bluuebunny/crossref_metadata_2025 huggingface dataset:
Grand Strategy Under Nonpolarity
Authors: Schweller Randall L.
Published: September 2021

The random and indeterminate nature of the current nonpolar world suggests a condition of increasing entropy. Relative capability advantages in today’s system do not translate as easily as they once did into power and influence over others. Unlike past multipolar and bipolar systems, the current system exerts only weak, if any, systemic constraints on actors. Thus, polarity has become a largely meaningless concept. Instead, we see an increase in the number and kinds of actors that can affect the system’s outcomes. In addition, complex process variables at the systemic and micro levels—especially those related to globalization and the digital revolution—are fundamentally reshaping the current and future dynamics of world politics. The key to grand strategy in this “hybrid world” of many types of actors wielding various kinds of power will be, first, for states to recognize the limits of traditional power bases and, second, to identify and cooperate with private actors that possess issue-specific resources, expertise, and influence with respect to the task at hand. That said, it is a complex and unpredictable world, not well-suited to the linear thinking associated with grand strategy.
Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up
Authors: Schumann Matthew E , Coombes Brandon J , Gascho Keith E , Geske Jennifer R , McDermott Mary C , Morrison Eleshia J , Reynolds Andrea L , Bernau Jessica L , Gilliam Wesley P
Published: September 2021

Background

Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary pain rehabilitation. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning; conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability.

Objective

To prospectively evaluate interdisciplinary pain rehabilitation outcomes, as well as to evaluate the mediating effects of both pain catastrophizing and pain self-efficacy on outcome.

Methods

Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a 3-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, depressive symptom questionnaires, and measures of physical performance were assessed before and after treatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and from pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome.

Results

Significant improvements from pre- to posttreatment in pain outcomes were observed, and more than 80% evidenced a reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes.

Conclusions

Interdisciplinary pain rehabilitation is an effective treatment, and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.
Raw scores on subjective sleepiness, fatigue, and vigor metrics consistently define resilience and vulnerability to sleep loss
Authors: Casale Courtney E , Yamazaki Erika M , Brieva Tess E , Antler Caroline A , Goel Namni
Published: September 2021

Study Objectives

Although trait-like individual differences in subjective responses to sleep restriction (SR) and total sleep deprivation (TSD) exist, reliable characterizations remain elusive. We comprehensively compared multiple methods for defining resilience and vulnerability by subjective metrics.

Methods

A total of 41 adults participated in a 13-day experiment: 2 baseline, 5 SR, 4 recovery, and one 36 h TSD night. The Karolinska Sleepiness Scale (KSS) and the Profile of Mood States Fatigue (POMS-F) and Vigor (POMS-V) were administered every 2 h. Three approaches (Raw Score [average SR score], Change from Baseline [average SR minus average baseline score], and Variance [intraindividual SR score variance]), and six thresholds (±1 standard deviation, and the highest/lowest scoring 12.5%, 20%, 25%, 33%, and 50%) categorized Resilient/Vulnerable groups. Kendall’s tau-b correlations compared the group categorization’s concordance within and between KSS, POMS-F, and POMS-V scores. Bias-corrected and accelerated bootstrapped t-tests compared group scores.

Results

There were significant correlations between all approaches at all thresholds for POMS-F, between Raw Score and Change from Baseline approaches for KSS, and between Raw Score and Variance approaches for POMS-V. All Resilient groups defined by the Raw Score approach had significantly better scores throughout the study, notably including during baseline and recovery, whereas the two other approaches differed by measure, threshold, or day. Between-measure correlations varied in strength by measure, approach, or threshold.

Conclusions

Only the Raw Score approach consistently distinguished Resilient/Vulnerable groups at baseline, during sleep loss, and during recovery‒‒we recommend this approach as an effective method for subjective resilience/vulnerability categorization. All approaches created comparable categorizations for fatigue, some were comparable for sleepiness, and none were comparable for vigor. Fatigue and vigor captured resilience/vulnerability similarly to sleepiness but not each other.
Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study
Authors: Khan James S. , Sessler Daniel I. , Chan Matthew T. V. , Wang C. Y. , Garutti Ignacio , Szczeklik Wojciech , Turan Alparslan , Busse Jason W. , Buckley D. Norman , Paul James , McGillion Michael , Fernández-Riveira Carmen , Srinathan Sadeesh K. , Shanthanna Harsha , Gilron Ian , Jacka Michael , Jackson Paul , Hankinson James , Paniagua Pilar , Pettit Shirley , Devereaux P. J.
Published: September 2021

Background

The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain.

Methods

This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery).

Results

Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain.

Conclusions

Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Interpretation of Enhanced Fecal and Urinary Plutonium Excretion Data under a 2-y Regular DTPA Treatment Started Months after Intake
Authors: Grémy Olivier , Blanchin Nicolas , Miccoli Laurent
Published: September 2021

In a worker who had internalized plutonium, most likely through inhalation of a somewhat soluble compound, an extensive diethylenetriaminepentaacetate (DTPA) treatment regimen was initiated several months after contamination. Numerous radiotoxicological analyses were performed in both fecal and urinary specimens collected, sometimes for three consecutive days after DTPA administration. Activity measurements showed the continued effectiveness of DTPA intravenous infusions in removing plutonium from tissues of retention even if the treatment regimen started very belatedly after contamination. In the present case, the activity excreted through urine within the first 24-h after a DTPA infusion contributed only about half of that activity excreted within the first three days (i.e., the cumulative activity of the first three 24-h urine collections). In addition, the careful study of the data revealed that DTPA-induced excretion of plutonium via fecal pathway significantly contributed to the overall decorporation. The intracellular chelation of plutonium may be responsible for this enhanced excretion of activity in feces as well as for the delayed and sustained increased clearance of activity in urine. The authors would suggest that the occupational physicians offer to individuals who internalized moderately soluble or soluble plutonium compounds undergo a long-term DTPA treatment, especially when it is not initiated promptly after intake. Under this scenario, measurements of plutonium in successive urine and fecal collections after treatment should be required to get a better estimate of the therapeutic benefit. Also, intracellular chelation and fecal route should be taken into account for better interpretation of radiotoxicological data and modeling of plutonium kinetics under delayed DTPA treatment.
Impact of Downtime on Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy
Authors: Shin Jungho , Song Hyun Chul , Hwang Jin Ho , Kim Su Hyun
Published: September 2021

Continuous renal replacement therapy (CRRT) downtime is considered a quality indicator; however, it remains uncertain whether downtime affects outcomes. This study retrospectively investigated the impact of downtime on clinical outcomes. Patients were classified as downtime <20% or ≥20% of potential operative time over 4 days from CRRT initiation. Patients with ≥20% downtime were matched to those with <20% downtime using 1:2 propensity score matching. There were 88 patients with <20% downtime and 44 patients with ≥20% downtime. The cumulative effluent volume was lower in patients with ≥20% downtime (p < 0.001). The difference in levels of urea and creatinine widened over time (p = 0.004 and <0.001). At days 2 and 3, daily fluid balance differed (p = 0.046 and 0.031), and the levels of total carbon dioxide were lower in those with ≥20% downtime (p = 0.038 and 0.020). Based on our results, ≥20% downtime was not associated with increased 28 day mortality; however, a subgroup analysis showed the interaction between downtime and daily fluid balance (p = 0.004). In conclusion, increased downtime could impair fluid and uremic control and acidosis management. Moreover, the adverse effect of downtime on fluid control may increase mortality rate. Further studies are needed to verify the value of downtime in critically ill patients requiring CRRT.
Smooth versus Textured Implant Breast Reconstruction: Patient-Reported Outcomes and Complications
Authors: Vorstenbosch Joshua , McCarthy Colleen M. , Shamsunder Meghana G. , Polanco Thais O. , Dabic Stefan , Wiser Itay , Matros Evan , Dayan Joseph , Disa Joseph J. , Pusic Andrea L. , Cavalli Michele R. , Encarnacion Elizabeth , Lee Meghan , Mehrara Babak J. , Nelson Jonas A.
Published: September 2021

Background:

The association between textured surface breast implants and breast implant-associated anaplastic large cell lymphoma has led to an increase in surgical procedures to exchange textured devices to smooth surface implants. Because patient satisfaction is an integral part of breast reconstruction, the purpose of this study was to compare patient-reported outcomes between smooth and textured implant recipients.

Methods:

Patients aged 18 years or older who underwent implant-based postmastectomy breast reconstruction with either smooth or textured devices from 2009 to 2017 and completed the BREAST-Q patient-reported outcome measure following reconstruction were included in this analysis. The primary outcomes of interest were mean and median BREAST-Q scores and postoperative complications.

Results:

Overall, 1077 patients were included—785 who underwent breast reconstruction with smooth implants and 292 who underwent breast reconstruction with textured implants. No statistical differences were observed between the textured and smooth implant groups for any of the BREAST-Q domain scores at any of the early (3-month) to late (2-year) postoperative time points. Smooth implant recipients reported significantly more rippling (p = 0.003) than textured implant recipients. In contrast, textured implant recipients had a higher rate of cellulitis than smooth implant recipients (p = 0.016).

Conclusions:

These data suggest that postoperative satisfaction with breasts or health-related quality of life following immediate postmastectomy implant-based breast reconstruction is likely independent of implant surface type. However, smooth breast implants may result in more rippling. The authors’ findings represent an important aid in counseling patients who have questions about the risks and benefits of replacing their textured implants with smooth surface devices.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Innovation, ICT penetration, trade and economic growth in developing and developed countries: a VECM approach
Authors: Singh Parul , Siddiqui Areej Aftab
Published: September 2021

Purpose

The development in information communication and technology (ICT) has led to many changes such as reorganization of economics, globalization and trade. With more innovation processes being organized and adopted across technologies, trade, etc., these are getting more closely related and needs fresh research perspective. This study aims to empirically investigate the interrelationship between ICT penetration, innovation, trade and economic growth in 20 developed and developing nations from 1995 to 2018.

Design/methodology/approach

The present paper examines both long-run and short-run relationships between the four variables, namely, innovation, ICT penetration, trade and economic growth, by applying panel estimation techniques of regression and vector error correction model. ICT penetration and innovation indices are constructed using principle component analysis technique.

Findings

The findings of the study highlight that for developed nations, growth, trade and innovation are significantly interlinked with no significant role of ICT penetration While for developing nations, significant relationship is present between growth and trade, ICT penetration and innovation. With respect to trade, in case of developed nations, significant relationship is present with ICT penetration. While for developing nations there is no significant result for trade promotion. On further employing the vector error correction model, the presence of short run causality between growth, trade and innovation in case of developed nations is established but no such causality between variables for developing nations is seen.

Originality/value

The present paper adds to the existing strand of literature examining interlinkage between innovation and growth by introducing new variables of ICT penetration and innovation.
Assessing advantage cluster: the case of Pithampur auto industry
Authors: Bhawsar Pragya
Published: September 2021

Learning outcomes

The learning outcomes of this paper will help students in understanding the dynamics of the formation of industry clusters and the benefits associated with industry clusters. The case will give stimulus towards the cluster competition.

Case overview/synopsis

The case describes the dilemma of a potential investor of a tyre company that wants to diversify its product line and is searching for a new strategic location. The investor is thoughtful about the Pithampur auto industry cluster for its upcoming investment. The case demonstrates how Pithampur has transformed into an “industry cluster” and the benefits it provides to firms in it. However, Pithampur is not the only auto industry cluster in India, clusters like Chakan-Pune is in competition with Pithampur for attracting investments. This is a cause of worry for the cluster’s stakeholders. The case projects amalgamation of concerns of the stakeholders of the clusters and those of potential investors in evaluating and benchmarking it with other clusters for a competitive future.

Complexity academic level

Suitable for both undergraduate and post-graduate students (MBA students).

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Subject code

CSS: 11: Strategy.
Institutionalizing the fight against money laundering in Tanzania: the potential, limitations and challenges
Authors: Mniwasa Eugene E.
Published: September 2021

Purpose

This paper aims to examine the authorities tasked to fight against money laundering in Tanzania and appraise the efficacy of the country’s anti-money institutional framework to tackle the problem.

Design/methodology/approach

The paper draws on a qualitative research and data generated from the analysis of documentary materials. It surveys the anti-money laundering (AML) law in Tanzania to describe the legal and institutional frameworks for tackling money laundering. It explores law-related and non-law aspects to interrogate and appraise the efficacy of Tanzania’s AML law and authorities. The qualitative data were generated using the thematic content analysis technique.

Findings

The law in Tanzania establishes authorities and vests them with powers to combat money laundering. The authorities, which are part of Tanzania’s AML institutional framework, have been instrumental in combating money laundering. Nevertheless, several law-related and non-law factors emasculate the efficacy of the AML law and authorities in Tanzania. Some political and economic factors wear off the effectiveness of the country’s AML institutional framework. The transnational nature and complexity of money laundering overwhelm the capacity of the AML authorities in Tanzania.

Practical implications

The paper provides useful insights on money laundering and the legal regime to counteract the scourge in Tanzania which sets up the country’s AML institutional framework. It raises some issues for researchers, policymakers and law enforcers who can re-examine the problem and revisit the law and re-evaluate authorities and propose measures that will enable the government to reinforce the country’s AML regime. The paper makes a case for the government to implement the reforms of the country’s AML policy, legal and institutional frameworks.

Originality/value

The paper investigates issues relating to money laundering and its control in Tanzania beyond the legal perspective to uncover limitations and challenges that emasculate the efficacy of the AML authorities in the Tanzanian context. The issues examined in this paper are not unique to Tanzania and, hence, have relevance to other jurisdictions in sub-Saharan Africa.
Accounting for investor sentiment in news and disclosures
Authors: Eachempati Prajwal , Srivastava Praveen Ranjan
Published: September 2021

Purpose

This study aims to develop two sentiment indices sourced from news stories and corporate disclosures of the firms in the National Stock Exchange NIFTY 50 Index by extracting sentiment polarity. Subsequently, the two indices would be compared for the predictive accuracy of the stock market and stock returns during the post-digitization period 2011–2018. Based on the findings this paper suggests various options for financial strategy.

Design/methodology/approach

The news- and disclosure-based sentiment indices are developed using sentiment polarity extracted from qualitative content from news and corporate disclosures, respectively, using qualitative analysis tool “N-Vivo.” The indices developed are compared for stock market predictability using quantitative regression techniques. Thus, the study is conducted using both qualitative data and tools and quantitative techniques.

Findings

This study shows that the investor is more magnetized to news than towards corporate disclosures though disclosures contain both qualitative as well as quantitative information on the fundamentals of a firm. This study is extended to sectoral indices, and the results show that specific sectoral news impacts sectoral indices intensely over market news. It is found that the market discounts information in disclosures prior to its release. As disclosures in quarterly statements are delayed information input, firms can use voluntary disclosures to reduce the communication gap with investors by using the internet. Managers would do so only when the stock price is undervalued and tend to ignore the market and the shareholder in other cases. Otherwise, disclosure sentiment attracts only long horizon traders.

Practical implications

Finance managers need to improve disclosure dependence on investors by innovative disclosure methodologies irrespective of the ruling market price. In this context, future studies on investor sentiment would be interesting as they need to capture man–machine interactions reflected in market sentiment showing the interplay of human biases with machine-driven decisions. The findings would be useful in developing the financial strategy for protecting firm value.

Originality/value

This study is unique in providing a comparative analysis of sentiment extracted from news and corporate disclosures for explaining the stock market direction and stock returns and contributes to the behavioral finance literature.
Cutaneous metastasis of primary diffuse large B‐cell lymphoma of the central nervous system developing 4 years after complete remission: Diagnosis confirmed by comparison of clones
Authors: Patel Bansri M. , Moesch John , Karunamurthy Arivarasan , Puleio Donna V. , Drappatz Jan , Akilov Oleg E. , Kazlouskaya Viktoryia
Published: September 2021

B‐cell lymphoma of the central nervous system (CNS) is a rare malignancy with diffuse large B‐cell lymphoma (DLBCL) variant being most common. Although DLBCL has a high propensity to relapse locally within the CNS, only a few cases of cutaneous metastasis have been described in the literature. We present a unique case of cutaneous metastasis of a primary DLBCL of the CNS in a 79‐year‐old man who was in clinical remission for 4 years until presenting with a lesion in the left adrenal gland and cutaneous nodules on the left flank. Skin biopsy specimen revealed a diffuse dermal infiltrate of atypical B‐cell lymphocytes with expression of CD20, BCL‐2, BCL‐6, and MUM‐1, suggestive of DLBCL. For differentiation between another primary or a recurrent process, immunoglobulin kappa (IgK) light chain gene rearrangement was performed and demonstrated that the DLBCL of the skin and CNS were of the same clonal origin. Restaging computerized tomography after initiating chemotherapy and daily ibrutinib showed complete resolution of the left adrenal mass and resolving cutaneous lesions. Our case demonstrates the rare, late cutaneous metastasis of DLBCL of the CNS and highlights the importance of genetic testing for the distinction between the primary and secondary lesions.
Relationship between blood glucose variability in ambulatory glucose profile and standardized continuous glucose monitoring metrics: Subanalysis of a prospective cohort study
Authors: Tokutsu Akemi , Okada Yosuke , Mita Tomoya , Torimoto Keiichi , Wakasugi Satomi , Katakami Naoto , Yoshii Hidenori , Uryu Kohei , Nishida Keiko , Arao Tadashi , Tanaka Yoshiya , Gosho Masahiko , Shimomura Iichiro , Watada Hirotaka
Published: September 2021

Aim

To clarify the relationship between ambulatory glucose profile (AGP) indexes and standardized continuous glucose monitoring (CGM) metrics in patients with type 2 diabetes (T2D).

Methods

This is an exploratory, cross‐sectional analysis of baseline data collected from a prospective, multicentre, 5‐year follow‐up observational study conducted and published previously by our group. The study participants were 999 outpatients with T2D who used CGM at baseline, and had no apparent history of cardiovascular disease. We investigated the relationship between average interquartile range (IQR) and time in range (TIR). We also calculated, for the first time, the cutoff values to achieve the TIR target values.

Results

In both the TIR more than 70% and TIR more than 90% achievement groups, the average IQR was notably small compared with the non‐achievement groups. Particularly in comparison of the TIR quartiles, the average IQR became significantly smaller as the TIR became larger. The average IQR correlated negatively with TIR, and the cutoff values for TIR of more than 70% achievement and TIR of more than 90% achievement were an average IQR (>70%/>90%) of 2.13/1.85 mmol/L.

Conclusion

Our results showed a negative correlation between TIR and the range of blood glucose variations visually represented in AGP. The results also showed that the range of blood glucose variations in AGP is associated with indices of intraday and interday blood glucose variations and also with hypoglycaemia. Our results may provide new perspectives in the assessment and application of AGP in the clinical setting.
Corporate Resilience and Response to COVID‐19
Authors: Cheema‐Fox Alex , LaPerla Bridget R. , Wang Hui (Stacie) , Serafeim George
Published: September 2021

The global COVID crisis provides a test case for the argument that public companies, by making significant and credible commitments to their stakeholder relationships, signal their resilience to investors and, by so doing, cushion their market values against a general collapse. As one example, by limiting layoffs, providing flexible work schedules, and offering paid sick leave, companies are likely to maintain higher employee productivity and avoid costs associated with excessive employee turnover. And companies that adapt their supply chains quickly to avoid costly production halts and secure the supply of important materials should have stronger relationships that result in both higher quality and lower long‐run costs. Yet another possibility is that companies that temporarily redirect operations to provide needed products and services such as masks and ventilators could experience stronger customer and brand loyalty.

Using multiple databases, regressions, matched sample analysis, and measures of media sentiment about particular companies, the authors report that companies exhibiting behavior perceived as strengthening their human capital and supply chain relationships, as well as a willingness to repurpose operations, experienced significantly less negative returns during the crisis. On the basis of this evidence, the authors conclude that a company's response towards its stakeholders can be important in preserving value, and propose that managements view their stakeholder investments as creating strategic resources, intangible assets whose value becomes most apparent during crises.
Performance of using opposing homozygotes for paternity testing in Japanese Black cattle
Authors: Komiya Ryota , Ogawa Shinichiro , Aonuma Tatsuya , Satoh Masahiro
Published: September 2021

Genome‐wide single nucleotide polymorphism (SNP) markers in Japanese Black cattle enable genomic prediction and verifying parent–offspring relationships. We assessed the performance of opposing homozygotes (OH) for paternity testing in Japanese Black cattle, using SNP genotype information of 50 sires and 3,420 fattened animals, 1,945 of which were fathered by the 50 genotyped sires. The number of OH was counted for each sire–progeny pair in 28,764 SNPs with minor allele frequencies of ≥0.05 in this population. Across all pairs of animals, the number of OH tended to increase as the pedigree‐based coefficient of relationship decreased. With a threshold of 288 (1% of SNPs) for paternity testing, most sire–progeny pairs were detected as true relationships. The frequency of Mendelian inconsistencies was 2.4%, reflecting the high accuracy of pedigree information in Japanese Black cattle population. The results indicate the utility of OH for paternity testing in Japanese Black cattle.
Association of morning blood pressure surge with chronic kidney disease progression in patients with chronic kidney disease and hypertension
Authors: Liu Xiang , Zhang Ting , Qin Aiya , Li Fangming , Zheng Zhiyao , Zhou Huan , Tang Yi , Qin Wei
Published: September 2021

Blood pressure (BP) usually rise from being asleep to awake, which is named the morning blood pressure surge (MBPS). Researches have reported that elevated MBPS was related with CV events, incident CKD in hypertensive patients. However, there have been no studies that have investigated the association between MBPS and renal or heart outcomes in patients with CKD and hypertension, in these patients, the MBPS is much lower because of high prevalence of night hypertension and reduced BP dipping. In this prospective two‐center observational study, we enrolled patients with CKD and hypertension and the 24 h ambulatory blood pressure monitoring (ABPM) was conducted in all patients. Time to total mortality, CKD progression and CV events was recorded; Finally, a total of 304 patients were enrolled and 94 (30.9%) of them had elevated MBPS. After a follow‐up for median 30 months, 23 (7.6%), 34 (11.2%), and 95 (31.3%) patients occurred death, CKD progression and new‐onset CV events, respectively. The Cox regression analysis suggested the elevated MBPS was a strong predictor of CKD progression (HR 2.35, 95%CI 1.2 ‐4.63, p = .013), independent of morning BP, while no associations were found between elevated MBPS and CV events (HR 1.02, 95%CI 0.66 ‐1.57), as well as death (HR 1.08, 95%CI 0.46 ‐2.55). In conclusion, we provided the first evidence that elevated MBPS was an important risk factor of CKD progression in patients with CKD and hypertension. Appropriate evaluation and management of MBPS may be helpful to postpone CKD progression.
Non‐drug pain relievers active on non‐opioid pain mechanisms
Authors: Marchesi Nicoletta , Govoni Stefano , Allegri Massimo
Published: September 2021

This review is aimed to summarize the pain‐relieving effect of non‐drug substances, mostly prescribed as integrators in treatment of pain, including especially in chronic postoperative pain (CPSP) and in chronic back pain after acute episodes. Their use reflects the fact that the current treatments for these syndromes continue to pose problems of unsatisfactory responses in a significant portion of patients and/or of an excess of side effects like those noted in the present opioid crisis. As integrators are frequently introduced into the market without adequate clinical testing, this review is aimed to collect the present scientific evidence either preclinical or clinical for their effectiveness. In particular, we reviewed the data on the use of: B vitamins; vitamin C; vitamin D; alpha lipoic acid (ALA); N‐acetylcysteine; acetyl L‐carnitine; curcumin; boswellia serrata; magnesium; coenzyme Q10, and palmitoylethanolamide. The combination of preclinical findings and clinical observations strongly indicate that these compounds deserve more careful attention, some of them having interesting clinical potentials also in preventing chronic pain after an acute episode. In particular, examining their putative mechanisms of action it emerges that combinations of few of them may exert an extraordinary spectrum of activities on a large variety of pain‐associated pathways and may be eventually used in combination with more traditional pain killers in order to extend the duration of the effect and to lower the doses. Convincing examples of effective combinations against pain are vitamin B complex plus gabapentin for CPSP, including neuropathic pain; vitamin B complex plus diclofenac against low back pain and also in association with gabapentin, and ALA for burning mouth syndrome. These as well as other examples need, however, careful controlled independent clinical studies confirming their role in therapy.
Reverse Double Objects in Hakka Ditransitive*
Authors: Wu Hsiao‐hung Iris
Published: September 2021

This paper deals with the ‘reverse’ double object construction in Hakka, where the theme NP precedes the goal NP without being mediated by an adpositional goal marker. I show that the reverse V‐theme‐goal order is sensitive to verb types and argue that this construction takes an underlying dative structure with a non‐thematic null prepositional goal marker. This formal syntactic account is shown to capture the word order alternations and grammatical properties observed in Hakka ditransitives.
Verbal autopsy models in determining causes of death
Authors: Tunga Mahadia , Lungo Juma , Chambua James , Kateule Ruthbetha
Published: September 2021

Objectives

To systematically review current practices, strengths and limitations of existing VA approaches to increase understanding of health system stakeholders and researchers.

Methods

The review was conducted and reported based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines, in which articles were systematically obtained from the PubMed and SCOPUS online databases. The search was limited to English language journal articles published between 2010 and 2020. The review identified 5602 articles and after thorough scrutiny, 25 articles related to VA approaches were included.

Results

(1) InterVA and Tariff are widely used VA models; (2) Bayes rule is the most common and successful algorithm; (3) the lack of standardised datasets and metrics to evaluate models creates bias in determining VA model performance; (4) performance of the models trained using in‐hospital data cannot be replicated in community death; (5) the performance of models among physicians and computer‐coded algorithms differs with variation in settings.

Conclusion

The physician‐certified verbal autopsy (PCVA) approaches are more effective in determining community CoD while computerised coding of verbal autopsy (CCVA) models perform well when the underlying CoD are reliably established using hospital data where data are trained in a similar environment to the target population. Our study recommends the use of hybrid models that combine strengths from various models and using an open standards dataset that includes death from different settings.
Fur4‐mediated uracil‐scavenging to screen for surface protein regulators
Authors: Paine Katherine M. , Ecclestone Gabrielle B. , MacDonald Chris
Published: September 2021

Cell surface membrane proteins perform diverse and critical functions and are spatially and temporally regulated by membrane trafficking pathways. Although perturbations in these pathways underlie many pathologies, our understanding of these pathways at a mechanistic level remains incomplete. Using yeast as a model, we have developed an assay that reports on the surface activity of the uracil permease Fur4 in uracil auxotroph strains grown in the presence of limited uracil. This assay was used to screen a library of haploid deletion strains and identified mutants with both diminished and enhanced comparative growth in restricted uracil media. Factors identified, including various multisubunit complexes, were enriched for membrane trafficking and transcriptional functions, in addition to various uncharacterized genes. Bioinformatic analysis of expression profiles from many strains lacking transcription factors required for efficient uracil‐scavenging validated particular hits from the screen, in addition to implicating essential genes not tested in the screen. Finally, we performed a secondary mating factor secretion screen to functionally categorize factors implicated in uracil‐scavenging.
Limitations in the structural determination of a close-packed overlayer
Authors: Tobin J. G.
Published: September 2021

The close-packed metal overlayer system c(10 × 2)Ag/Cu(001) has been the subject of extensive electronic structure studies. These include the examination of the two-dimensional behavior at low coverages, the development from two- to three-dimensionality, and the convergence to three-dimensional dispersion as in Ag(111). It would be of use to have a firmer picture of the placement of the first monolayer Ag atoms (d┴) versus the Cu(001) substrate. However, it will be demonstrated with FEFF that there are fundamental limitations to the extraction of that information with photon-induced electron diffraction.
Complement factor C1q mediates sleep spindle loss and epileptic spikes after mild brain injury
Authors: Holden Stephanie S. , Grandi Fiorella C. , Aboubakr Oumaima , Higashikubo Bryan , Cho Frances S. , Chang Andrew H. , Forero Alejandro Osorio , Morningstar Allison R. , Mathur Vidhu , Kuhn Logan J. , Suri Poojan , Sankaranarayanan Sethu , Andrews-Zwilling Yaisa , Tenner Andrea J. , Luthi Anita , Aronica Eleonora , Corces M. Ryan , Yednock Ted , Paz Jeanne T.
Published: September 2021

Neuroinflammation after brain injury

Traumatic brain injury affects millions of people every year and is a major cause of disability worldwide. Most of the maladaptive outcomes develop months or years later and are thought to be caused by secondary injuries that are indirect and long-term effects after the initial impact. Holden
et al
. found that secondary and chronic neuroinflammation and neurodegeneration are caused by the C1q molecule, a mediator of the complement pathway. C1q is responsible for chronic inflammation and secondary neuronal loss specifically in the cortico-thalamo-cortical circuit. Traumatic brain injury also leads to altered brain states that are caused by the C1q complement pathway. —PRS
Fibroadenoma in a suprapubic accessory breast
Authors: AlHarmi Rawan A Rahman , Alawi Nada , Al-Hashimi Fatima , Almehza Jassim
Published: September 2021

Ectopic breast tissue (EBT) is relatively common and can occur along the milk line or mammary ridge and often outside this line. We report a case of a female patient presenting with a suprapubic mass for 2 years, found later to be EBT containing a fibroadenoma. We believe this is a very rare finding. Moreover, we highlight the importance of considering EBT in the differential diagnoses of soft tissue masses.
Gastroschisis or exomphalos? An unusual abdominal defect
Authors: Sivaraj Jayaram , Boam Tristan , Gozzini Sara
Published: September 2021

A baby with an antenatal diagnosis of exomphalos was born at term. The abnormality had a highly unusual appearance, a right-sided paraumbilical defect, similar to gastroschisis, but with a sac typical of exomphalos containing both abdominal contents and over 1 L of serosanguinous fluid. The sac was drained and suspended from the top of the incubator in silo fashion. Definitive closure was achieved at day 3 of life, and the patient had a non-eventful recovery. Despite exomphalos and gastroschisis normally being discrete entities, ambiguity in the presentation this case necessitated a composite management approach.
Critical COVID-19 in a 24-week pregnant woman with 32 days of invasive mechanical ventilation before delivery of fetus: a case of successful collaborative multidisciplinary care
Authors: Agbontaen Kaladerhan Osemwengie , Somasundram Khevan , Baker Matthew
Published: September 2021

We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.
Incidental massive lower gastrointestinal hemorrhage caused by a rectal Dieulafoy’s lesion
Authors: Perez Del Nogal Genesis , Modi Rangesh , Salinas Ivania , Chakrala Kalyan
Published: September 2021

A Dieulafoy’s lesion is a rare cause of massive gastrointestinal (GI) bleeding. It represents an abnormally dilated submucosal artery that erodes the overlying epithelium in the absence of a primary ulcer. These lesions are usually located in the stomach, nevertheless, they have been found in all areas of the GI tract, including the oesophagus, duodenum and colon. Bleeding episodes are often self-limited, although bleeding can be recurrent and profuse. The case describes a 50-year-old woman who developed haemorrhagic shock secondary to a rectal Dieulafoy’s lesion and discusses the diagnostic and therapeutic approaches.
Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series
Authors: Wang Grace Hsin-Min , Man Kenneth K C , Chang Wei-Hung , Liao Tzu-Chi , Lai Edward Chia-Cheng
Published: September 2021

Objective

To evaluate the association between the use of antipsychotic drugs and cholinesterase inhibitors and the risk of falls and fractures in elderly patients with major neurocognitive disorders.

Design

Self-controlled case series.

Setting

Taiwan’s National Health Insurance Database.

Participants

15 278 adults, aged ≥65, with newly prescribed antipsychotic drugs and cholinesterase inhibitors, who had an incident fall or fracture between 2006 and 2017. Prescription records of cholinesterase inhibitors confirmed the diagnosis of major neurocognitive disorders; all use of cholinesterase inhibitors was reviewed by experts.

Main outcome measures

Conditional Poisson regression was used to derive incidence rate ratios and 95% confidence intervals for evaluating the risk of falls and fractures for different treatment periods: use of cholinesterase inhibitors alone, antipsychotic drugs alone, and a combination of cholinesterase inhibitors and antipsychotic drugs, compared with the non-treatment period in the same individual. A 14 day pretreatment period was defined before starting the study drugs because of concerns about confounding by indication.

Results

The incidence of falls and fractures per 100 person years was 8.30 (95% confidence interval 8.14 to 8.46) for the non-treatment period, 52.35 (48.46 to 56.47) for the pretreatment period, and 10.55 (9.98 to 11.14), 10.34 (9.80 to 10.89), and 9.41 (8.98 to 9.86) for use of a combination of cholinesterase inhibitors and antipsychotic drugs, antipsychotic drugs alone, and cholinesterase inhibitors alone, respectively. Compared with the non-treatment period, the highest risk of falls and fractures was during the pretreatment period (adjusted incidence rate ratio 6.17, 95% confidence interval 5.69 to 6.69), followed by treatment with the combination of cholinesterase inhibitors and antipsychotic drugs (1.35, 1.26 to 1.45), antipsychotic drugs alone (1.33, 1.24 to 1.43), and cholinesterase inhibitors alone (1.17, 1.10 to 1.24).

Conclusions

The incidence of falls and fractures was high in the pretreatment period, suggesting that factors other than the study drugs, such as underlying diseases, should be taken into consideration when evaluating the association between the risk of falls and fractures and use of cholinesterase inhibitors and antipsychotic drugs. The treatment periods were also associated with a higher risk of falls and fractures compared with the non-treatment period, although the magnitude was much lower than during the pretreatment period. Strategies for prevention and close monitoring of the risk of falls are still necessary until patients regain a more stable physical and mental state.
Modelling the impact of lockdown-easing measures on cumulative COVID-19 cases and deaths in England
Authors: Ziauddeen Hisham , Subramaniam Naresh , Gurdasani Deepti
Published: September 2021

Objectives

To assess the potential impacts of successive lockdown-easing measures in England, at a point in the COVID-19 pandemic when community transmission levels were relatively high.

Design

We developed a Bayesian model to infer incident cases and reproduction number (R) in England, from incident death data. We then used this to forecast excess cases and deaths in multiple plausible scenarios in whichRincreases at one or more time points.

Setting

England.

Participants

Publicly available national incident death data for COVID-19 were examined.

Primary outcome

Excess cumulative cases and deaths forecast at 90 days, in simulated scenarios of plausible increases inRafter successive easing of lockdown in England, compared with a baseline scenario whereRremained constant.

Results

Our model inferred anRof 0.75 on 13 May when England first started easing lockdown. In the most conservative scenario modelled whereRincreased to 0.80 as lockdown was eased further on 1 June and then remained constant, the model predicted an excess 257 (95% CI 108 to 492) deaths and 26 447 (95% CI 11 105 to 50 549) cumulative cases over 90 days. In the scenario with maximal increases inR(but staying ≤1), the model predicts 3174 (95% CI 1334 to 6060) excess cumulative deaths and 421 310 (95% CI 177 012 to 804 811) cases. Observed data from the forecasting period aligned most closely to the scenario in whichRincreased to 0.85 on 1 June, and 0.9 on 4 July.

Conclusions

When levels of transmission are high, even small changes inRwith easing of lockdown can have significant impacts on expected cases and deaths, even ifRremains ≤1. This will have a major impact on population health, tracing systems and healthcare services in England. Following an elimination strategy rather than one of maintenance ofR≤1 would substantially mitigate the impact of the COVID-19 epidemic within England.