Data collection/extraction methods

We studied 74 706 hospitalizations of 42 794 MassHealth members, 18–64 years old, managed‐care‐eligible, and ever hospitalized in 2016.

Principal findings

Among adult managed‐care‐eligible MassHealth members with at least one acute hospitalization, 8.7% were high‐frequency hospital users; they contributed 30.2% of hospitalizations and 69.4% of readmissions. High‐frequency users were more often male (77.1% vs. 50.0%; P < 0.001) and sicker (mean medical morbidity score was 3.3 vs. 1.9; P < 0.001) than others. They also had significant social risks: 33.1% with housing problems, 44.1% disabled, 83.2% with serious mental illness, and 77.1% with substance abuse disorder (vs. 22.0%, 27.3%, 60.2%, and 50.0%, respectively, for other hospital users [all P values <0.001]). Fully 50.7% of hospitalizations for high‐frequency users led to 30‐day readmissions (vs. 9.7%), contributing 72.0% of the variance in 30‐day readmission, and substantially affecting judgments about the relative performance of accountable care organizations.

Conclusions

A small group of high‐frequency hospital users have a disproportionate effect on 30‐day readmission rates. This negatively affects some Medicaid ACOs, and more broadly is likely to adversely affect safety net hospitals. How these metrics are used should be reconsidered in this context.
Concentration‐QT modelling of the novel DHFR inhibitor P218 in healthy male volunteers
Authors: Täubel Jӧrg , Lorch Ulrike , Ferber Georg , Spencer Christopher S. , Freier Anne , Coates Simon , El Gaaloul Myriam , Donini Cristina , Chughlay Mohamed Farouk , Chalon Stephan
Published: June 2021

Aims

Given the increasing emergence of drug resistance in Plasmodium, new antimalarials are urgently required. P218 is an aminopyridine that inhibits dihydrofolate reductase being developed as a malaria chemoprotective drug. Assessing the effect of new compounds on cardiac intervals is key during early drug development to determine their cardiac safety.

Methods

This double‐blind, randomized, placebo‐controlled, parallel group study evaluated the effect of P218 on electrocardiographic parameters following oral administration of seven single‐ascending doses up to 1000 mg in 56 healthy volunteers. Participants were randomized to treatment or placebo at a 3:1 ratio. P218 was administered in the fasted state with standardized lunch served 4 hours after dosing. 12‐lead ECGs were recorded in triplicate at regular intervals on the test day, and at 48, 72, 120, 168, 192 and 240 hours thereafter. Blood samples for pharmacokinetic evaluations were collected at similar time points. Concentration‐effect modelling was used to assess the effect of P218 and its metabolites on cardiac intervals.

Results

Concentration–effect analysis showed that P218 does not prolong the QTcF, J‐Tpeak or TpTe interval at all doses tested. No significant changes in QRS or PR intervals were observed. Two‐sided 90% confidence intervals of subinterval effects of P218 and its metabolites were consistently below the regulatory concern threshold for all doses. Study sensitivity was confirmed by significant shortening of QTcF after a meal.

Conclusion

Oral administration of P218 up to 1000 mg does not prolong QTcF and does not significantly change QRS or PR intervals, suggesting low risk for drug‐induced proarrhythmia.
New evidence on Islamic and conventional bank efficiency: A meta‐regression analysis
Authors: Chaffai Mohamed E.
Published: June 2021

This paper aims to conduct a comparison of the efficiency of Islamic banks (IBs) versus conventional banks (CBs) based on meta‐analysis. Empirical studies in this field, mainly in MENA or Gulf Cooperation Country regions, usually provide mixed conclusions and we do not know the reasons of this discrepancy in the results. We conduct a meta‐regression analysis (MRA) that is based on 35 studies and includes 484 estimates of efficiency scores by bank type among other characteristics. We employ Bayesian averaging technique to identify the main covariates explaining the heterogeneity of the results. Our findings suggest, first, no evidence of the superiority of one banking system over the other, neither in terms of technical, cost or profit efficiency. Second, we identify several important bank's and sample characteristics that have also important impacts on the provided efficiency estimates. Third, when we compare the studies into those who conduct a deep statistical comparison of the efficiency distributions by bank type and those who omit to do it, we find that CBs outperform IBs, suggesting a potential publication bias. Finally, with respect to the inefficiency, MRA suggests that the regions banking systems suffer from the inability of banks to maximize profit, so they are much less profitable than it should be. There are also some managerial deficiencies linked to cost minimization, rendering the region's banking system costly, compared to some deficiencies in the overall banking production process itself (technical efficiency).
Increased epithelial galectin‐13 expression associates with eosinophilic airway inflammation in asthma
Authors: Yi Lingling , Zhang Shuchen , Feng Yuchen , Wu Wenliang , Chang Chenli , Chen Dian , Chen Shengchong , Zhao Jianping , Zhen Guohua
Published: June 2021

Background

Airway eosinophilic inflammation is a central feature in asthma which is mainly driven by type 2 response. The expression of galectin‐13 was up‐regulated in a parasitic infection model which is also characterized by type 2 immune response. We hypothesized that galectin‐13 may be involved in airway eosinophilic inflammation in asthma.

Objective

To unveil the role of galectin‐13 in asthma airway inflammation.

Methods

We measured galectin‐13 expressions in bronchial brushings, sputum, and plasma of asthma patients (n = 54) and healthy controls (n = 15), and analysed the correlations between galectin‐13 expression and airway eosinophilia. We used human bronchial epithelial cell line 16HBE to investigate the possible mechanism by which galectin‐13 participates in eosinophilic inflammation.

Results

The expression of galectin‐13 was markedly increased in subjects with asthma compared to controls. Epithelial galectin‐13 mRNA levels in asthmatic subjects were strongly correlated with eosinophilic airway inflammation (the percentage of sputum eosinophils, the number of eosinophils in bronchial submucosa and FeNO) and the expression of Th2 signature genes (CLCA1, POSTN and SERPINB2). Inhaled corticosteroid (ICS) treatment reduced plasma galectin‐13 levels, and baseline plasma galectin‐13 levels reflect the response to ICS treatment. In cultured 16HBE cells, knockdown of galectin‐13 suppressed IL‐13‐stimulated MCP‐1 and eotaxin‐1 expression by inhibiting the activation of EGFR and ERK.

Conclusions & Clinical Relevance

Galectin‐13 is a novel marker for airway eosinophilia in asthma, and may contribute to allergic airway eosinophilic inflammation by up‐regulating the expression of MCP‐1 and eotaxin‐1. Plasma galectin‐13 levels may be useful for predicting responses to ICS treatment.
Thyroid FNA terminology: The case for a single unified international system for thyroid FNA reporting
Authors: Poller David N. , Cochand‐Priollet Beatrix , Trimboli Pierpaolo
Published: June 2021

The use of reporting terminologies for thyroid FNA cytology enables standardisation and international alignment of the reporting of thyroid cytology results, which is essential. There are currently three major internationally recognised systems: Bethesda (TBS), UK RCPath (Thy), and Italian (TIR). A fourth terminology system used in Japan has identical categories to TBS but with different nomenclature. The aim of this review is to discuss the strengths and weaknesses of the TBS, UK RCPath, and TIR systems, and to make the case for international terminology harmonisation and standardisation.
Assessing seizure burden in pediatric epilepsy using an electronic medical record–based tool through a common data element approach
Authors: Fitzgerald Mark P. , Kaufman Michael C. , Massey Shavonne L. , Fridinger Sara , Prelack Marisa , Ellis Colin , Ortiz‐Gonzalez Xilma , Fried Lawrence E. , DiGiovine Marissa P. ,   CHOP Pediatric Epilepsy Program Collaborative, Melamed Susan , Malcolm Marissa , Banwell Brenda , Stephenson Donna , Witzman Stephanie M. , Gonzalez Alexander , Dlugos Dennis , Kessler Sudha Kilaru , Goldberg Ethan M. , Abend Nicholas S. , Helbig Ingo
Published: June 2021

Objective

Improvement in epilepsy care requires standardized methods to assess disease severity. We report the results of implementing common data elements (CDEs) to document epilepsy history data in the electronic medical record (EMR) after 12 months of clinical use in outpatient encounters.

Methods

Data regarding seizure frequency were collected during routine clinical encounters using a CDE‐based form within our EMR. We extracted CDE data from the EMR and developed measurements for seizure severity and seizure improvement scores. Seizure burden and improvement was evaluated by patient demographic and encounter variables for in‐person and telemedicine encounters.

Results

We assessed a total of 1696 encounters in 1038 individuals with childhood epilepsies between September 6, 2019 and September 11, 2020 contributed by 32 distinct providers. Childhood absence epilepsy (n = 121), Lennox‐Gastaut syndrome (n = 86), and Dravet syndrome (n = 42) were the most common epilepsy syndromes. Overall, 43% (737/1696) of individuals had at least monthly seizures, 17% (296/1696) had a least daily seizures, and 18% (311/1696) were seizure‐free for >12 months. Quantification of absolute seizure burden and changes in seizure burden over time differed between epilepsy syndromes, including high and persistent seizure burden in patients with Lennox‐Gastaut syndrome. Individuals seen via telemedicine or in‐person encounters had comparable seizure frequencies. Individuals identifying as Hispanic/Latino, particularly from postal codes with lower median household incomes, were more likely to have ongoing seizures that worsened over time.

Significance

Standardized documentation of clinical data in childhood epilepsies through CDE can be implemented in routine clinical care at scale and enables assessment of disease burden, including characterization of seizure burden over time. Our data provide insights into heterogeneous patterns of seizure control in common pediatric epilepsy syndromes and will inform future initiatives focusing on patient‐centered outcomes in childhood epilepsies, including the impact of telemedicine and health care disparities.
Developing the right tools for the job: Lin28 regulation of early life T‐cell development and function
Authors: Dong Mengqi , Mallet Gauthier Ève , Fournier Marilaine , Melichar Heather J.
Published: June 2021

T cells comprise a functionally heterogeneous cell population that has important roles in the immune system. While T cells are broadly considered to be a component of the antigen‐specific adaptive immune response, certain T‐cell subsets display innate‐like effector characteristics whereas others perform immunosuppressive functions. These functionally diverse T‐cell populations preferentially arise at different stages of ontogeny and are tailored to the immunological priorities of the organism over time. Many differences in early life versus adult T‐cell phenotypes can be attributed to the cell‐intrinsic properties of the distinct progenitors that seed the thymus throughout development. It is becoming clear that Lin28, an evolutionarily conserved, heterochronic RNA‐binding protein that is differentially expressed among early life and adult hematopoietic progenitor cells, plays a substantial role in influencing early T‐cell development and function. Here, we discuss the mechanisms by which Lin28 shapes the T‐cell landscape to protect the developing fetus and newborn. Manipulation of the Lin28 gene regulatory network is being considered as one means of improving hematopoietic stem cell transplant outcomes; as such, understanding the impact of Lin28 on T‐cell function is of clinical relevance.
Different ways of managing risk as reported in 10‐Ks: A supervised learning approach
Authors: Friberg Richard , Seiler Thomas
Published: June 2021

We use supervised learning on annual reports of publicly listed US firms (10‐Ks) to build textual measures of risk management via derivatives, insurance, diversification, long‐run contracts, and credit lines. Validation exercises favor these supervised learning‐based measures over those based on word lists. Panel regressions (1996–2015) indicate that firms using one form of risk management are more likely to also use other forms. In contrast, intensive use of one risk management technique associates with less intensive use of other methods. Findings are consistent with a model featuring fixed costs of organizational capacity for managing risks and increasing marginal costs of hedging.
Nitrogen supply and physical disturbance shapes Arctic stream nitrogen uptake through effects on metabolic activity
Authors: Myrstener Maria , Thomas Steven A. , Giesler Reiner , Sponseller Ryan A.
Published: June 2021

Climate change in the Arctic is altering the delivery of nutrients from terrestrial to aquatic ecosystems. The impact of these changes on downstream lakes and rivers is influenced by the capacity of small streams to retain such inputs. Given the potential for nutrient limitation in oligotrophic Arctic streams, biotic demand should be high, unless harsh environmental conditions maintain low biomass standing stocks that limit nutrient uptake capacity.

We assessed the drivers of nutrient uptake in two contrasting headwater environments in Arctic Sweden: one stream draining upland tundra and the other draining an alluvial valley with birch forest. At both sites, we measured nitrate (NO3−) uptake biweekly using short‐term slug releases and estimated rates of gross primary production (GPP) and ecosystem respiration from continuous dissolved oxygen measurements.

Catchment characteristics were associated with distinct stream chemical and biological properties. For example, the tundra stream maintained relatively low NO3− concentrations (average: 46 µg N/L) and rates of GPP (0.2 g O2 m−2 day−1). By comparison, the birch forest stream was more NO3− rich (88 µg N/L) and productive (GPP: 1.7 g O2 m−2 day−1). These differences corresponded to greater areal NO3− uptake rate and increased NO3− use efficiency (as uptake velocity) in the birch forest stream (max 192 µg N m−2 min−1 and 96 mm/hr) compared to its tundra counterpart (max 52 µg N m−2 min−1 and 49 mm/hr) during 2017. Further, different sets of environmental drivers predicted temporal patterns of nutrient uptake at these sites: abiotic factors (e.g. NO3− concentration and discharge) were associated with changes in uptake in the tundra stream, while metabolic activity was more important in the birch forest stream.

Between sites, variation in uptake metrics suggests that the ability to retain pulses of nutrients is linked to nutrient supply regimes controlled at larger spatial and temporal scales and habitat properties that promote biomass accrual and thus biotic demand.

Overall, constraints on biotic potential imposed by the habitat template determined the capacity of these high latitude streams to respond to future changes in nutrient inputs arising from climate warming or human land use.

​
Sevoflurane alleviates hepatic ischaemia/reperfusion injury by up‐regulating miR‐96 and down‐regulating FOXO4
Authors: He Binghua , Yang Fan , Ning Yingxia , Li Yalan
Published: June 2021

Hepatic ischaemia/reperfusion (I/R) injury represents an event characterized by anoxic cell death and an inflammatory response, that can limit the treatment efficacy of liver surgery. Ischaemic preconditioning agents such as sevoflurane (Sevo) have been highlighted to play protective roles in hepatic I/R injury. The current study aimed to investigate the molecular mechanism underlying the effects associated with Sevo in hepatic I/R injury. Initially, mouse hepatic I/R injury models were established via occlusion of the hepatic portal vein and subsequent reperfusion. The expression of forkhead box protein O4 (FOXO4) was detected using reverse transcription quantitative polymerase chain reaction and Western blot analysis from clinical liver tissue samples obtained from patients who had previously undergone liver transplantation, mouse I/R models and oxygen‐deprived hepatocytes. The morphology of the liver tissues was analysed using haematoxylin‐eosin (HE) staining, with apoptosis detected via TUNEL staining. Immunohistochemistry methods were employed to identify the FOXO4‐positive cells. Mice with knocked out FOXO4 (FOXO4‐KO mice) were subjected to I/R. In this study, we found FOXO4 was highly expressed following hepatic I/R injury. After treatment with Sevo, I/R modelled mice exhibited an alleviated degree of liver injury, fewer apoptotic cells and FOXO4‐positive cells. FOXO4 was a target gene of miR‐96. Knockdown of FOXO4 could alleviate hepatic I/R injury and decrease cell apoptosis. Taken together, the key observations of our study suggest that Sevo alleviates hepatic I/R injury by means of promoting the expression of miR‐96 while inhibiting FOXO4 expression. This study highlights the molecular mechanism mediated by Sevo in hepatic I/R injury.
A multicentre open‐label study of apremilast in palmoplantar pustulosis (APLANTUS)
Authors: Wilsmann‐Theis D. , Kromer C. , Gerdes S. , Linker C. , Magnolo N. , Sabat R. , Reich K. , Mössner R.
Published: June 2021

Background

Palmoplantar pustulosis (PPP) is a chronic skin disease with painful erythematous scaly or crusty lesions and pustules on the palms and soles. Apremilast is a phosphodiesterase 4 inhibitor that has proven effective in the therapy of psoriasis, psoriatic arthritis and in oral ulcers associated with Behcet’s disease.

Objective

To explore the efficacy of apremilast in PPP.

Methods

APLANTUS was a phase 2 single‐arm multicentre study of apremilast in 21 subjects with moderate‐to‐severe PPP. Primary endpoint was the per cent change of the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at week 20 compared to baseline.

Results

20 weeks of oral treatment with apremilast in patients with moderate‐to‐severe PPP resulted in a significant decrease of the PPPASI with a median reduction of 57.1% (p < 0.001), and 61.9% of patients achieved at least a 50% improvement of the PPPASI relative to baseline. The total number of pustules per patient decreased significantly relative to baseline with 76.2% of patients achieving at least a 50% reduction in total pustules count at week 20. Improvement of PPP was also apparent in a significant decrease of the dermatologic life quality index (DLQI). The median DLQI score dropped from 8.5 at baseline to 2.0 at week 20 (p = 0.030). Apremilast was generally well tolerated, and no serious adverse events occurred.

Conclusions

Patients with PPP treated with apremilast showed benefit both in objective and subjective disease parameters. Apremilast should be investigated further in this difficult‐to‐treat skin condition.

EudraCT number: 2016‐005122‐11.
Longitudinal association between polypharmacy and development of pruritus: a Nationwide Cohort Study in a Japanese Population
Authors: Kogame T. , Kamitani T. , Yamazaki H. , Ogawa Y. , Fukuhara S. , Kabashima K. , Yamamoto Y.
Published: June 2021

Background

Although polypharmacy is known to cause side‐effects due to drug–drug interactions, dermatological symptoms triggered by polypharmacy are not fully addressed.

Objective

To investigate whether polypharmacy is associated with the risk of pruritus.

Method

A cohort study was performed to examine cross‐sectional and longitudinal relationships between polypharmacy and pruritus in a general population. Data were collected from the Norm Study conducted in 2016 and 2017, which is a nationwide survey based on a self‐administered questionnaire with Japanese representative participants aged 16–84 years. Presence of polypharmacy which was defined as concurrent use of ≥5 prescribed drugs. Primary outcomes were the presence of severe pruritus at baseline for the cross‐sectional analysis and the development of severe pruritus after one year for the longitudinal analysis. Multivariable modified Poisson regression analyses were performed to estimate risk ratios (RRs) and 95% confidence intervals (95%CIs) with adjustment for potential confounders (age, gender, smoking habits, drinking habits, depressive symptoms, moderate activities based on IPAQ score and presence of 11 comorbid conditions including skin disease).

Results

The study included 3126 participants (mean age, 48.7 years); nearly half (49.8%) were male. In all, 332 participants (10.3%) had polypharmacy in the cross‐sectional analysis. Participants with polypharmacy were more likely to present with severe pruritus at baseline than those who were not using drugs (adjusted RR = 1.52 [95%CI 1.15–2.01, P = 0.003]). The longitudinal analysis (n = 1803) was limited to those without severe pruritus at baseline; participants with polypharmacy at baseline were more likely to develop severe pruritus after a one‐year follow‐up period than those not using drugs (adjusted RR = 1.46 [95%CI 1.14–1.87, P = 0.002]).

Conclusion

Polypharmacy was associated with the presence of pruritus at baseline and may predict the future risk of developing pruritus.
Morphological deformities in the invasive driftwood catfish Trachelyopterus galeatus in the Upper Paraná River basin, Brazil: a sign of human impact?
Authors: Ferraz João D. , Jarduli Lucas R. , Garcia Diego A. Z. , Casimiro Armando C. R. , de Almeida Fernanda S. , Orsi Mário L.
Published: June 2021

In this study, the authors report morphological deformities in driftwood catfish Trachelyopterus galeatus (Auchenipteridae), an invasive catfish occurring in the Upper Paraná River basin, Brazil. The frequency of anomalous individuals reached 18.3% of all catches. X‐ray images showed anomalies, or total absence of structures, in the pelvic girdle. The authors also observed the absence of the adipose fin and mental barbels. These findings are of extreme importance for evidencing the anthropogenic impact on aquatic communities as the region suffers within fragmentation by dams and pollution from several human activities. This sort of information can be used in management systems and environmental monitoring, especially to protect other species and the native fish assemblage.
Dohsa‐hou Relaxation Enhances Cardiac Parasympathetic Activity Assessed by Analysis of Heart Rate Variability
Authors: Kuwashima Ryuji , Sakakibara, Masahito , Yoshikawa Yoshimi
Published: June 2021

This study examined whether Dohsa‐hou relaxation might enhance cardiac autonomic nervous activity as assessed by analysis of heart rate variability (HRV). Healthy adults in a parenting support group (N = 40, 16 men and 24 women, mean age = 31.2 years, SD = 3.9 years), participated in this study. Participants were randomly assigned to the Dohsa‐hou or control groups. The Dohsa‐hou group performed two Dohsa‐hou treatments, Kukan no hineri (Torso Twist) and Kao no yurume (Facial Loosening), for 5 min each, whereas the control group spent 10 min undergoing quiet rest. Electrocardiograms (ECG) were taken for 5‐min at the baseline and 5‐min after the treatment (post‐treatment measure). Participants also completed the Self‐Rating Scale of Dohsa‐hou (S‐Dohsa) at baseline and post‐treatment. Results indicated that the power of the high‐frequency component of HRV increased significantly in the Dohsa‐hou compared to the control group (p = .033). Moreover, the S‐Dohsa Relief and Rest subscale score also increased significantly in the Dohsa‐hou compared to the control group (p < .001), suggesting that Dohsa‐hou relaxation enhanced cardiac parasympathetic activity accompanied by a subjective relaxation response.
Discourse and manipulation: Nursing in question
Authors: de Araújo Cristina Nunes Vitor , Pereira Àlvaro , Ramos Flávia Regina Souza , Santos Ana Carla Petersen de Oliveira
Published: June 2021

The history of Brazilian nurses is marked by several challenges, in part resulting from discontinuous and fragile activity boundaries among the health professions that share the same work objective in care services. A field of constant disputes, the Brazilian health system, was the target of a lawsuit filed by the Federal Council of Medicine that temporarily suspended nurses’ activities in primary care. This study aimed to demonstrate the manipulative discourse present in the text of the injunction request by medical doctors against legislation by the Brazilian Federal Government in 2017. This is a qualitative and documental study that used the theoretical–methodological framework of critical discourse studies based on Teun Van Dijk's analytical categories. The results pointed to manipulative discourse through a polarization between manipulators’ good qualities and intentions and the bad qualities of nurses and Brazilian primary care policies; episodic manipulation by the presentation of documental and historical evidence of the submission of nursing roles; and social manipulation marked by strong emotional appeal. The study demonstrated that manipulative discourse extrapolated linguistic categories in the form of ideology and history.
Challenging situations and competence of nursing staff in nursing homes for older people with dementia
Authors: Piirainen Paula , Pesonen Hanna‐Mari , Kyngäs Helvi , Elo Satu
Published: June 2021

Background

Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require.

Methods

Data were collected using mixed methods in a cross‐sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open‐ended questions. Quantitative data acquired were analysed statistically, and responses to the open‐ended question were analysed using content analysis methodology.

Results

Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self‐management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia.

Conclusion

Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia.
Influence of ACPA‐positive rheumatoid arthritis on visual field testing in patients with arterial hypertension: A comparative cross‐sectional study
Authors: Wendelstein Jascha , Fuchs Barbara , Schlittgen Sarah , Zielke Robert , Brünner Jeanette , Bolz Matthias , Alten Rielke , Erb Carl
Published: June 2021

Purpose

To evaluate a possible influence of anti‐cyclic citrullinated peptide autoantibodies (ACPA) ‐ positive rheumatoid arthritis (RA) on visual field (VF) testing in patients with arterial hypertension (aHT).

Methods

We conducted an observational cross‐sectional study comparing patients with ACPA‐positive RA and aHT, patients with aHT and healthy subjects. Further inclusion criteria were visual acuity (VA) of 0.8 or better and age between 40 and 60 years. VF testing was performed with standard automated achromatic perimetry (SAP), short wavelength automated perimetry (SWAP) (Octopus 300®) and flicker perimetry (Pulsar®). Results were analysed for a possible correlation with blood pressure or RA‐activity.

Results

Twenty subjects with RA and aHT, 26 patients with aHT and 22 healthy participants were examined. Significant differences were found for mean sensitivity (MS) in SWAP comparing RA‐patients with healthy participants (ΔMS −3.06, p = 0.001) and with hypertensive patients (ΔMS −2.32, p = 0.007). In SAP we observed a significant difference between patients with RA and healthy subjects regarding loss variance (LV) (ΔLV = +9.77, p = 0.004). Flicker perimetry did not demonstrate significant differences between groups. A correlation of VF changes with blood pressure level or RA‐activity was not observed.

Conclusion

Patients with ACPA‐positive RA and aHT showed significant impairment of VF performance in SWAP compared to patients with aHT alone and healthy subjects. SAP also revealed a significant difference of LV between RA‐patients and healthy subjects. aHT does not seem to induce functional changes in VF testing alone.
CARD14‐associated papulosquamous eruption (CAPE) in a toddler responding to treatment with acitretin
Authors: Wong Gabriel Hong Zhe , Chia Shi Yun , Wei Heming , Rafi'ee Khadijah , Koh Mark Jean Aan , Tan Ene Choo
Published: June 2021

CARD14‐associated papulosquamous eruption (CAPE) is a rare autosomal dominant dermatosis that presents classically in early childhood with clinical features of both psoriasis and pityriasis rubra pilaris (PRP). The disease is known to be refractory to topical and systemic therapies classically used for psoriasis, with the majority of reported cases requiring treatment with biologics, such as ustekinumab and secukinumab. We present a toddler with a clinical presentation consistent with CAPE and found to have a novel heterozygous variant of the CARD14 gene. She was refractory to treatment with topical emollients and topical corticosteroids, but responsive to oral acitretin.
Sequential paternal haploidentical donor liver and HSCT in EPP allow discontinuation of immunosuppression post‐organ transplant
Authors: Malkiel Sarah , Sayed Blayne A. , Ng Vicky , Wall Donna A. , Rozmus Jacob , Schreiber Richard A. , Faytrouni Farah , Siddiqui Iram , Chiang Kuang‐Yueh , Avitzur Yaron
Published: June 2021

Background

EPP is characterized by photosensitivity and by liver disease. When LT is performed in EPP, recurrence often occurs in the allograft due to ongoing protoporphyrin production in bone marrow. Therefore, curative treatment requires allogeneic HSCT after LT. Long‐term immunosuppression could be spared by using the same donor for both transplants.

Methods

A 2‐year‐old girl with EPP in liver failure underwent liver transplant from her father. Transfusion and apheresis therapy were used to lower protoporphyrin levels before and after liver transplant. Ten weeks after liver transplant, she underwent HSCT, using the same donor. Conditioning was with treosulfan, fludarabine, cyclophosphamide, and ATG. GVHD prophylaxis was with abatacept, methotrexate, MMF, and tacrolimus. We followed the patient's erythrocyte protoporphyrin and liver and skin health for 2 years after transplant.

Results

After hematopoietic stem cell engraftment, a decline in protoporphyrin levels was observed, with clinical resolution of photosensitivity. Liver biopsies showed no evidence of EPP. Mild ACR occurred and responded to steroid pulse. Two years post‐HSCT, the patient has been weaned off all immunosuppression and remains GVHD and liver rejection free.

Conclusions

Sequential liver and HSCT from the same haploidentical donor are feasible in EPP. This strategy can allow for discontinuation of immune suppression.
Risk factors for post‐transplant Epstein‐Barr virus events in pediatric recipients of hematopoietic stem cell transplants
Authors: Enok Bonong Pascal R. , Buteau Chantal , Duval Michel , Lacroix Jacques , Laporte Louise , Tucci Marisa , Robitaille Nancy , Spinella Philip C. , Cuvelier Geoffrey D. E. , Lewis Victor , Vercauteren Suzanne , Alfieri Caroline , Trottier Helen
Published: June 2021

Background

Epstein‐Barr virus (EBV) can cause severe disease following hematopoietic stem cell transplant (HSCT), including post‐transplant lymphoproliferative disorder (PTLD). The objective was to analyze risk factors associated with post‐transplant EBV outcomes among pediatric allogeneic HSCT recipients.

Methods

We used data from 156 pediatric allogeneic HSCT recipients enrolled in the Canadian multicenter TREASuRE study. Cox and Prentice‐Williams‐Petersen models were used to analyze risk factors for post‐transplant EBV events including occurrence and recurrence of EBV DNAemia, increase in EBV viral load (EBV‐VL), and preemptive use of rituximab, an effective therapy against PTLD.

Results

Females were at higher risk for increasing EBV‐VL (adjusted hazard ratio (HR) = 2.83 [95% confidence intervals (CI): 1.33–6.03]) and rituximab use (HR = 3.08 [1.14–8.30]), but had the same EBV DNAemia occurrence (HR = 1.21 [0.74–1.99]) and recurrence risks (HR=1.05 [0.70–1.58]) compared to males. EBV DNAemia was associated with recipient pre‐transplant EBV seropositivity (HR = 2.47 [1.17–5.21]) and with graft from an EBV‐positive donor (HR = 3.53 [1.95–6.38]). Anti‐thymocyte globulin (ATG) was strongly associated with all EBV outcomes, including the use of rituximab (HR = 5.33 [1.47–19.40]). Mycophenolate mofetil (MMF) significantly decreased the risk of all EBV events including the rituximab use (HR = 0.13 [0.03–0.63]).

Conclusion

This study in pediatric allogeneic HSCT patients reveals a reduced risk of all EBV outcomes with the use of MMF. Risk factors for EBV events such as EBV‐VL occurrence and recurrence include EBV positivity in the donor and recipient, and use of ATG, whereas risk factors for the most severe forms of EBV outcome (EBV‐VL and the use of rituximab) include female sex and ATG use.
Complicated Webs: Experiential Risk in the Vietnamese Coffee Industry
Authors: Grant Sarah G.
Published: June 2021

This article explores the political and cultural dimensions of risk and uncertainty as coffee farmers and other industry professionals emerge from crisis and traverse complex economic, environmental, and political landscapes in post‐Đổi Mới (Economic Reform) Vietnam. Based on ethnographic research across the coffee industry and the everyday lives of farmers, this article conceptualizes risk, on the one hand, as a technique of market expansion and, on the other hand, as an experience. It discusses a contrast between emergent market‐based discourses of risk management and experiential knowledge of risk in the Vietnamese coffee industry. In educational and training spaces, coffee industry experts interpret risk within a narrow framework of profitability and long‐term production. Vietnamese coffee farmers, in contrast, experience risk as part of the everyday coffee production landscape, which is shaped by environmental instability, crop failure, and economic volatility. This article argues that this experiential risk catalyzes farmers to employ novel mitigation strategies and to confront contentious state agricultural policies and international development programs. [Vietnam, risk, uncertainty, coffee, commodities]
Touch‐induced emotional comfort results in an increase in the salivary antioxidant potential: A correlational study
Authors: Proskurnina Elena V. , Sokolova Svetlana V. , Portnova Galina V.
Published: June 2021

A pleasant touch reduces psychoemotional stress via the oxytocin mechanism due to its anti‐inflammatory and antioxidant effects. Our research is aimed to reveal the correlations between the subjectively perceived pleasantness of touch, the antioxidant potential of saliva, and salivary oxytocin. A total of 56 healthy volunteers aged 18–38 years participated in the study. The control group consisted of 24 volunteers. The participants were subjected to tactile stimulation using a specially designed protocol. They ranked the touch pleasantness on a scale from 1 to 10. Heart rate variability and low‐frequency/high‐frequency ratios from the power spectral density of ECG were determined to assess psychoemotional relaxation. Salivary oxytocin and antioxidant capacity were quantified before and after the touch test. We found a significant increase in salivary antioxidant potential and oxytocin after pleasant tactile stimulation for the participants compared to the control group. The difference in antioxidant capacity values before and after the test positively correlated with mean pleasantness in the touch test (r = 0.57) and the difference in heart rate variability (r = 0.67); it negatively correlated with the difference in low‐frequency/high‐frequency ECG band ratio (r = −0.59). Oxytocin ratio positively correlated with the difference in antioxidant capacity values (r = 0.47). As a result of tactile stimulation, a significant increase in the antioxidant capacity of saliva and salivary oxytocin was found in the test group compared to the control group. These findings support further studies of the effects of pleasant touch on hormonal and oxidative metabolism.
The COVID University Challenge: A Hazard Analysis of Critical Control Points Assessment of the Return of Students to Higher Education Establishments
Authors: Edmunds Kelly L. , Bowater Laura , Brainard Julii , de Coriolis Jean‐Charles , Lake Iain , Malik Rimsha R. , Newark Lorraine , Ward Neil , Yeoman Kay , Hunter Paul R.
Published: June 2021

The COVID‐19 pandemic has disrupted economies and societies throughout the world since early 2020. Education is especially affected, with schools and universities widely closed for long periods. People under 25 years have the lowest risk of severe disease but their activities can be key to persistent ongoing community transmission. A challenge arose for how to provide education, including university level, without the activities of students increasing wider community SARS‐CoV‐2 infections. We used a Hazard Analysis of Critical Control Points (HACCP) framework to assess the risks associated with university student activity and recommend how to mitigate these risks. This tool appealed because it relies on multiagency collaboration and interdisciplinary expertise and yet is low cost, allowing rapid generation of evidence‐based recommendations. We identified key critical control points associated with university student’ activities, lifestyle, and interaction patterns both on‐and‐off campus. Unacceptable contact thresholds and the most up‐to‐date guidance were used to identify levels of risk for potential SARS‐CoV‐2 transmission, as well as recommendations based on existing research and emerging evidence for strategies that can reduce the risks of transmission. Employing the preventative measures we suggest can reduce the risks of SARS‐CoV‐2 transmission among and from university students. Reduction of infectious disease transmission in this demographic will reduce overall community transmission, lower demands on health services and reduce risk of harm to clinically vulnerable individuals while allowing vital education activity to continue. HACCP assessment proved a flexible tool for risk analysis in a specific setting in response to an emerging infectious disease threat. Systematic approaches to assessing hazards and risk critical control points (#HACCP) enable robust strategies for protecting students and staff in HE settings during #COVID19 pandemic.
AI-Timoshenko: Automatedly Discovering Simplified Governing Equations for Applied Mechanics Problems From Simulated Data
Authors: Huang Zhanchao , Li Chunjiang , Huang Zhilong , Wang Yong , Jiang Hanqing
Published: June 2021

The simplified governing equations of applied mechanics play a pivotal role and were derived based on ingenious assumptions or hypotheses regarding the displacement fields for specific problems. In this paper, we introduce a data-driven method by the name AI-Timoshenko in honor of Timoshenko, father of applied solid mechanics, to automatically discover simplified governing equations for applied mechanics problems directly from discrete data simulated by the three-dimensional (3D) finite element method. The simplified governing equations are in variational form, which is compact and advantageous for data-driven discovery. AI-Timoshenko liberates applied mechanicians from burdensome labor, including assumptions, derivation, and trial and error. The simplified governing equations for Euler–Bernoulli and Timoshenko beam theories are successfully rediscovered using the present AI-Timoshenko method, which shows that this method is capable of discovering simplified governing equations for applied mechanics problems.
Statics and Dynamics of V-Shaped Microbeams Under Axial Forces
Authors: Ouakad Hassen M. , Alcheikh Nouha , Mbarek Sofiane Ben , Rocha Rodrigo , Younis Mohammad I.
Published: June 2021

This work proposes an examination into the static and dynamic behaviors of in-plane V-shaped microbeam under both electric forces and axial loads. The microbeams are actuated with two separate electrodes of uniform air gap across their length. The effects of the initial rise and DC bias voltage are examined while varying the axial loads ranging from compressive to tensile. The numerical analysis is based on a nonlinear equation of motion of a shallow V-shaped microbeam. The static and eigenvalue problem were solved using a modal expansion based reduced-order modeling for numerous equilibrium positions. The analytical model is validated by comparing to an experimental case study. The results show rich and diverse static and dynamic behavior. It is shown that the microbeam may exhibit only the pull-in or snap-through and pull-in instabilities. Various multistate and hysterics behaviors are demonstrated when varying the actuation forces and the initial rise. High tunability is demonstrated when varying the axial and DC loads for the first two symmetric vibration modes. With various axial load and DC actuation options and different geometrical configurations, this particular V-shaped microbeam shows a capacity of increasing the static deflection range before pull-in, allowing more variation of its fundamental natural frequency. Therefore, it could be more promising for the realization of different wide-range tunable microresonator as compared to the regular straight and even bell-shaped microbeams. These results are very useful in microscale applications that can be benefit for designing some structures with low power consumption, high sensitivity, and wide tuning range. Such rich behavior can be very useful for high-performance microscale applications designs.