bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical cytomegalovirus reactivation, cytokines and spontaneous preterm birth in Kenyan women
Authors: Begnel E R , Drake A L , Kinuthia J , Matemo D , Huang M-L , Ásbjörnsdóttir K H , Chohan V , Beima-Sofie K , John-Stewart G , Lehman D , Slyker J
Published: December 2020

Genital cytomegalovirus (CMV) reactivation is common during the third trimester of pregnancy. We hypothesized that cervical CMV shedding may increase risk of spontaneous preterm birth (sPTB) through the release of inflammatory cytokines in the cervix. We conducted a nested case–control analysis to determine the relationship between CMV shedding and sPTB using data and samples from a prospective cohort study in western Kenya. Women who delivered between 28 + 0 and 33 + 6 weeks gestation were matched by gestational age at sample collection to controls who delivered ≥ 37 + 0 weeks. Levels of CMV DNA and interleukin (IL)-1 beta (β), IL-6, IL-8 and tumor necrosis factor (TNF)-α were measured in cervical swabs. We used conditional logistic regression to assess relationships between CMV shedding, cervical cytokine levels and sPTB. Among 86 cases and 86 matched controls, cervical CMV levels were not significantly associated with sPTB [odds ratio (OR) = 1·23, 95% confidence interval (CI) = 0·59–2·56], but were significantly associated with higher levels of cervical IL-6 (β = 0·15, 95% CI = 0·02–0·29) and TNF-α (β = 0·14, 95% CI = 0·01–0·27). In univariate analysis, higher odds of sPTB was associated with higher cervical IL-6 levels (OR = 1·54, 95% CI = 1·00–2·38), but not with other cervical cytokines. In this cohort of Kenyan women, we did not find a significant association between cervical CMV shedding and sPTB before 34 weeks.
Comparison of ambulatory blood pressure between patients with primary aldosteronism and other forms of hypertension
Authors: Libianto Renata , Menezes Serena , Kaur Amrina , Gwini Stella May , Shen Jimmy , Narayan Om , Fuller Peter J. , Yang Jun , Young Morag J.
Published: December 2020

Objective

Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure‐matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end‐organ damage. However, PA is currently substantially under‐diagnosed. The standard screening test for PA, the aldosterone‐to‐renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening.

Study design

Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM.

Results

In this study, PA patients were younger and had higher 24‐h, day, and night‐time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day‐night blood pressure variability between the two groups.

Conclusions

An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.
Comparison of high‐flow oxygenation with noninvasive ventilation in COPD exacerbation: A crossover clinical trial
Authors: Rezaei Abbas , Fakharian Atefeh , Ghorbani Fariba , Idani ‪Esmaeil , Abedini Atefeh , Jamaati Hamidreza
Published: December 2020

Objectives

To compare the therapeutic effects of high‐flow‐oxygen‐Therapy (HFT) and noninvasive‐ventilation (NIV) for stabilizing chronic obstructive pulmonary disease during exacerbation.

Methods

In this randomized clinical trial at Masih‐Daneshvari hospital, between July 2019 and Oct 2019, 30 exacerbated‐COPD‐patient with PaCO2 64.58 ± 11.61 mm Hg, Respiratory Rate 24.43 ± 2.75, and PH 7.31 ± 0.02 were divided into two groups, N = 15. By a simple randomized allocation, patients receive either NIV or HFT for 1 hour, and following a washout period of 30 minutes, they switched to the other treatment option. Arterial Blood Gas Parameters, as well as Respiratory Rate (RR), Dyspnea Score, Heart Rate (HR), and Oxygen Saturation (SO2), were compared before and after the intervention and between groups.

Results

Baseline patient characteristics were similar in the two groups. Pre and post‐analysis revealed that in both groups, all improved significantly. After the first period, there was no difference in all parameters between groups except for SO2 which was significantly higher in HFT (%92.1 ± 1) than that of NIV (%89 ± 1), P = .001. Likewise, following the washout period, patients in HFT and NIV had a dyspnea score of 1.93 ± 0.7 and 2.73 ± 0.9, respectively, P = .01. No carryover‐effect and was observed but the period effect was significant for some outcomes. A significant improvement in SO2 and HR was observed by HFT according to treatment effect by combining two periods’ results. During the study, no side effects were reported.

Conclusion

In this short‐term study HFT appears feasible for patients with COPD exacerbation to reduce dyspnea score and improve respiratory distress.
Epicardial adipose tissue is associated with increased systolic pulmonary artery pressure in patients with chronic obstructive pulmonary disease
Authors: Kalaycıoğlu Ezgi , Çetin Mustafa , Çinier Göksel , Özyıldız Ali Gökhan , Durmuş İsmet , Kırış Tuncay , Gökdeniz Tayyar
Published: December 2020

Objectives

Pulmonary hypertension (PHT) is one of the essential predictors of mortality in chronic obstructive pulmonary disease (COPD). It is thought that PHT is due to vasoconstriction secondary to hypoxia caused by airway obstruction in COPD patients; however, loss of capillary bed with emphysema, inflammation, and endothelial dysfunction may also play a role in the development of PHT. Epicardial adipose tissue (EAT) has a role as a metabolically active endocrine organ and secretes various proinflammatory cytokines. We hypothesized that EAT thickness in COPD patients might be associated with the systolic pulmonary arterial pressure (PAPs) level, and we aimed to test it.

Methods

The present study included 129 consecutive patients with the diagnosis of COPD. All patients underwent transthoracic echocardiographic evaluation. The relationship between PAPs and EAT thickness was evaluated.

Results

Positive correlations with PAPs were reported with age, EAT, white blood cell (WBC) and GOLD grade score (range 0.197‐0.275, P values 0.026 to 0.002), negative correlations with body‐mass index (BMI), hyperlipidemia, FEV1 (% predicted) and pO2 (range −0.216 to −0.340, P values .014 to <.001). In stepwise linear regression analysis, BMI (P = .003), EAT (P = .002), WBC (P = .001), and FEV1 (% predicted) (P = .010), were independently associated with PAPs.

Conclusion

EAT thickness in COPD patients with preserved left ventricular systolic function is associated with increased PAPs, and this association is independent of the parameters indicating the severity of COPD.
Overheard conversations can influence children’s generosity
Authors: Qin Wen , Zhao Li , Compton Brian J. , Zheng Yi , Mao Haiying , Zheng Jiaxin , Heyman Gail D.
Published: December 2020

Understanding the factors that promote the development of generosity has both theoretical and practical importance. This study examines one potential influence: overheard conversations that contain evaluative statements about the behavior of others that were described as widely shared opinions. In Study 1 (N = 120), younger (mean age 4.1 years old) and older (mean age 5.9 years old) participants overheard two adults discuss a target child's act of generosity, and in a between‐subjects manipulation, the conversation included either praise for the target child, or criticism. Participants in the older group were more likely to behave generously on a distribution task if the overheard conversation involved praise rather than criticism, but the participants in the younger group showed no such effect. Study 2 (N = 150) and Study 3 (N = 60) were preregistered follow‐up studies that included older children only (a 5‐year‐old group). Study 2 showed that children were again more likely to share after overhearing a conversation in which an individual who behaved generously was described in favorable terms, and the same effect was seen when the overheard conversation involved criticism of an individual who did not share. The procedure of Study 3 matched that of Study 1, except the distributions were made in private, and the overheard conversation effect was seen once again. These findings suggest that by age 5, children can use information they hear about individuals who are not present to guide their own behavior, and that overheard evaluative comments can promote generosity.
Development of a new comorbidity index for adults with cerebral palsy and comparative assessment with common comorbidity indices
Authors: Whitney Daniel G , Kamdar Neil S
Published: December 2020

Aim

To develop a new comorbidity index for adults with cerebral palsy (CP), the Whitney Comorbidity Index (WCI), which includes relevant comorbidities for this population and better predicts mortality than the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI).

Method

Data from the Optum Clinformatics Data Mart was used for this retrospective cohort study. Diagnosis codes were used to identify adults aged 18 years or older with CP (n=1511 females, n=1511 males; mean [SD; range] age=48y [19y 2mo; 18–89y]) and all comorbidities in the year 2014. The WCI was developed based on the comorbidities of the CCI and ECI and other relevant comorbidities associated with 2‐year mortality using Cox regression and competing risk analysis. The WCI was examined as unweighted (WCIunw) and weighted (WCIw). The model fit and discrimination (C‐statistic) of each index was assessed using Cox regression.

Results

Twenty‐seven comorbidities were included in the WCI; seven new comorbidities that were not part of the CCI or ECI were added. The WCIunw and WCIw showed a better model fit and discrimination for 1‐ and 2‐year mortality compared to the CCI and ECI. The WCIunw and WCIw were strong predictors for 1‐ and 2‐year mortality (C‐statistic [95% confidence interval] ranging from 0.81 [0.76–0.85] to 0.88 [0.82–0.94]).

Interpretation

The new WCI, designed to include clinically relevant comorbidities, provides a better model fit and discrimination of mortality for adults with CP.

What this paper adds

Common comorbidity indices exclude relevant comorbidities for adults with cerebral palsy (CP).

A new comorbidity index for adults with CP was created by harmonizing clinical theory and data‐driven methods.

The Whitney Comorbidity Index better predicted 1‐ and 2‐year mortality than other commonly used comorbidity indices.
Long‐term outcomes of metabolic surgery in overweight and obese patients with type 2 diabetes in Asia
Authors: Huang Yu‐Min , Lin Yen‐Kuang , Lee Wei‐Jei , Hur Kyoung Yul , Kasama Kazunori , Cheng Anton Kui Sing , Lee Ming‐Hsien , Wong Simon Kin‐Hung , Soong Tien‐Chou , Lee Kuo‐Ting , Lomanto Davide , Lakdawala Muffazal , Su Yen‐Hao , Wang Weu
Published: December 2020

Aim

To assess the outcomes of metabolic surgery in overweight and obese patients in Asia with type 2 diabetes (T2D).

Materials and Methods

The treatment outcomes of 1999 patients from the Asian Diabetes Surgery Summit database were analysed. The changes in treatment effects across time were assessed with respect to the surgical procedures performed by using generalized estimating equations.

Results

The most commonly performed procedure was the single‐anastomosis gastric bypass (32.6%). Weight (from 106.2 ± 25.1 to 77.9 ± 18.8 kg), body mass index (BMI; from 38.7 ± 7.9 to 28.5 ± 5.9 kg/m2), blood sugar (from 9.3 ± 4.1 to 5.7 ± 1.8 mmol/L) and HbA1c (from 8.4% ± 1.8% to 6.0% ± 1.1%) significantly improved from baseline to 1 year (P < .001) and remained stable at 5 years (weight, 86.3 ± 23.3 kg; BMI, 31.7 ± 7.9 kg/m2; blood sugar, 5.8 ± 1.8 mmol/L, and HbA1c, 6.4% ± 1.2%; all P < .001 vs. baseline). Blood pressure and most lipid disorders also improved significantly. Of the treatment procedures, single‐anastomosis gastric bypass had the most satisfactory outcomes with statistical significance for most disorders, whereas adjustable gastric banding displayed the least satisfactory outcomes.

Conclusions

Metabolic surgery remarkably improved body weight, T2D and other metabolic disorders in Asian patients. However, the efficacy of individual procedures varied substantially.
A review of the pivotal role of cardiac MRI in mitral valve regurgitation
Authors: Gajjar Kushani , Kashyap Kartikeya , Badlani Jayshiv , Williams Ronald B , Biederman Robert W.W.
Published: December 2020

Cardiac imaging is the cornerstone of defining the etiology, quantification, and management of mitral regurgitation (MR). This continues to be even more so the case with emerging transcatheter techniques to manage MR. Transthoracic echocardiography remains the first‐line imaging modality to assess MR but has limitations. Cardiac MRI(CMR) provides the advantages of quantitative nonvisual estimation, 3D volumetric data, late gadolinium, T1, and extracellular volume measurements to comprehensively assess mitral valvular pathology, cardiac remodeling, and the prognostic impact of therapies. This review describes the superiority, technical aspects and growing evidence behind CMR, and lays the roadmap for the future of CMR in MR.
The importance of the insular cortex for vestibular and spatial syndromes
Authors: Baier Bernhard , Cuvenhaus Hannah Sophie , Müller Notger , Birklein Frank , Dieterich Marianne
Published: December 2020

Background and purpose

The aim of the study was to identify the neuroanatomical correlates and associations of neuropsychological syndromes after acute unilateral right‐hemisphere brain lesions. The neuropsychological syndromes considered were orientation in three‐dimensional space such as tilts of the subjective visual vertical or of the subjective haptic vertical, pusher syndrome, visual neglect and unawareness of paresis (anosognosia for hemiparesis). These neuropsychological phenomena have been found to occur separately or in different combinations after lesions to the right insular cortex.

Method

Magnetic resonance imaging scans were obtained from 82 patients with acute right‐hemispheric stroke. A lesion–behavior mapping analysis was conducted to specify the neuroanatomical correlates of the above‐mentioned neuropsychological syndromes.

Results

In all analyses of the individual neuropsychological syndromes the insular cortex was affected.

Conclusions

Thus, the insular cortex is involved in (self‐)perception and orientation within a three‐dimensional space. Since isolated lesions of the insular cortex did not induce the above neuropsychological phenomena, there have to be other regions involved.
Monitoring multiple damage mechanisms in crack‐patched structures using optical infrared thermography
Authors: Martens Ulrike , Schröder Kai‐Uwe
Published: December 2020

The ability to understand the overall long‐term damage behaviour of crack patched components is essential to improve methods for the performance prediction. The method of passive infrared thermography comprises great opportunities to support the comprehension of the subsurface damage progress of crack‐patched structures. Quasi‐static and cyclic coupon tests are performed with patched metallic specimens and monitored with qualitative and comparative passive infrared thermography. Different test set‐ups help to differentiate between pure metallic crack growth and adhesive damage on thermal images. Results show that metallic crack growth can be monitored from the patched side, also in combination with local delamination at the patch/metal interface overlaying the crack. Thus, it is possible to evaluate position and size of the different damage types at the same time with a rather simple test set‐up. The information on the degradation progress of the crack patched component under loading conditions can help identify the driving damage mechanism of the particular repair configuration. This knowledge can in return be used in the patch design process.
Analysis of efficacy of lenvatinib treatment in highly advanced hepatocellular carcinoma with tumor thrombus in the main trunk of the portal vein or tumor with more than 50% liver occupation: A multicenter analysis
Authors: Chuma Makoto , Uojima Haruki , Hiraoka Atsushi , Kobayashi Satoshi , Toyoda Hidenori , Tada Toshifumi , Hidaka Hisashi , Iwabuchi Shogo , Numata Kazushi , Itobayashi Ei , Itokawa Norio , Kariyama Kazuya , Ohama Hideko , Hattori Nobuhiro , Hirose Shunji , Shibata Hiroshi , Tani Joji , Imai Michitaka , Tajiri Kazuto , Moriya Satoshi , Wada Naohisa , Iwasaki Shuitirou , Fukushima Taito , Ueno Makoto , Yasuda Satoshi , Atsukawa Masanori , Nouso Kazuhiro , Fukunishi Shinya , Watanabe Tsunamasa , Ishikawa Toru , Nakamura Shinichiro , Morimoto Manabu , Kagawa Tatehiro , Sakamoto Michiie , Kumada Takashi , Maeda Shin
Published: December 2020

Aims

To assess the safety, efficacy, and prognostic impact of clinical factors associated with lenvatinib treatment in highly advanced hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein trunk (VP4) or tumor with more than 50% liver occupation (tm50%LO).

Methods

A total of 61 highly advanced HCC patients (41 patients with tm50%LO and 20 patients with VP4) who were treated with lenvatinib at multicenter were enrolled and retrospectively analyzed for treatment outcomes according to their clinical status, including tumor morphology.

Results

The most frequent grade ≥3 adverse event in tm50%LO HCC was elevated aspartate aminotransferase (17.1%). Objective response rates were 37.5% and 0% in tm50%LO HCC patients with Child–Pugh grade (CP)‐A and CP‐B, respectively, and 26.7% and 0% in VP4 HCC patients with CP‐A and CP‐B, respectively. Estimated median progression‐free survival and overall survival were 132 days and 229 days, and 101 days and 201 days in patients with tm50%LO and VP4, respectively. In multivariate analysis, modified albumin‐bilirubin grade (hazard ratio 0.372, 95% CI 0.157–0.887; p = 0.0241) and tumor morphology (hazard ratio 0.322, 95% CI 0.116–0.889; p = 0.0287) were independently associated with progression‐free survival in patients with tm50%LO HCC. In VP4 HCC, median progression‐free survival was worse in CP‐B (57 days) than in CP‐A patients (137 days, p = 0.0462).

Conclusions

Lenvatinib treatment offers a benefit in highly advanced HCC (tm50%LO or VP4) patients with good liver function or nodular‐type tumor. The various characteristics identified in this study might be useful as indicators of lenvatinib treatment in highly advanced HCC with tm50%LO or VP4, which are considered very refractory cancers.
Detailed paleoseismic history of the Hinagu fault zone revealed by the high‐density radiocarbon dating and trenching survey across a surface rupture of the 2016 Kumamoto earthquake, Kyushu, Japan
Authors: Shirahama Yoshiki , Miyashita Yukari , Kametaka Masao , Suzuki Yuji , Miyairi Yosuke , Yokoyama Yusuke
Published: December 2020

The NE‐trending Hinagu fault zone, length 81 km, is one of the major active faults in Kyushu, Japan. From north to south, it is divided into three segments based on geomorphic features and paleoseismic behavior: the Takano‐Shirahata, Hinagu, and Yatsushiro Sea segments. The 2016 Kumamoto earthquake produced a 6‐km‐long surface rupture with a dextral strike‐slip displacement on the northern part of the Takano‐Shirahata segment. Surface rupture, a faint east‐side‐up flexure with a vertical offset of less than 8 cm, was observed near the middle of the Takano‐Shirahata segment. To examine past surface‐rupturing earthquakes on the Takano‐Shirahata segment, including rupture frequency and timing, we conducted a paleoseismic study with boring and trenching at Yamaide. A trench across the surface rupture exposed multiple fault strands associated with multiple surface‐rupturing events that deformed several strata of fine‐grained sediments. By structural and stratigraphic interpretation, high‐density radiocarbon dating and tephra analysis, and Bayesian modeling, we constrained the timing of seven events, Events 1–7, to 0.84–1.25, 1.31–7.06, 9.99–11.0, 10.8–12.1, 12.0–13.0, 14.2–15.1, and before 14.8 kcal BP. Slip during Events 1–6 was obviously larger than the 2016 slip. The estimated average recurrence interval was about 2596–2860 years, but the interval between Events 2 and 3 was much longer than other intervals. Moreover, the vertical throw associated with Event 2 was larger than that of other events. This implies that the Takano‐Shirahata segment has a period with rare larger earthquakes and a period with frequent smaller earthquakes. Some events might have produced ruptures on both the Takano‐Shirahata and the northern part of the Hinagu segments simultaneously or in a short time. The variety of recurrence intervals suggests that the seismic activity has been affected by one or both activities of the Futagawa fault zone and the Hinagu segment.
Liquidity and the International Allocation of Economic Activity
Authors: Rodriguez‐Lopez Antonio
Published: December 2020

I present a model to study the linkages between the market for liquidity and the international allocation of economic activity. Private assets' liquidity properties affect interest rates, with consequences on entry, production, and market capitalization. In a closed economy, the liquidity market increases the size and productivity of the sector that generates liquid assets. In an open economy, cross‐country differences in financial development generate an allocation of economic activity favoring the country supplying the most liquid assets. Supporting the theory, I show that asset acceptability as collateral is negatively correlated with yields, and positively correlated with measures of economic activity.
ADAMTS13 activity to von Willebrand factor antigen ratio predicts acute kidney injury in patients with COVID‐19: Evidence of SARS‐CoV‐2 induced secondary thrombotic microangiopathy
Authors: Henry Brandon Michael , Benoit Stefanie W. , de Oliveira Maria Helena Santos , Lippi Giuseppe , Favaloro Emmanuel J. , Benoit Justin L.
Published: December 2020

Introduction

Severe COVID‐19 is often compounded by a prothrombotic state that is associated with poor outcomes. In this investigation, we aimed to evaluate ADAMTS13 activity, von Willebrand factor level (VWF:Ag), and the corresponding ADAMTS13 activity/VWF:Ag ratio, in patients with COVID‐19 and for associations with disease progression and acute kidney injury (AKI).

Methods

Patients presenting to the emergency department (ED) with COVID‐19 were enrolled in this prospective, observational study. ADAMTS13 activity and VWF:Ag were measured at index ED visit. The primary endpoint was severe AKI defined by KDIGO stage 2 + 3 criteria, while the secondary endpoint was peak 30‐day COVID‐19 severity.

Results

A total of 52 adult COVID‐19 patients were enrolled. Overall, we observed that 23.1% of the cohort had a relative deficiency in ADAMTS13 activity, while 80.8% had elevated VWF:Ag. The ADAMTS13 activity/VWF:Ag ratio was significantly lower in patients with severe AKI (P = .002) and those who developed the severe form of COVID‐19 (P = .020). The ADAMTS13 activity/VWF:Ag ratio was negatively correlated with age (P < .001) and LDH (P < .001), while positively correlated with hemoglobin (P = .041). After controlling for confounders, a one‐unit increase in ADAMTS13/VWF:Ag ratio was associated with 20% decreased odds of severe AKI.

Conclusion

A low ADAMTS13 activity:VWF:Ag ratio at ED presentation is associated with progression to severe COVID‐19 disease and severe AKI, with a pattern suggestive of a secondary microangiopathy. Further interventional studies should be conducted to assess the restoration of ADAMTS13:VWF:Ag ratio in hospitalized patients with COVID‐19.
Assessment of medical practitioners' knowledge about paediatric oral diagnosis and gaze patterns using eye tracking technology
Authors: Snell Sarah , Bontempo Daniel , Celine Gregory , Anthonappa Robert
Published: December 2020

Background

Most studies regarding the oral health knowledge of medical practitioners are based on surveys.

Aim

To assess medical practitioners’ knowledge in diagnosing and managing children oral health issues using eye tracking technology.

Design

Forty‐one medical practitioners completed a cross‐sectional survey questionnaire and subsequently viewed 5 clinical images of children's oral cavities to indicate the issues observed and their management. Tobii eye tracking device captured each participant's visual search behaviours and mean length of fixation (LOF) for each area of interest (AOI). Participant self‐reported confidence in examining the oral cavity, and qualification level was recorded for data analysis.

Results

No correlation between time spent viewing the soft tissues and self‐reported confidence examining the oral cavity was observed (P = .25). Self‐reported confidence in examining the oral cavity was not associated with a correct diagnosis. LOF on the decayed teeth was significantly associated with a correct diagnosis of ‘caries’ (P < .05), and paediatric training was associated with a correct diagnosis of dental caries (P < .05).

Conclusion

Medical practitioners’ diagnosis and management were poorly correlated with their objective visual search behaviours of the intraoral images. Self‐reported confidence in examining and managing oral issues was not correlated with a correct diagnosis, with the majority not confident of examining children oral cavity.
Process evaluation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A mixed methods study
Authors: Abraham Jens , Bake Mareike , Berger‐Höger Birte , Köpke Sascha , Kupfer Ramona , Meyer Gabriele , Möhler Ralph
Published: December 2020

Aims

To describe the implementation process and fidelity of two versions of a guideline‐based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters.

Design

Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three‐arm cluster randomized controlled trial.

Methods

Quantitative and qualitative process data were collected during the study period (February 2015–February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi‐structured interviews were analysed using content analysis. An in‐depth analysis was conducted by contrasting responding and non‐responding clusters regarding the intervention goal and primary outcome.

Results

Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in‐depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects.

Conclusion

Although both versions of a guideline‐based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least‐restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions.

Impact

For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.
Validation of the VT‐LVAD score for prediction of late VAs in LVAD recipients
Authors: Darma Angeliki , Arya Arash , Dagres Nikolaos , Kühl Michael , Hindricks Gerhard , Eifert Sandra , Saeed Diyar , Borger Michael , Martins Raphaël P. , Leclercq Christophe , Galand Vincent
Published: December 2020

Objectives

This study sought to validate the performance of the VT‐LVAD risk model in predicting late ventricular arrhythmias (VAs) in patients after left ventricular assist device (LVAD) implantation.

Background

The need for implantable cardioverter‐defibrillator (ICD)‐implantation in LVAD recipients is not well studied. A better selection of the patients with high risk for late VAs could lead to a more targeted ICD‐implantation or replacement.

Methods

The study evaluated the performance of the VT‐LVAD prognostic score (VAs prior LVAD, no ACE‐inhibitor in medication, heart failure duration > 12 months, early VAs post‐LVAD implantation, atrial fibrillation prior LVAD, idiopathic dilated cardiomyopathy) for the endpoint of the occurrence of late VAs in 357 LVAD patients in Heart Centre of Leipzig.

Results

From the initial 460 patients, 357 (age: 58 ± 10 years; left ventricular ejection fraction: 20 ± 6%; HeartWare: 50%; HeartMate III: 42%) were assigned to four risk groups according to their VT‐LVAD score varying from low risk to very high risk. After 25 months, late VAs occurred in 130 patients. The VT‐LVAD score was an independent predictor of late VAs (multivariate analysis; p = < .001; goodness‐of‐tip p = .347; odds ratio: 4.8). While there was no statistically significant difference between the low‐ and intermediate‐risk group, risk stratification for patients with high risk and very high risk performed more accurately (pairwise comparison p = .005 and p < .001, respectively).

Conclusions

The VT‐LVAD score predicted accurately the occurrence of late VAs in high‐risk LVAD recipients in a large external cohort of LVAD recipients supporting its utility for more targeted ICD implantations.
Results from the prospective, multicenter AMBULATE‐CAP trial: Reduced use of urinary catheters and protamine with hemostasis via the Mid‐Bore Venous Vascular Closure System (VASCADE® MVP) following multi‐access cardiac ablation procedures
Authors: Al‐Ahmad Amin , Mittal Suneet , DeLurgio David , Joseph Gallinghouse G. , Horton Rodney P. , Preminger Mark W. , David Burkhardt J. , Natale Andrea
Published: December 2020

Introduction

Manual compression (MC), historically the most common method to achieve hemostasis after percutaneous vascular procedures, is time consuming, requires prolonged bedrest, and is uncomfortable for patients and clinicians. Recent studies demonstrate the efficacy and safety of vascular closure devices and suggest shorter times to hemostasis and patient ambulation compared with MC. The current study evaluated the feasibility of the VASCADE® venous vascular closure system (VVCS) while allowing for urinary catheter (UC) elimination, and elimination of protamine and/or same calendar day discharge (SCDD).

Methods and Results

In this prospective, multicenter trial, patients were enrolled and assigned to the following groups: no UC, no protamine, and/or SCDD (no co‐enrollment in no protamine and SCDD). After completing the catheter‐based cardiac procedure, access sites were closed using the VVCS. Outcomes included final hemostasis (all sites) without major access site‐related complications at 30 days, rates of access site closure‐related complications, device success, and study group success. All 168 patients had hemostasis without major access site‐related complications through 30 days. In the no UC group, 160 out of 164 (97.6%) patients did not receive a UC. Additionally, 39 out of 41 (95.1%) patients received heparin without protamine reversal and no access site bleeding‐related ambulation delays, and 18 out of 18 (100%) patients were discharged on the same day. There were no major access site closure‐related complications, few minor complications, and adverse events were generally mild and well managed.

Conclusion

The VVCS was effective for achieving hemostasis following catheter‐based procedures; access site closure‐related complications and adverse events were well managed.
Tgfb3 and Mmp13 regulated the initiation of liver fibrosis progression as dynamic network biomarkers
Authors: Guo Jinsheng , Liu Weixin , Zeng Zhiping , Lin Jie , Zhang Xingxin , Chen Luonan
Published: December 2020

Liver fibrogenesis is a complex scar‐forming process in the liver. We suggested that the liver first responded to chronic injuries with gradual changes, then reached the critical state and ultimately resulted in cirrhosis rapidly. This study aimed to identify the tipping point and key molecules driving liver fibrosis progression. Mice model of liver fibrosis was induced by thioacetamide (TAA), and liver tissues were collected at different time‐points post‐TAA administration. By dynamic network biomarker (DNB) analysis on the time series of liver transcriptomes, the week 9 post‐TAA treatment (pathologically relevant to bridging fibrosis) was identified as the tipping point just before the significant fibrosis transition, with 153 DNB genes as key driving factors. The DNB genes were functionally enriched in fibrosis‐associated pathways, in particular, in the top‐ranked DNB genes, Tgfb3 negatively regulated Mmp13 in the interaction path and they formed a bistable switching system from a dynamical perspective. In the in vitro study, Tgfb3 promoted fibrogenic genes and down‐regulate Mmp13 gene transcription in an immortalized mouse HSC line JS1 and a human HSC line LX‐2. The presence of a tipping point during liver fibrogenesis driven by DNB genes marks not only the initiation of significant fibrogenesis but also the repression of the scar resolution.
Analysis of differentially expressed genes in oral epithelial cells infected with Fusobacterium nucleatum for revealing genes associated with oral cancer
Authors: Zhang Shuwei , Li Chen , Zhang Zhiying , Li Yuchao , Li Qian , Geng Fengxue , Liu Junchao , Pan Yaping
Published: December 2020

Accumulating evidence links Fusobacterium nucleatum with tumorigenesis. Our previous study demonstrated that F. nucleatum infection can induce epithelial‐mesenchymal transition (EMT) in oral epithelial cells and elaborated a probable signal pathway involved in the induction of EMT. However, the comprehensive profiling and pathways of other candidate genes involved in F. nucleatum promoting malignant transformation remain largely elusive. Here, we analysed the transcriptome profile of HIOECs exposed to F. nucleatum infection. Totally, 3307 mRNAs (ǀLog2FCǀ >1.5) and 522 lncRNAs (ǀLog2FCǀ >1) were identified to be differentially expressed in F. nucleatum‐infected HIOECs compared with non‐infected HIOECs. GO and KEGG pathway analyses were performed to investigate the potential functions of the dysregulated genes. Tumour‐associated genes were integrated, and top 10 hub genes (FYN, RAF1, ATM, FOS, CREB, NCOA3, VEGFA, JAK2, CREM and ATF3) were identified by protein‐protein interaction (PPI) network, and Oncomine was used to validate hub genes' expression. LncRNA‐hub genes co‐expression network comprising 67 dysregulated lncRNAs were generated. Together, our study revealed the alteration of lncRNA and potential hub genes in oral epithelial cells in response to F. nucleatum infection, which may provide new insights into the shift of normal to malignant transformation initiated by oral bacterial infection.
Decentring Norms in EU Relations with the Southern Neighbourhood
Authors: Keukeleire Stephan , Lecocq Sharon , Volpi Frédéric
Published: December 2020

The EU's external promotion of norms and the idea of normative power Europe itself are increasingly contested, which is especially true in the EU's southern neighbourhood. However, whereas scholars of EU foreign policy acknowledge the contestation of external norms, they find it difficult to understand why other normative frameworks could be equally or more appealing to Middle Eastern and North African (MENA) countries, as they entail norms that are less prominent in the Western catalogue of liberal values. To facilitate the detection and analysis of a wider set of norms, we situate them along several continua of norm orientations and apply this framework to the EU's southern neighbourhood. EU foreign policy scholars can then examine whether different norms overlap or compete or are complementary or even incompatible, and the extent to which values promoted by European actors are congruent with normative frameworks in the MENA region.
Self‐stated recovery from flooding: Empirical results from a survey in Central Vietnam
Authors: Hudson Paul , Pham My , Hagedoorn Liselotte , Thieken Annegret , Lasage Ralph , Bubeck Philip
Published: December 2020

Social inequalities lead to flood resilience inequalities across social groups, a topic that requires improved documentation and understanding. The objective of this paper is to attend to these differences by investigating self‐stated flood recovery across genders in Vietnam as a conceptual replication of earlier results from Germany. This study employs a regression‐based analysis of 1,010 respondents divided between a rural coastal and an urban community in Thua Thien‐Hue province. The results highlight an important set of recovery process‐related variables. The set of relevant variables is similar across genders in terms of inclusion and influence, and includes age, social capital, internal and external support after a flood, perceived severity of previous flood impacts, and the perception of stress‐resilience. However, women were affected more heavily by flooding in terms of longer recovery times, which should be accounted for in risk management. Overall, the studied variables perform similarly in Vietnam and Germany. This study, therefore, conceptually replicates previous results suggesting that women display slightly slower recovery levels as well as that psychological variables influence recovery rates more than adverse flood impacts. This provides an indication of the results' potentially robust nature due to the different socio‐environmental contexts in Germany and Vietnam.
Local wound management factors related to biofilm reduction in the pressure ulcer: A prospective observational study
Authors: Koyanagi Hiroe , Kitamura Aya , Nakagami Gojiro , Kashiwabara Kosuke , Sanada Hiromi , Sugama Junko
Published: December 2020

Aims

Critical colonization in pressure ulcers delays healing and has been studied. However, local wound management includes no clear strategy for preventing the development of biofilms. Therefore, this multicenter, prospective, observational study was conducted to examine the effect of local management on the biofilm area of pressure ulcers with critical colonization.

Methods

Participants were 34 patients with a pressure ulcer deeper than the dermis and in a state of critical colonization. The primary outcome was the change over a week in the proportion of the biofilm area in relation to that of the pressure ulcer area. We investigated the relationship between primary outcome and local wound management. The wound‐blotting method was used for determining the biofilm area. To calculate the change in the biofilm area, baseline proportion was subtracted from proportion 1 week later.

Results

Six types of topical treatment were used in three facilities. The proportion of the biofilm area at 1 week follow‐up was significantly smaller with iodine ointment than that without iodine ointment (p = .02). The standardized partial regression coefficient of iodine ointment adjusted by the type of medical facility was −0.26 (p = .003).

Conclusion

This study revealed that the use of iodine ointment reduced the proportion of the biofilm area in the pressure ulcer surface. To manage pressure ulcers in a state of critical colonization, these results suggest that local management include the use of iodine ointment.
Targeting weather insurance markets
Authors: Mukherjee Anita , Cole Shawn , Tobacman Jeremy
Published: December 2020

The suitability of insurance products often depends greatly on individual circumstances. This paper examines the challenges of heterogeneity in a relatively new product, weather‐indexed insurance. This index insurance product has been launched in over a dozen countries, with the goal of enabling households engaged in agricultural activity a means to manage risk. Using data from a large‐scale field experiment, we build and calibrate a model which accounts for household investment decisions, including the scope for self‐insurance via labor markets to (risky) wage work. Our results show that insurance is most valuable to households with reduced access to wage labor, or to those who face wages that are sensitive to rainfall risk. These findings have important implications for areas where index insurance is most effective.
National Context, Parental Socialization, and the Varying Relationship Between Religious Belief and Practice
Authors: Voas David , Storm Ingrid
Published: December 2020

Parents are crucial agents of religious socialization, but the broader social environment is also influential. A key question is whether parents are more or less influential when their religious beliefs and practices are not shared by people around them. Current thinking on the issue has largely been shaped by Kelley and De Graaf, who argued that parental religious socialization matters most in secular countries. We maintain that that conclusion is mistaken: levels of parental and national religiosity are both important, but their effects are largely independent of each other. Kelley and De Graaf's findings rely on the assumption that religious belief and practice are different expressions of the same underlying phenomenon (religiosity) and vary in the same way across time and space. These measures are not equivalent, however. In relatively religious societies, belief in God is widespread even among those who do not attend services, whereas in societies where religious involvement is low, nonchurchgoers tend to be nonbelievers.
Drainage basins serve as multiple glacial refugia for alpine habitats in the Sierra Nevada Mountains, California
Authors: Weng Yi‐Ming , Kavanaugh David H. , Schoville Sean D.
Published: December 2020

The evolutionary histories of alpine species are often directly associated with responses to glaciation. Deep divergence among populations and complex patterns of genetic variation have been inferred as consequences of persistence within glacier boundaries (i.e., on nunataks), while shallow divergence and limited genetic variation are assumed to result from expansion from large refugia at the edge of ice shields (i.e., massifs de refuge). However, for some species, dependence on specific microhabitats could profoundly influence their spatial and demographic response to glaciation, and such a simple dichotomy may obscure the localization of actual refugia. In this study, we use the Nebria ingens complex (Coleoptera: Carabidae), a water‐affiliated ground beetle lineage, to test how drainage basins are linked to their observed population structure. By analysing mitochondrial COI gene sequences and genome‐wide single nucleotide polymorphisms, we find that the major drainage systems of the Sierra Nevada Mountains in California best explain the population structure of the N. ingens complex. In addition, we find that an intermediate morphotype within the N. ingens complex is the product of historical hybridization of N. riversi and N. ingens in the San Joaquin basin during glaciation. This study highlights the importance of considering ecological preferences in how species respond to climate fluctuations and provides an explanation for discordances that are often observed in comparative phylogeographical studies.
Extended active inference: Constructing predictive cognition beyond skulls
Authors: Constant Axel , Clark Andy , Kirchhoff Michael , Friston Karl J.
Published: December 2020

Cognitive niche construction is the process whereby organisms create and maintain cause–effect models of their niche as guides for fitness influencing behavior. Extended mind theory claims that cognitive processes extend beyond the brain to include predictable states of the world. Active inference and predictive processing in cognitive science assume that organisms embody predictive (i.e., generative) models of the world optimized by standard cognitive functions (e.g., perception, action, learning). This paper presents an active inference formulation that views cognitive niche construction as a cognitive function aimed at optimizing organisms' generative models. We call that process of optimization extended active inference.
Expression of programmed cell death ligand‐1 by immune cells in the microenvironment is a favorable prognostic factor for primary diffuse large B‐cell lymphoma of the central nervous system
Authors: Tsuyuki Yuta , Ishikawa Eri , Kohno Kei , Shimada Kazuyuki , Ohka Fumiharu , Suzuki Yuka , Mabuchi Seiyo , Satou Akira , Takahara Taishi , Kato Seiichi , Miyagi Shohei , Ozawa Hiroyuki , Kawano Tasuku , Takagi Yusuke , Hiraga Junji , Wakabayashi Toshihiko , Nakamura Shigeo
Published: December 2020

Primary diffuse large B‐cell lymphoma (DLBCL) of the central nervous system (PCNS‐DLBCL) is rare. Thirty‐nine patients consecutively diagnosed as having PCNS‐DLBCL were analyzed to highlight the prognostic value of the expression of programmed cell death ligand‐1 (PD‐L1) by neoplastic cells and immune cells in the microenvironment. They were positive for CD20 in all (100%), CD5 in two (5%), CD10 in nine (23%), BCL‐2 in 27 (69%), BCL‐6 in 34 (87%), and MUM‐1 in 37 (95%). Only one case was positive for neoplastic PD‐L1, with an unexpectedly long clinical course of 92 months. The remaining 38 cases were further divided into three groups based on the percentage of PD‐L1+ cells among microenvironmental immune cells. Cutoffs of < 5%, 5–40%, and ≥ 40% successfully stratified mean prognoses with three‐year overall survival (OS) of 21%, 63%, and 100% (P = 0.009), respectively. Progression‐free survival (PFS) and OS were different between the groups with and without methotrexate (MTX)‐containing chemotherapy (P = 0.007 and P < 0.001, respectively). Multivariate analysis identified three independent adverse factors of OS: PD‐L1 negativity (< 5%) on microenvironmental immune cells (P = 0.027), deep structure involvement (P = 0.034), and performance status (PS) 2–4 (P = 0.009). The study showed that PD‐L1 expression on immune cells in the microenvironment was associated with prognosis among patients with PCNS‐DLBCL.